Ask the patient when they first noticed an increase in their alcohol intake and try to identify any factors that played a role in this:
“When did you first notice an increase in the amount of alcohol you were drinking?”
“Was there anything going on at the time that played a role in this?”
Current drinking pattern
Assess the patient’s current drinking pattern:
“How often do you drink alcohol?”
“Do you drink alcohol every day?”
“Do you drink alcohol every week?”
“Do you drink alcohol at a particular time of the day?”
Quantification of alcohol intake
Quantify the patient’s alcoholintake:
“How much do you drink on an average day?”
“How much do you drink in an average week?”
“What kind of alcoholic drinks do you drink?”
“Is there anything that makes you drink more or less in a day?”
“How much do you spend on alcohol each week?”
It may be useful to write down alcohol intake on a piece of paper (Monday – Sunday with approximate timings and drinks had). This ensures a history which is as comprehensive as possible and accounts for varied intake across the week.
Ask about the patient’s drinking behaviours:
“Where do you drink?”
“Who do you drink with?”
Previous attempts at abstinence
Ask if the patient has previously attempted to stop drinking:
“Have you ever tried to stop drinking before?”
“What happened when you tried?”
“Did you have any support?”
“Why do you think it was unsuccessful?”
Impact of alcohol
Screen for evidence of alcoholdependence including biological and psychological signs.
Biological signs of dependence
Screen for biologicalsigns of dependence:
“If you stop drinking, do you…get the shakes/sweat a lot/feel sick/notice any physical changes?”
“Do you have to drink more than you used to, to get the same effects?”
Psychological signs of dependence
Screen for psychologicalsigns of dependence:
“Do you feel a compulsion/need to drink?”
“How important is drinking to you?”
“If you stop drinking, do you notice that you…feel down/angry/anxious?”
Effects on day to day life
Ask if alcohol has impacted the patient’s relationships with others:
“Has alcohol impacted any of your personal relationships?”
“How has it affected them?”
Ask if alcohol has impacted the patient’s job:
“Has alcohol had any impact on your job or ability to work?”
Explore of the patient currently drives, as this has significant safety and legal implications:
“Do you currently drive?”
“What kind of vehicle do you drive?”
“Do you drive for work?”
“Have you ever driven whilst under the influence of alcohol?”
Ask what the patient’s diet looks like on an average day and if they feel alcohol is negatively affecting it:
“What does your diet look like on an average day?”
“Do you feel that alcohol impacts the way in which you eat?”
Ask if the patient has ever had involvement of the police for alcohol-related issues:
“Have you ever committed a crime or had the police involved as a result of your drinking?”
Perform a brief assessment of the patient’s current mood to identify signs of depression:
“During the past month have you felt low, depressed or hopeless?”
“Have you recently had little interest or pleasure in doing things?”
Screen for thoughts of self-harm or suicide:
“Have you had any thoughts of hurting yourself?”
“Have you ever thought of ending your life?”
Screen for thoughts of harming others:
“Do you ever have thoughts of harming others?”
Past medical history
Ask if the patient has any medicalconditions:
“Do you have any medical conditions?”
“Are you currently seeing a doctor or specialist regularly?”
If the patient does have a medical condition, you should gather more details to assess howwellcontrolled the disease is and what treatment(s) the patient is receiving. It is also important to ask about any complications associated with the condition including hospitaladmissions.
Ask if the patient has previously undergone any surgery or procedures (e.g. banding of oesophageal varices):
“Have you ever previously undergone any operations or procedures?”
“When was the operation/procedure and why was it performed?”
Ask if the patient has any allergies and if so, clarify what kind of reaction they had to the substance (e.g. mild rash vs anaphylaxis).
Alcohol-related medical conditions
Alcohol-related medical conditions include:
Upper gastrointestinal bleeding
Ask if the patient is currently taking any prescribedmedications or over-the-counterremedies:
“Are you currently taking any prescribed medications or over-the-counter treatments?”
If the patient is taking prescribed or over the counter medications, document the medicationname, dose, frequency, form and route.
Identify medications whose side effects are potentiated by alcohol (e.g. benzodiazepines).
Ask the patient if they’re currently experiencing any sideeffects from their medication:
“Have you noticed any side effects from the medication you currently take?”
Explore the patient’s socialhistory to understand their socialcontext.
General social context
Explore the patient’s general social context including:
the type of accommodation they currently reside in (e.g. house, bungalow) and if there are any adaptations to assist them (e.g. stairlift)
who else the patient lives with and their personal support network (if children at home, consider if social services need to be involved)
what tasks they are able to carry out independently and what they require assistance with (e.g. self-hygiene, housework, food shopping)
if they have any carer input (e.g. twice daily carer visits)
Record the patient’s smokinghistory, including the type and amount of tobacco used.
Recreational drug use
Ask the patient if they use recreationaldrugs and if so determine the type of drugs used and their frequency of use.
Ask the patient if they gamble and if they feel this is a problem.
Gambling is causative of several decrements to health directly, such as increased sedentary behaviour during the time spent gambling, poor sleep, reduced levels of self-care and anxiety. Patients with a gambling problem are also more likely to have substance misuse issues.1
Offer leaflets about alcohol dependence and the negative health impact of alcohol.
Offer referral to an alcohol rehabilitation service if appropriate.
Dispose of PPE appropriately and wash your hands.
Ewing, JA (1984), Detecting alcoholism: The CAGE questionnaire, JAMA, 1984 Oct 12;252(14):1905-7. Available from: [LINK].
Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG; The Alcohol Use Disorders Identification Test, Guidelines for Use in Primary Care, Second Edition, Department of Mental Health and Substance Dependence, World Health Organization. Available from: [LINK].