Alcohol misuse

Overview

This review covers interventions in hazardous and harmful alcohol users aged 18 years and older being treated in primary care or in emergency departments. In defining hazardous and harmful alcohol consumption, we have used the WHO categorisation of alcohol-use disorders.[1] Dependent drinkers (who have more serious alcohol misuse problems than harmful or hazardous drinkers) are not covered by this review. It is important to note that threshold levels of hazardous and harmful consumption often vary by country and culture.[2] Hazardous alcohol consumption is defined as a pattern of alcohol consumption that increases the individual's risk of alcohol-related harm, but is not currently causing alcohol-related harm. The quantity and frequency of alcohol consumption that constitutes hazardous consumption is usually specified using threshold levels of consumption. In the UK, these levels are specified as: in excess of 14 standard drinks for women and 21 standard drinks for men in any week, where a standard drink constitutes 10 mL by volume or 8 g by weight of pure ethanol.[1] Harmful alcohol consumption is a pattern of consumption likely to have already led to alcohol-related harm. In the ICD-10, alcohol consumption is defined as harmful if: there is clear evidence that alcohol is responsible for physical or psychological harm; the nature of the harm is identifiable; alcohol consumption has persisted for at least 1 month over the previous 12 months; and the individual does not meet the criteria for alcohol dependence.[3] Harmful alcohol consumption is also conceptualised in terms of a pattern of alcohol consumption in excess of specified limits, which currently stands in the UK as 35 standard drinks for women and 50 standard drinks for men in any week.[2] Hazardous and harmful alcohol users are unlikely to seek treatment specifically for alcohol-related problems, but they may come to the attention of health services through opportunistic screening for alcohol use, or, in the case of people with harmful levels of alcohol consumption, because they exhibit alcohol-related harm at presentation. Alcohol-related harm may be acute (such as alcohol-related accidents, alcohol poisoning, or acute pancreatitis), and may also be chronic (such as hypertension, cirrhosis, depression and anxiety, fetal alcohol syndrome, and fetal alcohol effects). ...read more. Diagnosis: Clinical presentations in primary and emergency care that are associated with excessive alcohol use include hypertension, accidental injury, hand tremors, duodenal ulcers, gastrointestinal bleeding, cognitive impairments, anxiety, and depression.[4] There are several short paper-based screening instruments available for use in primary-care populations. The Alcohol Use Disorder Identification Test (AUDIT) is a 10-item questionnaire that addresses quantity and frequency of alcohol use, alcohol-related problems, and symptoms of mild alcohol dependence.[5] It exhibits high levels of sensitivity (92%) and specificity (94%).[6] A score of 8 or more is indicative of hazardous alcohol use, and a score of 16 or more indicative of harmful alcohol use. Several shortened versions of the AUDIT exist. AUDIT-C[7] incorporates the first three questions of AUDIT, and measures the quantity and frequency of alcohol consumption; it also has acceptable levels of sensitivity and specificity in primary-care populations (sensitivity: 78% for males, 50% for females; specificity: 75% for males, 93% for females). The FAST alcohol screening test[8] is a short AUDIT derivative specifically developed for use in emergency departments. It identifies 90% of the hazardous alcohol users identified by the 10-item AUDIT questionnaire. Other short screening instruments include the Michigan Alcohol Screening Test,[9] CAGE,[10] and the Paddington Alcohol Test (PAT).[11] A number of biological markers of alcohol use can be used in the diagnosis of hazardous or harmful use. These include elevations in mean red blood cell volume (MCV), serum gamma glutamyl transferase (GGT), and carbohydrate deficient transferrin (CDT). While the results of biochemical tests may be useful as motivating factors in addressing an individual's alcohol consumption, they are less sensitive and specific than screening questionnaires in identifying hazardous and harmful alcohol use.[12]

Latest citations

Dating violence: outcomes following a brief motivational interviewing intervention among at-risk adolescents in an urban emergency department. ( 22 September 2014 )

Universal Internet-based prevention for alcohol and cannabis use reduces truancy, psychological distress and moral disengagement: A cluster randomised controlled trial. ( 22 September 2014 )