## Alcohol

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It is often necessary lo ask whether the patient is teetotal or drinks alcohol, with the approximate weekly quantity in units. A past or current history of an alcohol problem should be noted. Comments like 'social drinker' are meaningless and should be clarified.

Hie approximate quantity of alcohol consumed in an average week should be calculated in units. This is usually obtained by asking the patient to go through a typical week's drinking day b\ day and then calculating the total alcohol consumed.

There arc two way s of calculating units. The first, which is less accurate and may underestimate intake is in terms of standard measures. The second method is based on direct calculation of the alcohol content of drinks. This is more accurate given the range of alcohol strengths in heers, cider and wine in particular (Table 1.9).

Comparing the methods. A patient says she drinks two glasses of wine every evening. By method one this equates to 2 units per night. By method two, if the wine is a standard bottle (7511 ml) wilh an alcohol content of 12'r. one bottle contains 'J units so each glass is 1.5 unit-, and the patient i- drinking 3 units per night - 50r* greater (han by method one.

TABLE 1.9 Calculating units ol alcohol

Method one

Standard measure = one glass of wine, one halt pmt ol beer, one 'short ol spirits s 1 unit of alcohol

Method two Assumptions: 1 unit = 10 m! of pure alcohol x% proof = x units of alcohol per litre

Examples:

40% proof spirits contains 400 ml pure alcohol or 40 units per litre, so one standard 750 ml bottle contains 30 units of alcohol 4% beer contains 40 ml of pure alcohol or 4 units per litre, so one large (500 ml) can contains 2 units of alcohol

TABLE 1.10 The content of a detailed alcohol history

Drinking habits Quantity and type of dnnk Amount of money spent on alcohol

Daily-weekly pattern (especially binge dnnking and morning drinking) Usual place ol drinking Alone or accompanied Purpose

### Attitudes to alcohol

The recommended limits for 'safe' drinking are 21 units per week for men and 14 units per week for women. Such guidelines should lie interpreted wilh caution. A man who drinks 21 units per week in a single binge could develop alcohol-induced problems. Oil the other hand, drinking above these levels does not necessarily imply an alcohol problem - ii is simply thai complications become increasingly more likely. Certainly, average weekly intakes above 50 units in men and 40 units in women imply hazardous drinking. If excessive drinking is suspected, either currently or in the recent past, the clinician requires lo take a more detailed history ol drinking habits I Table 1.10).

In taking a history from a defensive or evasive patient it may be necessary to concentrate on closed questions requiring direct yes or no replies. It is also useful to crosscheck the history through its internal consistency, for instance whether the quantity the patient admits to drinking tallies with the stated amount of money being spent on alcohol. Similarly patients who evade questions that evaluate the extent of their drinking through direct inquiry may reveal useful information when asked about the duration and circumstances of periods of abstinence.

Additional questioning may be indicated lo assess if the patient has developed an alcohol dependence syndrome, exhibiting withdrawal symptoms such as 'the shakes'. A

Problems at work (e.g. dismissal) Problems with personal relationships (e.g. domestic violence; separation) Problems with the law

(e.g. drlrik driving) Psychological problems (e.g. depression, attempted suicide)

Fig. 1,9 Alcohol-related disorders, further layer of questions relate to assessing the presence of the different aspects of alcohol-related problems (Tig. I.LJ),