• 20-25% consume etoh at a harmful or hazardous level

• 3/4 presenting to GP with etoh related probelms - problems not detected

Alcohol misuse

• maladaptive pattern of alcohol use

• high daily consumption

• regular heavy weekendend drunking

• binge drinking

• ONe or more >12mo

  • failiure to fulfil major role obligations

  • eposure to physical hazards

    • driving

    • operating machinery when impaired by etoh use

  • legal problems

  • social or interpersonal problems

Alcohol dependence

• maladaptive pattern of alcohol use leading to clinically signifiant impairment or distress: ≥ 3 of:

  • tolerance

    • need for markedly increase amounts of alcohol to achieve intoxication or desired effect

    • continued use of same amount of alcohol with markedly diminiished effect

  • withdrawal - 2 or more:

    • autonomic hyperactivity

      • sweating

      • HR >100

    • hand tremor

    • nausea or vomiting

    • transient visual auditory or tactile hallucinations

    • psychomotor agitiation

    • anxiety

    • grand mal seizures

  • alcohol consumed in larger amounts or over longer period than was intended

  • persistent desire or unsuccessful efforts made to cut down or control alcohol use

  • great deal of time spent in activities necessary to obtain, consume or recover

  • important social or occupational or recreational activities are given up or reduced becuase of etoh use

  • use continued despite psychial or psychological probelm that is likely to have been caused or exacerbated by substance

Screening

Have you ever drunk more than you meant to in the last year?

have you felt that you wanted to cut down on your drinking the past year?

if yes, is this something you would like help with?

AUDIT

• alcohol use disorders identification test

• AUDIT -C = shortened

  • similar validity

  • How often did you have a drink containing alcohol in the past year?

    • Never, monthly, 2-4/month, 2-3/week, ≥4/week

    • 0-4

  • How many drinks did you have on a typical day when you were drinking in thte past year

    • 0-2, 3-4, 5-6, 7-9, ≥10

    • 0-4

  • How often did you have ≥ 6 on one occasion in the past year

    • never, \<monthly, monthly, weekly, daily

    • 0-4

  • ≥4 = problem etoh use in men, women ≥3

CAGE

• lifetime alcohol use problems

• Cut down

• Annoyed by people criticizing your drinking

• Guilty about drinking

• Eye opener

• spec 77%, Sens 91% for identification of alcoholism

Biomarker

• GGT

  • ≥ 5 drinks/day for several weeks

  • moderate sens/spec

• AST

• MCV

  • heavy drinking lasting at least a few months

• Carbodyfrate deficient transferin

  • 5drinks/day for 2wks

  • superior or equal to GGT

  • very good biomarker of relapse to drinking