A strategy to reduce the bad effects of alcohol in your patients might comprise:
Helping people to cut down
- Take more non-alcoholic drinks; reduce the sip frequency, eg by shadowing a slow drinker in the group. Don't pick up your glass until he does (and don't hold your glass for long: put it down to avoid unconscious sipping).
- Limit your drinking to social occasions and learn to sip, not gulp.
- Don't buy yourself a drink when it is your turn to buy a drinks round.
- Go out to the pub later. Take days of rest when no alcohol is used.
- Learn graceful ways of refusing: No more for me please, I expect I'll have to drive Jack home or I'm seeing what it's like to cut down.
Maintaining reduced drinking
- Agree goals with the patient.
- Suggest he keeps an alcohol diary in which he records all drinking.
- Teach him to estimate his alcohol intake (u/week, see below).
- Consider an Alcohol Card in the notes to show: units/week; pattern of drinking; reasons for misuse; each alcohol-related problem (and whether a solution has been agreed and action implemented); job record; family events; biochemical markers (GGT, MCV); weight.
- Give feedback about how he is doing eg if GGT (γ-glutamyl transpeptidase) falls are discussed at feedback, there is much lower mortality, morbidity and hospitalization compared with randomized control subjects.
- Enlist family support; agree a system of rewards for sobriety.
- Group therapy, self-help groups, disulfiram, local councils on alcohol, community alcohol teams and treatment units may also help.
Setting limits for low-risk drinking
eg 20U/week if 14U/week if there are no absolutes: risk is a continuum. NB: higher limits are proposed, on scant evidence (eg 4U/day; 3U for women). One unit is 9g ethanol, ie 1 measure of spirits, 1 glass of wine, or half a pint of ordinary-strength beer.81 Primary care is a good setting for prevention: intervention leads to less alcohol consumption by ~15%, reducing the proportion of heavy drinkers by 20% at one-twentieth the cost of specialist services. There is no evidence that GP intervention has to include more time-consuming advice such as compressed cognitive/behavioural strategies. Simple advice works fine as judged by falling GGT levels at least for men. After interventions, women may report drinking less, but this is not reflected in a falling GTT.
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