1. How and when to take a more
detailed history of alcohol
consumption
© Clinical Skills Resource Centre, University of Liverpool, UK

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When to take a more detailed history
 Have there been any concerning answers to questions
about the patient’s alcohol consumption?
 Think about the patient’s presenting symptoms – could they
be related to alcohol?
 Think about the patient’s past medical history – are there
any possible alcohol-related disorders?
 Is there evidence of alcohol dependence?
 Past treatment (including self-help) for alcohol excess?
 Are there any complications evident? (physical,
psychological, family, occupational, legal e.g. drink-driving
convictions)

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Features which may be indicative of
alcohol misuse
 Physical effects of alcohol excess (short term)
 ‘Hangover’ – Nausea, Tremors, Sweats
 Blackouts or faints
 Accidents
 Psychological
 Craving
 Loss of control
 Social
 Work problems
 Absenteeism, Loss of jobs
 Relationships (e.g. marital discord, sexual dysfunction, etc)
 Legal problems (e.g. Drink driving offences)
 Financial problems
 Loss of friends or social status

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Longer term possible problems of
alcohol use
 Cardiovascular disorders
 Cardiomyopathy
 Hypertension
 Dysrhythmias
 Gastrointestinal disorders
 Dental caries
 Oesophagitis / gastritis
 Haematemesis
 Diarrhoea
 Hepatomegaly, cirrhosis
 Acute & chronic pancreatitis
 CNS
 Peripheral neuropathy
 Myopathy
 Respiratory disorders
 Inhalation of vomit
 (Tuberculosis)
 Cancer (mouth, tongue, pharynx,
larynx, oesophagus, liver)
 Sexual problems
 Drinking during pregnancy (fetal
alcohol syndrome)
 Psychiatric
 Anxiety and depression
 Misuse of other substances
 Personality changes
 Dementia
 Wernicke-Korsakoff syndrome
 Cognitive changes

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Features of alcohol dependence
 Strong desire or compulsion to take alcohol
 Difficulties in controlling alcohol use
 Physiological withdrawal state when alcohol use
has ceased or been reduced
 Evidence of increased tolerance to alcohol
 Progressive neglect of alternative pleasures or
interests because of alcohol use
 Persistence with alcohol use despite harmful
consequences.

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Drinkers’ own view
If alcohol excess is suspected, then it is important to elicit the
patient’s own health beliefs regarding their consumption, as
this will influence their compliance with treatment / advice.
 Do they classify their drinking:
 ‘experimental’ (common in the young)
 ‘social’ (their own definition)
 ‘a problem’
 How might their family classify the drinking?
 Attitude to problem drinking
 ‘unwilling to change’
 ‘unsure about change’
 ‘ready to change’

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Audit questionnaire
 If you suspect alcohol abuse or dependency,
ask the Audit questionnaire.
 See VITAL for the questionnaire and
instructions on how to use it.
 Note there are various assessment
questionnaires available and so different
practices / hospitals may use different
questionnaires. The Audit Questionnaire is
suggested by the World Health Organisation
(WHO).