Alcohol Misuse

AUDIT - assessment

The Alcohol Use Disorder Identification Test (AUDIT) has been developed by the World Health Organization as a simple screening tool to pick up the early signs of hazardous and harmful drinking and identify possible alcohol dependence.

Downloadable version for patient self assessment here.

FRAMES - brief intervention tool

Refer to the FRAMES model of intervention (powerpoint) for risky or harmful alcohol consumption, as provided by the Drug and Alcohol Clinical Advisory Service. It provides a suggested format for brief intervention in primary care.

Further advice and resources can be found in Clinical Knowledge Summary section - Alcohol - problem drinking.

Referrals

For patients who required further help and support with regards their alcohol use then please refer to the local providers as below:

Bristol - Refer to Bristol ROADS Also see Breaking Free for online support for Bristol patients with alcohol or drug problems. 

South Gloucestershire - Refer to DHI

North Somerset - Refer to With you

Children (aged 17 and under) - see Children and Young People section of Remedy

Red Flags

Offer admission to hospital for immediate (unplanned) medically assisted alcohol withdrawal for people in acute alcohol withdrawal with, or who are likely to be at high risk of developing, alcohol withdrawal seizures or delirium tremens.

Urgently admit people with clinical features of Wernicke's encephalopathy (such as confusion, loss of coordination [ataxia], eye paralysis [ophthalmoplegia], nystagmus, memory disturbance, hypothermia, hypotension, and coma) for treatment with parenteral thiamine.

Please see the clinical protocol for Wernicke's Encephalopathy (WE) and Pabrinex that has been developed by UHBW Trust to be used by nurses, doctors and pharmacists for assessment and intervention of adult inpatients suspected or at risk of WE due to alcohol misuse.

Wet clinic

Drinking preventing your patient from accessing health care?

BDP and the Homeless Health Service work collaboratively to run drop-in “Wet Clinic” sessions in Bristol where individuals can access health care from a nurse and a GP without needing to stop drinking.

The goal of these sessions is to improve access to vital healthcare for people who are dependent on alcohol by lowering the barriers associated with seeing a GP at a traditional surgery.

In addition to support with alcohol, Pabrinex injections may be offered and opportunistic liver fibroscans via the mobile service. Consultations are visible under “All Records” in EMIS. For further details of the clinic, see the poster.

Sessions are run:

• Emmanuel Meeting House, Narrow Lewins Mead, Bristol, BS1 2NN - Tues 2-4pm
• The Wild Goose Drop-in Centre, 32 Stapleton Road, Easton, Bristol, BS5 0QY  - Weds 2-4pm
• St Francis Centre, St Francis Road, Bristol, BS3 1JP  - Thurs 2:30-4:30pm

Detox in primary care

For information on undertaking detox in the community please discuss with your practice alcohol lead or local alcohol service.

For Bristol GP's (ROADS) only - Guidance on a patient’s suitability for either a primary care or secondary care alcohol detox

Chlordiazepoxide reducing regime charts

Chlordiazepoxide reducing regime charts for alcohol detoxification have been developed to support primary care clinicians. 

• Standard dose chlordiazepoxide reducing regime chart for alcohol detoxification (For use in people drinking <20 units daily and no other risks)
• Medium dose chlordiazepoxide reducing regime chart for alcohol detoxification (For use in people drinking >20 units daily or those using less with risk factors for Delirium Tremens or seizures.)

Pabrinex Prescribing Scoring System  A scoring system to assess the risk of Wernicke's encephalopathy (WE) to support prescribers when considering whether intramuscular Pabrinex® is also required.

Please also see Guidance on Administration of Intramuscular Pabrinex

Using and prescribing thiamine in alcohol dependence – SPS - Specialist Pharmacy Service – The first stop for professional medicines advice

Relapse prevention

Relapse prevention support should be offered to clients who have undertaken a detoxification. A variety of strategies may be used.

For third sector support see the groups listed on the NHS Choices website in addition to local services in the Referral section above.

For information on pharmacological therapies used see: https://remedy.bnssgccg.nhs.uk/formulary-adult/chapters/4-central-nervous-system/48-substance-dependence/

Resources

See the Clinical Knowledge Summaries page: Alcohol- problem drinking which has advice on screening, brief interventions and management of alcohol problems in primary care.

Harm reduction strategies for alcohol dependence leaflet (South London & Maudsley NHS Foundation Trust)

COVID-19: information on stopping drinking for people dependent on alcohol, Public Health England - Advice on stopping drinking for people dependent on alcohol.

Driving

DVLA guidance is available on drug or alcohol misuse and dependence (pg. 100).

GMC guidance is available on how to speak to a patient about driving, what to do if you’re unsure about their fitness to drive, and the steps to take if a patient continues to drive after you’ve advised them to stop.

Additional Services

To find additional services within BNSSG please use your MiDoS Login: Login - MiDoS Admin - 2019 (midosweb.co.uk) If you need your password resent, or be issued with one, please contact: Dosteam.southwest@nhs.net

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.