Alcohol Problems

EXCESSIVE AND HARMFUL DRINKING

For men, excessive drinking is more than 4 SDs/d. For women, drinking becomes a serious problem at >2 SDs/d. This level can also affect the fetus of the pregnant woman. High-risk or harmful drinking occurs at more than 6 drinks a day for men and 4 drinks a day for women.

LABORATORY INVESTIGATIONS

The following blood tests may be helpful in the identification of excessive chronic alcohol intake:

• blood alcohol

• serum GGT ↑ in chronic drinkers (returns to normal with cessation of intake)

• MCV: >98 fL (i.e. macrocytosis)

• carbohydrate deficient transferrin ↑ in chronic drinkers

MEASURING ALCOHOL INTAKE

One SD contains 10 g alcohol—1 middy (or pot) of standard beer (285 mL), 2 middies of low-alcohol beer or 5 middies of super-light beer. These are equal in alcohol content to one small glass of table wine (120 mL), one glass of sherry or port (60 mL) or one nip of spirits (30 mL).

APPROACH TO MANAGEMENT

The challenge to the family doctor is early recognition of the problem. Several studies have shown that early intervention and brief counselling by the doctor are effective in leading to rehabilitation. Some of the results are very revealing:

• Patients expect their family doctor to advise on safe drinking levels.

• They will listen and act on our advice.

• Treatment is more effective if offered before dependence or chronic disease has developed.

A brief practical management plan A six-step management plan, which has been employed in a general practice early intervention program, is as follows:

1. Feed back the results of your assessment and specifically the degree of risk associated with their daily alcohol intake and bout drinking. Emphasise any damage that has already occurred.

2. Listen carefully to their reaction. They will need to ventilate their feelings and may respond defensively.

3. Outline the benefits of reducing drinking (e.g. save money, better health).

4. Set goals for alcohol consumption which you both agree are feasible.

   • For men: aim for fewer than 10 SDs/week.

   • For women: aim for fewer than 10 SDs/week.

   • For patients with severe ill effects and who are physically dependent on alcohol, long-term abstinence is advisable.

5. Set strategies to keep below the upper low-risk limits, e.g:

   • Quench thirst with non-alcoholic drinks before ...