ALCOHOL HISTORY Some common terminologies

Intoxication: > 3 standard drinks in female, > 6 in males / day Dependence: >8 in female , > 10 in males / day everyday. ----craving for alcohol ---- inability to reduce or stop alcohol consumption ---- experience withdrawal symptoms when stopping alcohol consumption ---- increased tolerance of alcohol

Alcohol abuse or alcoholism: A pattern of pathological use for at least a month causing impairment in social & occupational functioning and deterioration of physical health.

Effects of Alcohol on the body

Social effects Physical effects Psychological effects Social effects- First stage Lack of recognition by the person that he or she is in the early stages of a progressive illness Increasing tolerance and an ability to drink great amounts of alcohol without any apparent impairment A conscious effort to seek out more drinking opportunities Drinking is not social but a psychological escape from stress and problems

 The need to drink becomes more intense Physical effects of alcoholism as well as psychological effects of alcohol dependency Chronic hangovers Denial Unsuccessful attempts to stop drinking Increasing tolerance More frequent blackouts The loss of control becomes more pronounced, meaning that the individual is unable to drink according to his or her intentions. Third stage Unreasonable resentments The start of physical deterioration Increasing tremors Relationships fail

Social effects- Second stage

Social effects- Fourth stage

Characterized by a chronic loss of control. In the earlier stages of the disease, the individual may have been able to maintain a job. Now, however, drinking starts earlier in the day and usually continues throughout the day. Destroyed lives & relationships Wife battering Birth defects such as fetal alcohol syndrome Destroyed Work Child abuse Broken, dysfunctional homes Traffic fatalities or injuries on the highways

Physical Effects
Cardiovascular problems such as high blood pressure, cardiomyopathy (damage to the heart muscle), heart failure, and strokes Alcohol liver disease, Cirrhosis of the liver Gastritis & ulcers from the perforation of the stomach and the intestines Pancreatitis Sexual problems such as erectile dysfunction and impotence in men Neurological damage- peripheral neuropathy, memory loss, dementia, cerebellar dysfunction Increased risk of cancer, diabetes

Psychological effect
Depression & Anxiety Dis- social personality disorder Hallucinations Communication with a patient Open ended- Tell me about your drinking Non judgmental- I accept you, do not judge you Non Confrontational- Drinking is very bad for you so you must quit Emphatic- How can I help you with your drinking Win patients trust & confidence- You are very courageous to tell me about this Develop rapport Ensure confidentiality Be culturally sensitive

History taking- Longitudinal method

When did you take your 1st drink? When did you start drinking socially? What kind of drinks do you normally take? Have you tried giving up? What happened? How long could you stay off? Elicits self motivational statements Problem recognition- I never realized how much I drink Expression of concern- I am worried about my work and family Intent to change- I dont know how but I can try Optimism- I think I will try and get over this.

How much and how often ??

Alcohol content of drinks Wines- 8-14% Fortified Wines- 16-22%- Port wine, Sherry Vodka/Whiskey/Rum - 40% Beer 3-10% Social drinking Drinks alone Drinks in the morning Drinks whenever he is worried, upset Males at risk- 4 or more units / day or 21 or more/ week Women at risk- 3 or more units /day or 14 or more/ week

To calculate the amount of alcohol

One unit is 10ml of pure alcohol in UK. In USA one standard drink = 1.5 UK units. To work out the number of units: Volume Drunk (L) x % of alcohol = Units e.g. for a large bottle of vodka: 1L x 40% = 40 Units Example Henry drinks a pint (500ml) of beer everyday. Do you think Henry has an alcohol problem. The alcohol content of the beer he drinks is 4%. 500ml= 0.5 L 0.5 L x 4 = 2 units/ day 14 units / week

Associated symptoms
Problems in sleeping Headaches Vision problems Pain in abdomen, jaundice Palpitations Feeling depressed or anxious Blackouts Memory problems Weight gain / loss In females obstetric history and any problems in the child CAGE Questionnaire C- Have you ever felt the need to cut down drinking A- Have people annoyed you by criticizing your drinking G- Have you felt guilty about drinking E- Eye opener- Do you drink the first thing in the morning 2 positive points are considered as identifying factors for an alcohol problem.

Alcohol withdrawal symptoms

Agitation Acute tremors the shakes Nausea Retching Insomnia Benefits Good evidence that drinking < 1 drinks for women and 1-2 drinks per day for men helps prevent heart disease from middle age onwards.