Alcohol Use and Alcohol Use Disorders

Dr David Harniess

MBChB MRCGP DCH DRCOG

Learning Objectives

•Familiarisation with mhGAP intervention guide

•Assessing for alcohol intoxication

•Recognising alcohol withdrawal state and its management

•Assessing harmful alcohol consumption

•Assessing for alcohol dependence

•Managing alcohol withdrawal

Acute Alcohol Intoxication

What are the symptoms and signs of acute alcohol intoxication?

Whilst walking around the Soukh you find a man lying on the street with blood pouring from his head following a fall. You notice an empty bottle of brandy lying near his hand. What initial clinical assessment would you make?

mhGAP Intervention Guide for Acute Alcohol Intoxication

Recognising alcohol withdrawal state and its management

What are the symptoms and signs of acute alcohol withdrawal?

What features make you consider how severe the alcohol withdrawal is likely to be?

mhGAP Guide on Identifying and Managing Acute Alcohol Withdrawal

Management of alcohol withdrawal where confusion or change in consciousness occurs

Assessing for harmful alcohol consumption

• How many units are in:– 375ml can of lager at 3.5%– A bottle of wine at 12.5%– A bottle of brandy or whisky 500ml at 40%– A 2 litre bottle of cider at 5%– Libyan home brewed spirits?

What is the recommended safe amount of alcohol that can be consumed in a week for a man/ for a woman?

Screening Tools used in Assessing Harmful amounts of Alcohol

CAGE questionnaireCut down (anyone suggested previously)Angry when asked previouslyGuilty about drinkingEye opener (1st drink in morning)

FAST score questionnaireAUDIT-C questionnaire (WHO Audit

questionnaire)

How do you assess for dependency of alcohol?

How do you manage alcohol withdrawal?

Emergency detoxification

Diazepam reducing regime 3- 7 days

Thiamine for 5 days

Hydration and electrolyte correction?

Any delirium consider haloperidol

Alcohol detoxification at home or in hospital?

Harm reduction strategies – any thoughts?

ANY QUESTIONS??????????????

Case Scenario of Alcohol Use in Libya

22 year old Libyan medical student has failed his 4th year. He has felt very low and stopped going out with his friends. He has been struggling to sleep for a long time and started to have a drink of whisky at night to help him get off to sleep. Over the last few weeks his mum has noticed he has been more irritable, prone to angry outbursts and not joining them for family meals. He has started regularly going to the Soukh on his motorbike and was involved in a road traffic accident on the way home today. The police have come to the house with her son who looks very edgy, shaky and sees he needs to be sick and says he needs to see the doctor.

Questions to consider

What are the differential diagnoses in this case?

What are the issues of alcohol raised in this case?

If you were his doctor how would you manage him in the first instance?

Once the emergency situation has been resolved and you can assess him what more information would you like to elicit?