Toby Reynolds

Abstract Alcohol-use disorders including acute intoxication and withdrawal are common in the acute medical setting. Acute physicians should be aware of the indications for inpatient detoxification, and be able to liase with specialist alcohol services in the hospital and in the community to determine those patients for whom community-based detoxification may be beneficial. Additionally, it is important to recognise the benefit of Brief Interventions for higher-risk drinkers who are not yet dependent. For patients with confusion and a possible history of high alcohol intake and malnutrition, acute physicians should maintain a high index of suspicion for Wernicke’s Encephalopathy and treat appropriately with parenteral thiamine. References NHS Information Centre. Statistics on Alcohol: England. 2011. [Document online] available at URL: http://www.ic.nhs.uk/webfiles/publications/003_Health_Lifestyles/Alcohol_2011/NHSIC_Statistics_on_Alcohol_England_2011.pdf. Hall W, Zador D. The alcohol withdrawal syndrome. The Lancet 1997; 349: 1897-1900. Scottish Intercollegiate Guidelines Network. The management of harmful drinking and alcohol dependence in primary care (Guideline No 74). 2004. [Document online] available at URL: http://www.sign.ac.uk/guidelines/fulltext/74/index.html. Department of Health (UK). Alcohol Misuse Interventions: Guidance on Developing a Local Programme of Improvement. [Document online] available at URL: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4123297. National Health Service (UK). Your drinking and you. 2010. [Document online] available at URL: http://www.gravesham.gov.uk/media/pdf/c/b/your-drinking-and-you.pdf. The National Clinical Guideline Centre for acute and chronic conditions. Alcohol use disorders: diagnosis and clinical management of alcohol-related physical complications (clinical guideline 100), 2010. [Document online] available at URL: http://www.nice.org.uk/nicemedia/live/12995/48989/48989.pdf. Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA, for the Ambulatory Care Quality Improvement Project. The AUDIT Alcohol Consumption Questions (AUDIT-C): An Effective Brief Screening Test for Problem Drinking. Arch Intern Med. 1998; 158: 1789-1795. Ewing JA. Detecting Alcoholism. JAMA 1984; 252: 1905-1907. Smith SG, Touquet R, Wright S, Das Gupta N. Detection of alcohol misusing patients in accident and emergency departments: the Paddington alcohol test (PAT). Accid Emerg Med 1996; 13: 308-312. Hodgson R, Alwyn T, John B, Thom B, Smith A. The Fast Alcohol Screening Test. Alcohol and Alcoholism 2002; 37: 61-66. Grant BF, Stinson,F.S., Harford,T.C. Age of onset of alcohol use and DSM-IV alcohol abuse and dependence: A 12 year follow-up. Journal of Substance Abuse 2001;13:493-504. Sørensen HJ, Manzardo AM, Knop J, et al. The Contribution of Parental Alcohol Use Disorders and Other Psychiatric Illness to the Risk of Alcohol Use Disorders in the Offspring. Alcoholism: Clinical and Experimental Research; 35: 1315-1320. Mayfield RD, Harris RA, Schuckit MA. Genetic factors influencing alcohol dependence. British Journal of Pharmacology 2008; 154: 275-287. Boschloo L, Vogelzangs N, Smit JH, et al. Comorbidity and risk indicators for alcohol use disorders among persons with anxiety and/or depressive disorders: Findings from the Netherlands Study of Depression and Anxiety (NESDA). Journal of Affective Disorders; 131: 233-242. Amato L, Minozzi S, Davoli M. Efficacy and safety of pharmacological interventions for the treatment of the Alcohol Withdrawal Syndrome. Cochrane Database of Systematic Reviews 2011; (6): CD008537. Sullivan JT, Sykora K, Schneiderman J, et al. Assessment of Alcohol Withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar). British Journal of Addiction 1989; 84:1353-1357. Muzyk AJ, Fowler JA, Norwood DK, et al. Role of alpha-2 Agonists in the Treatment of Acute Alcohol Withdrawal. Ann Pharmacother 2011; 45: 649-657. Moos RH, Moos BS. Rates and predictors of relapse after natural and treated remission from alcohol use disorders. Addiction 2006; 101: 212-222. House of Commons (UK). Supplementary memorandum by the Department of Health (AL 01B) 2010. [Document online] available at URL: http://www.parliament.the-stationery-office.co.uk/pa/cm200910/cmselect/cmhealth/151/151we03.htm. Heather N. FJ. Brief interventions for alcohol problems in hospital settings. Nursing Times 2005; 101: 38-41. Moyer A, Finney JW, Swearingen CE, et al. Brief interventions for alcohol problems: a meta-analytic review of controlled investigations in treatment-seeking and non-treatment-seeking populations. Addiction 2002; 97: 279-292. Thomson AD, Marshall EJ. The natural history and pathophysiology of Wernicke’s Enchephalopathy and Korsakoff’s Psychosis, 2006; 151-158. Hardern R, Protheroe D. Use of section 5(2) of the Mental Health Act on a medical admissions unit. J R Soc Med 2003; 96: 474 Full Text File size: 147 KB Downloads: 1256