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Alcohol?
For starting a talk,
four methods are available:
• Giving the Screening:
health questionnaire for daily medical practice to
all new patients, asking them to fill it whilst waiting.
When checking the positive answers, before the physical examination,
notice the twelve ones evoking the possible role of alcohol:
poor sleep, tranquilizers, tiredness, anxiety, poor memory,
depression, suicidal ideas, hypertension, gout, cramps, tremor,
after-effects of accidents.
• In the waiting-room,
leaving the leaflet Drugs,
suicide, alcohol: my freedom, my health. Will the
patient talk over?
• Giving the questionnaire
Smoking, drinking:
where am I at? to all smokers, for their
being smokers.
Will some ones come back for a talk?
• If a presumption raises
during the interview, start mentioning alcohol only during
or after the physical
examination. For instance, Have you ever
felt we might consider together the place of
alcohol in your life? Don't count the drinks and don't
expect all symptoms to be present.
The first step into dependence
is usually being no more free of stopping after the second
or third drink.
Later, one specific symptom of dependence is enough. Few
diseases have so many specific symptoms as alcohol dependence:
delirium; morning tremor, sweats, nausea, vomiting, all
relieved by alcohol; self-declaring trapped by alcohol;
self-declaring obsessed with alcohol supply; craving episodes;
at a late stage, the regression of tolerance.
If no specific symptom is present, many other symptoms are
available to be combined: see the book: Drugs,
alcohol: talking within the family.
The case report follows the
questionnaire
Smoking, drinking,
where am I at?
then includes the physical examination and eventually:
ECG, larynx exam, blood glucose, triglycerides, urate; exploring
liver, pancreas, subdural hematoma according to clinical features.
Sometimes, blood markers of alcohol intake,
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