CPD: Key Questions on alcohol related problems

Key learning points

About 25% of the population drink at a level that could be harmful and 4% are dependent on alcohol
If a patient is suffering significant harm, abstinence is preferred – but if this is not achievable, reducing consumption is still worthwhile
Those with physical dependence should not stop drinking abruptly unless in a medically assisted detoxification
Treatment for dependence has good outcomes, with maintained abstinence in 25% and a significant reduction in intake in another 40%
All patients at risk of physical withdrawal should have oral thiamine.

Dr Steve Brinksman is a GP in Birmingham

Q. What symptoms, examination findings, investigation abnormalities or scenarios should alert GPs to the possibility of alcohol misuse?

A. There are many conditions that are more common in those with alcohol use disorders (AUD).¹ Many have other common or multiple causes, so the role of alcohol may be missed. Excess alcohol is a significant cause of hypertension, gastro-oesophageal reflux disorder (GORD), gastritis, depression and anxiety. Reducing or stopping alcohol can lower BP by a similar amount to some antihypertensive medications,² reduce GORD and improve mental health symptoms.

These conditions are all common presentations in a primary care setting. Screening for AUD at this point and providing appropriate interventions may reduce the need for other medications and prevent further problems related to alcohol use.

Patients presenting with poor sleep, irritability, poor concentration, stress at home or work, flare-ups of psoriasis, cardiac arrhythmias, weight loss and abdominal pain, seizures and the need for emergency contraception should be screened for AUD.

Apart from raised BP, many of the physical signs of AUD are associated with late-stage disease but the presence of jaundice, an enlarged liver, cardiomyopathy, tremor, spider naevi, palmar erythema and Dupuytren’s contracture should trigger screening for AUD as should abnormal LFTs or raised MCV. However it is important not to rely on LFTs as screening tests as they are often normal and may provide false reassurance. If excess alcohol is a possible cause for the presenting condition, it should be assessed using validated screening tools, not venepuncture.