Alcohol Misuse

🔍 When to Suspect

Physical symptoms (liver disease, gastritis, neuropathy), mental health issues (anxiety, depression), or social/work problems related to drinking

From the full topic in The Ocean Library: Alcohol Misuse

🧭 When to suspect

Problem drinking sits on a spectrum – from increasing-risk (hazardous) use, through harmful drinking, to alcohol dependence. Most people who drink above safe limits are not dependent.

Many present without ever mentioning alcohol:

• Physical problems (deranged LFTs, dyspepsia or gastritis, peripheral neuropathy, falls or unexplained injury)

• Mental health problems (anxiety, depression, insomnia)

• Social and occupational difficulties (relationship breakdown, money or work problems)

Others ask directly for help to cut down, or are brought in by a worried family member.

The two core skills in primary care are:

• To stratify the drinking level – by calculating units and using the Alcohol Use Disorders Identification Test (AUDIT) questionnaire

• To never miss the dangerous complications: alcohol withdrawal (seizures, delirium tremens) and Wernicke's encephalopathy

Management then follows from where the person sits on the spectrum and from their own goal, whether that is moderation or abstinence.

The UK low-risk guideline is to drink no more than 14 units a week, for both men and women.

• Spread it over three or more days, with several drink-free days.

• One unit is about 10 ml or 8 g of pure alcohol.

• Use the AUDIT score to grade risk and direct action.

AUDIT score	Classification	Action
0–7	Low risk	Positive feedback – no intervention needed
8–15	Increasing risk (hazardous)	Brief intervention – structured advice + motivational interviewing
16–19	Higher risk (harmful)	• Brief intervention + psychological support • Consider referral
≥ 20	Possible dependence	• Comprehensive assessment • Refer to specialist alcohol services

Raise suspicion particularly in those with:

• A family history of alcohol problems

• Coexisting depression or anxiety

• Chronic social stress

• Unexplained physical signs such as a raised gamma-GT or macrocytosis

Screen with Cut down, Annoyed, Guilty, Eye-opener (CAGE) or AUDIT-C and follow up with the full AUDIT where indicated.

Source: NICE CG115 · UK Chief Medical Officers' low-risk drinking guidelines

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