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Recognising problem drinking

Recognising people with alcohol-related problems is diffi cult – probably less than 20% are known to their general practitioner (although problem drinkers consult their GP twice as frequently as those whose alcohol consumption is within the safe limits), and a large proportion are missed in accident and emergency departments. Recognition is particularly diffi cult among teenagers, elderly people and doctors. About half of the doctors reported to the General Medical Council for health diffi culties liable to affect professional competence have an alcohol problem. Doctors may be alerted to an alcohol problem by the presenting complaint. The essential fi rst stage in improving recognition is taking a drinking history, and this should be combined with selected investigations.

Amount of alcohol consumed in units. Always enquire about quantity and type of drink. Many doctors are unaware of the unit values for common descriptions of daily intake Time of fi rst alcoholic drink of the day Pattern of drinking: problem drinking is characterised by the establishment of an unvarying pattern of daily drinking Presence of withdrawal symptoms such as early morning shakes or nausea. Specifi c questioning should follow the World Health Organization’s Alcohol Use Disorders Identifi cation Test (AUDIT), which includes questions from the well-known CAGE questionnaire.

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