Taking an alcohol history can be a bit daunting at first – especially as you’re asking questions which may upset or anger a patient. However, it is important that history taking is as thorough as possible, so below is a template to elicit this information (with some stock phrases for difficult questions, which you might find handy!)
Personally, I find that signposting throughout allows the patient to prepare for more difficult questions, and allows you to organise yourself – these are in quotation marks between the sections.
If anyone has any other ways of asking questions that they like, feel free to leave them in the comments.
Opening the consultation
Introduce yourself – name/role
Ask the patient to confirm who they are – name / DOB
Explain the purpose of the consultation and gain consent
“I’ve been asked to come and speak to you today regarding your alcohol intake. Is that okay with you?”
“I appreciate that some of these questions may be difficult, but it is important that you are honest. If you would like to stop at any time, let me know.”
Find out the reason for their presentation:
“What is it that has brought you in to see us today?”
It’s useful to assess severity at this point and to get an overall idea of the person’s drinking habits.
The CAGE questionnaire comes in useful here! A score over 2 suggests problematic drinking.
“I’m going to ask some general questions about your alcohol use and how it affects you.”
C – Have you ever felt that you should cut down on your drinking?
A – Do you get annoyed if people comment on the amount which you drink?
G – Do you ever feel guilty about the amount you drink?
E – Have you ever had an eye-opener? (A drink first thing on the morning to stave off a hangover – ‘”to stop the shakes ” / “settle the nerves” / “hair of the dog”)
“Do you feel that you have a problem with alcohol?” (if so, enquire when this started/why)
Details of alcohol intake
When did they have their first drink? – good/bad experience?
When did they notice their alcohol intake increase?
- “Did your drinking gradually increase, or was the increase sudden?”
- “Is there anything in your life you feel caused your intake to increase?” (think adverse life events)
Current drinking pattern:
- Every day? / Weekends?
- Time of day – mornings / evenings / all day
Quantify and clarify intake:
- “How much do you drink, in an average day?”
- “What do you drink? When?”
- “How much do you drink at that time?”
- “Where do you tend to drink?”
- “Who do you drink with?”
- “What do you drink in a week?”
- “Is there anything that makes you drink more/less in a day?”
- “How much do you spend on alcohol?”
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.
Assess the impact of alcohol
Biological signs of dependence present?
- “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?” (tolerance)
Psychological signs of withdrawal present?
- “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 daily living
Diet – adequate intake? / type of food (balanced?) / eating pattern
Occupation – is the patient working? / what is their job? / is it impacted by drinking?
Relationships – has alcohol impacted friendships/relationships?
Alcohol-related crime? – particularly aggression, drunk and disorderly, drink driving
- “Have you been in contact with the police as a result of alcohol-related incidents?”
Living situation? – where do they live / who do they live with?
Previous attempts at abstinence:
- “Have you ever tried to stop drinking before? Why?“
- “Why do you think it was unsuccessful?“
If not already revealed, assess desire to stop drinking
Here, it would be polite to thank the patient for divulging the information…
“Thank you for sharing that information with me. Now, we’ll move on from talking about alcohol to ask some questions about your health at the moment.”
Past medical history
General medical history / previous surgery
“Is there anything you see your doctor for regularly?”
“Have you ever had any surgery in the past?”
Liver disease / peptic ulcers /pancreatitis /ischaemic heart disease
- “Have you ever had to go to hospital for drink-related illnesses/injuries?”
Prescribed medication – “Are you prescribed any medication / Do you take it?”
Over the counter medication – Aspirin / St John’s Wort / other herbal remedies
Recreational drug use – “Do you take any other recreational drugs?”
Ensure to document clearly any allergies stated.
Clarify what the allergic reaction was – e.g. lip swelling vs “a bit of a rash”
Focus particularly on history of alcohol/drug dependence
History of any mental illness
“Lastly, I’m just going to ask some questions about your mood. These may seem a little strange, but we ask them to everyone who comes in with issues like this.”
Assess risk to self:
- “How has your mood been?”
- “How is your appetite?”
- “What is your sleeping pattern like?”
- “Are there things you enjoy in life? What?”
- “How is your concentration?”
- “Have you had any thoughts of hurting yourself?”
- “Have you ever thought of ending it all?” (If so, any plans)
Assess risk to others:
- “Do you ever have thoughts of harming others?”
- Note who is at home – if any dependents etc
Closing the consultation
Thank the patient
Offer leaflets discussing alcohol dependence and the health impact of alcohol
Offer referral to alcohol rehabilitation service if appropriate
1. Ewing, JA (1984), Detecting alcoholism: The CAGE questionnaire, JAMA, 1984 Oct 12;252(14):1905-7. <http://www.ncbi.nlm.nih.gov/pubmed/6471323?dopt=Abstract> accessed 17/05/2014