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Box 1: Screening and brief interventions
ASSESS
elicit patient’s concernshow does alcohol f it in?
ELICIT AND RECORD
typical day’s drinking
maximum
in
a
dayalcohol related physical, emotional and social problems
CONSIDER
FAST or CAGE plus two consumption questions MCV, GGT
DELIVER BRIEF INTERVENTION
discuss
costs
and
benef its
of
drinking
f rom
patient’s
perspectiveoff er inf ormation about health risks
(patient may not be receptive on
f irst consultation;
repeated interviews / reviews may
be necessary)
IS THE PATIENT INTERESTED?
AGREE GOAL SOW SEEDS
REDUCTION ABSTINENCE*
Assisting goal of reduction Assisting goal of abstinence
Elicit patient’s concerns
Regular review to off er encouragement
Enlist support of f amily and
f riends
Consider use of local alcohol services
Plan
medically assisted
withdrawal if indicated, at home or in hospital
Yes
* Absolute indications for
abstinence:
alcohol related organ
damage severe dependence (eg
morning drinking to stop
h h k i f il d
No
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Beverage type Alcohol by
volume (%)
Measure Alcohol content
(units)
Beers /lagers Barbican
Kaliber
Tennents LA
Mild/ ligh
t beer s(vari
ous bran
ds
)Best bitter (various brands)
Skol
McEwans / Labatt
Guinness draf t stout
Gr olsch
Pr emium beer / lager (various brands)
Stella Ar tois
Lowenbrau Pils
Hof meister Special
Kestral Super
0.02
0.05
1.2
3.1
3.5
3.6
4.0
4.1
5.0
5.0
5.2
6.0
9.0
9.5
440ml
Pint
440ml
Pint
Pint
Pint
Pint
Pint
440ml
Pint
330ml
440ml
440ml
440ml
<0.01
0.03
0.5
1.8
2.0
2.0
2.3
2.3
2.2
2.8
1.7
2.6
4.0
4.2
Ciders /Perries Str ongbow LA
Woodpecker
Str ongbow
Old English
Str ongbow Super
Diamond White
Str ong White Cider
0.9
3.5
4.5
5.5
8.0
8.2
8.4
330mlPint
1000ml
Pint
Pint
275ml
1000ml
0.3
2.0
4.5
3.1
4.5
2.3
8.4
Spirit based drinks
with mixers
(alcopops)
Hooch
WKD Original Vodka Blue or Ir on Br ew
Smirnoff Ice
Bacar di Br eezer
Metz Snapps (Black, Still or Original)
Vodka Red Squar e (Barr s Irn Br u)
Af ter shock
4.7
5.5
5.5
5.4
5.4
5.5
40.0
330ml
330ml
275ml
275ml
275ml
275ml
700ml
1.6
1.8
1.5
1.5
1.5
1.5
28.0
Vodka Hooch Lemon / Apple / Orange / Hooper s Hooch 4.7-5.1 330ml 1.6-1.7
Shooters (addition to
main drink)
Jelly Pots
SidekickAf ter shock
Fr ostbite
Absinthe
15.0
20.0
40.0
50.0
75.0
47ml
30ml
30ml
30ml
30ml
0.7
0.6
1.2
1.5
2.3
Wines Various brands 9-14 750ml 6.8
-10.5
A purchased glass of wine can var y f r om 125 to 250 ml and can contain 1.1-3.5 units per glass depending on % alcohol.A small (125ml) glass of average str ength (12%) wine contains 1.5 units.
Fortified Wines and
similar
Cinzano bianco/ Buckf ast
Cr of t Original Sherr y
Cockburn’s Port
14.7
17.5
20.0
750ml
750ml
750ml
11.0
13.1
15.0
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1. If you have been chemically dependent on alcohol, stopping drinking causes you to gettense, edgy, perhaps shaky or sweaty, and unable to sleep. There can be vomiting ordiarrhoea. This “rebound” of the nervous system can be severe. Medication controls thesymptoms while the body adjusts to being without alcohol. This usually takes three to
seven days from the time of your last alcoholic drink. If you don’t take medication, thesymptoms would be worst in the first 48 hours, and then gradually disappear. This is why,if you do take medication, the dose starts high and then reduces. If you have beenprescribed 10 mg tablets of chlordiazepoxide, use the table below to remind you when totake the right number of tablets.
2. YOU HAVE AGREED NOT TO DRINK ALCOHOL. You may get thirsty. Drink fruit juicesand water but do not overdo it. You do not have to “flush” alcohol out of the body. Morethan three litres of fluid could be too much. Don’t drink more than three cups of coffee or
five cups of tea. These contain caffeine which disturbs sleep and causes nervousness.3. AIM TO AVOID STRESS. The important task is not to give in to the urge to take alcohol.
Help yourself relax by going for a walk, listening to music, or taking a bath.
4. SLEEP. You may find that even with the capsules, or as they are reduced, your sleep isdisturbed. You need not worry about this - lack of sleep does not seriously harm you,starting to drink again does. Your sleep pattern will return to normal in a month or so. It isbetter not to take sleeping pills so that your natural sleep rhythm returns. Try going to bedlater. Take a bedtime snack or milky drink.
5. The capsules may make you drowsy so you must not drive or operate machinery. Ifyou get drowsy, miss out a dose.
6. MEALS. Even when you are not hungry, try to eat small amounts regularly. Your appetitewill return.
Number of chlordiazepoxide (10 mg) tablets to take and when to take them whenwithdrawing from alcohol as an outpatient
First thing 12 noon 6 pm Bedtime
Day 1 - 3 3 3
Day 2 2 2 2 3
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Yes, if patient: is conf used or has hallucinations has a histor y of pr evious complicated withdr awal has epilepsy or histor y of fits
is under nour ished has sever e vomiting or diarrhoea is at r isk of suicide has sever e dependence coupled with unwillingness
to be seen daily has a pr eviously failed home-assisted withdr awal has uncontrollable withdr awal symptoms has an acute physical or psychiatr ic illness has multiple substance misuse has a home environment unsuppor tive of abstinence
Advise the patient that he / she may have mild anxiety / insomnia f or a few days
Is medication required?
Is admission necessary?
Yes, if r ecent withdr awal symptoms, or dr inking
>15 units / day (men),
>10 units / day (women)
No, if patient sober and has no withdr awal symptoms
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