Substance Abuse Service

Alcohol Problems

Alcohol problems can be identified by taking a thorough clinical history and the use of self-report or therapist administered screening tools.

Testing for biological signs of heavy drinking can also be useful, particularly if there is doubt about the accuracy of amounts / frequency of drinking.

For further details see: Drummond, C., Ghodse, H. Use of Investigations in the diagnosis and management of alcohol use disorders. (Advances in Psychiatric Treatment (1999) vol.5 pp. 366-375)

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When to ask about alcohol

 

1. As part of routine examination
2. Before prescribing medication which may interact with alcohol
3. In response to problems that may be alcohol related, or where existing problems may be exacerbated by alcohol use.

What to ask about alcohol

 

1. Do you drink? / What type of alcohol? – beer / wine / spirits / cider / etc.
   .
2. How much?  (Quantity)
   e.g. “On a typical day, how much might you drink?”
           “What’s the most you would drink over a day?”
   It may be helpful to provide an overestimate / clarify meaning.
   e.g. if they state they have “a couple” or “a few” does this mean 2 or 3 drinks or 6 or 7?
   .
3. How often?   (Frequency)
   e.g. “How many days would you drink in an average week?
   When a person says that they drink at weekends, it is wise to check what days they mean, as an individuals perception of the “weekend” varies greatly.
   .
4. Pattern?
   e.g. Daily drinking or binge pattern?
           Drinking alone or in company?
           Periods of abstinence?
   .
5. Associated problems?
   Physical / psychological /social / forensic / employment

Screening Tools (adults)

CAGE questionnaire (Ewing et al)

C = “Have you ever felt you ought to Cut down on your drinking?
A = “ Have people Annoyed you by criticising your drinking?
G = “Have you ever felt Guilty about your drinking?”
E = “ Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover? (Eye – opener)

CAGE is a useful short screening tool for alcohol dependence, particularly for men. It may not be so sensitive for women drinkers or for detecting harmful use.

Scoring:
Positive answers to two or more questions are indicative of probable dependence.

AUDIT: this is a 10 item questionnaire developed by the World Health Organisation. It identifies both hazardous and harmful alcohol use

The AUDIT may be superior as

• It detects people at risk of dependence as well as those already dependent.
  
• Assessing behaviour over the past year means it is more relevant to current drinking than instruments which refer to behaviour over a lifetime
  

(Proudfoot & Teeson, 2001)

                               Audit Questionnaire                 Audit Guidelines           

The AUDIT tool is also available to fill in online at www.irishhealth.com and feedback on results is given.

 

What is Problem / Hazardous / Harmful Drinking?

A pattern of alcohol use that is causing damage to health; the damage may be to physical or mental health. Any 1 of the following in a 12 month period indicates problem drinking:, providing the person is not alcohol dependent.

• Drinking interfering with a persons ability to fulfil work, school or home life obligations
• Drinking in physically hazardous situations
• Legal problems as a result of drinking e.g. drunk driving, drunk and disorderly
• Continuing to drink despite social or personal problems caused by or made worse by drinking
  

What is Alcohol Dependence?

Alcohol dependence is when a person has experienced any 3 of the following in a 12-month period:

• A strong desire or sense of compulsion to drink
• Unable to control drinking or cut down
• Drinking larger amounts of alcohol over a longer time than intended
• Physical withdrawal state when alcohol use has stopped or been reduced.
  The person may drink alcohol when having physical symptoms (such as shakes, sweating etc|.) or take a substitute substance to relieve symptoms
• Evidence of tolerance – where it takes more alcohol to have the same effect
• Prior pleasures or interests reduced or given up because of time spent drinking and increased amount of time used to obtain alcohol or to recover from its effects
• Persisting with drinking despite clear evidence of very harmful consequences caused by or made worse by alcohol

Diagnostic_Criteria for alcohol abuse (DSM), Harmful use of alcohol (ICD) and alcohol dependence (DSM & ICD) are available to view and download from www.who.int