Useful site with lots of answers • www.smmgp.org.uk • Look at DR Fixit
Audit questions • How often do you have six or more drinks on one occasion? • How often do you have a drink containing alcohol? • How many standard drinks containing alcohol do you have on a typical day when drinking? • how often have you needed a drink in the morning • feeling of guilt • unable to remember what happened the night before • Have you or someone else been injured • someone suggested you cut down • failed to do what was normally expected of you because of drinking? • found that you were not able to stop • There are lots of subsets with five of these questions • Audit PC is the common one in GP • http://www.cks.nhs.uk/alcohol_problem_drinking/management/detailed_answers/hazardous_and_harmful_drinking#-263237
Which patients are unlikely to be safe to home detox? • Confused or hallucinating • previously complicated withdrawal • history of fits • emaciated • severe vomiting or diarrhoea not controllable with symptomatic relief • at risk of suicide • severe dependence coupled with unwillingness to be seen regularly • has a previously failed home-assisted withdrawal • has uncontrollable withdrawal symptoms • an acute physical or psychiatric illness • multiple substance misuse • has a home environment unsupportive of abstinence. • However……………..
FRAMES • Focus on their reasons for change, • In a non confrontational way help them take responsibility for cutting down, -make a plan, with options for changing drinking patterns • agree an achievable target, • use a non judgmental style to help the patient sort out what they want to do so that they believe that they can do it.
Advice to patients on withdrawing from alcohol at home • If you have been chemically dependent on alcohol, stopping drinking causes you to get tense, edgy, perhaps shaky or sweaty, and unable to sleep. There can be vomiting or diarrhoea. This “rebound” of the nervous system can be severe. Medication controls the symptoms while the body adjusts to being without alcohol. This usually takes three to seven days from the time of your last alcoholic drink. If you don’t take medication, the symptoms would be worst in the first 48 hours, and then gradually disappear. This is why, if you do take medication, the dose starts high and then reduces. If you have been prescribed 10 mg tablets of chlordiazepoxide, use the table below to remind you when to take the right number of tablets.YOU HAVE AGREED NOT TO DRINK ALCOHOL. You may get thirsty. Drink fruit juices and water but do not overdo it. You do not have to “flush” alcohol out of the body. More than three litres of fluid could be too much. Don’t drink more than three cups of coffee or five cups of tea. These contain caffeine which disturbs sleep and causes nervousness.AIM TO AVOID STRESS. The important task is not to give in to the urge to take alcohol. Help yourself relax by going for a walk, listening to music, or taking a bath.SLEEP. You may find that even with the capsules, or as they are reduced, your sleep is disturbed. You need not worry about this - lack of sleep does not seriously harm you, starting to drink again does. Your sleep pattern will return to normal in a month or so. It is better not to take sleeping pills so that your natural sleep rhythm returns. Try going to bed later. Take a bedtime snack or milky drink. The capsules may make you drowsy so you must not drive or operate machinery. If you get drowsy, miss out a dose.MEALS. Even when you are not hungry, try to eat small amounts regularly. Your appetite will return.Number of chlordiazepoxide (10 mg) tablets to take and when to take them when withdrawing from alcohol as an outpatient First thing 12 noon 6 pm Bedtime • Day 1 - 3 3 3 • Day 2 2 2 2 3 • Day 3 2 1 1 2 • Day 4 1 1 - 2 • Day 5 - 1 - 1 • http://www.sign.ac.uk/guidelines/fulltext/74/annex6.html