YCN Head & Neck NSSG Alcohol Assessment and Detoxification Management Guidelines

Size: px
Start display at page:

Download "YCN Head & Neck NSSG Alcohol Assessment and Detoxification Management Guidelines"

Transcription

1 YCN Head & Neck NSSG Alcohol Assessment and Detoxification Management Guidelines *** VALID ON DATE OF PRINTING ONLY - all guidelines available at *** page 1 of 18

2 i Document Control Title Author(s) Owner Alcohol Assessment and Detoxification Management Guidelines Rosie Ratcliffe & Caroline Salt YCN Head & Neck NSSG Version Control Version/ Draft Date Revision summary Initial draft version Minor update Final agreed first version Final agreed second version Contributors to current version Contributor Author/Editor Section/Contribution YCN Head & Neck NSSG Rosie Ratcliffe & Caroline Salt Karen Williams, Advanced Clinical Nurse Specialist - Substance Misuse Liaison Service, York Hospital YCN Head & Neck NSSG YCN Head & Neck NSSG YCN Head & Neck NSSG General General General *** VALID ON DATE OF PRINTING ONLY - all guidelines available at *** page 2 of 18

3 ii Information Reader Box Title Author(s) Alcohol Assessment and Detoxification Management Guidelines YCN Head & Neck NSSG Publication date 7 th February 2012 Review date 7 th February 2015 Proposed Target Audience for Consultation / Final Statement Proposed Circulation List for Final Statement Contact details All consultations and notification of updated guidelines from the YCN Head and Neck group will be consulted to: YCN Head and Neck group All YCN Head and Neck Group guidelines will be made available electronically at No hard copies will be circulated by the Group. Yorkshire Cancer Network 21 Wetherby Road Harrogate HG2 7RY *** VALID ON DATE OF PRINTING ONLY - all guidelines available at *** page 3 of 18

4 iii Table of Contents I DOCUMENT CONTROL... 2 II INFORMATION READER BOX... 3 III TABLE OF CONTENTS INTRODUCTION KEY AIMS AND OBJECTIVES ASSESSMENT OF ALCOHOL USE ASSESSMENT ALCOHOL UNIT CONVERSION CHART AUDIT-C Scoring: REMAINING AUDIT QUESTIONS CLINICAL MANAGEMENT FOLLOWING ASSESSMENT NEGATIVE SCREENING (AUDIT-C SCORE < 5) POSITIVE SCREENING (AUDIT-C SCORE > 5) Clinical management for patients drinking at increasing and high risk levels or who are potentially dependent includes Brief interventions and advice Clinical markers ALCOHOL WITHDRAWAL ASSESSMENT AND CLINICAL MANAGEMENT THE CLINICAL INSTITUTE WITHDRAWAL ASSESSMENT ALCOHOL REVISED (CIWA-AR) DETOXIFICATION PRESCRIPTION REGIMES EXCEPTIONAL CASES WERNICKES ENCEPHALOPATHY PROPHYLAXIS TREATMENT KEY RECOMMENDATIONS REFERENCES APPENDIX IMPLEMENTED PATHWAYS FOR ALCOHOL ASSESSMENT AND DETOXIFICATION WISMS pathway York pathway *** VALID ON DATE OF PRINTING ONLY - all guidelines available at *** page 4 of 18

5 1 Introduction High levels of alcohol consumption is a significant problem among patients with head and neck cancer (NICE, 2004). Evidence suggests that as well as being a contributing factor in the development of head and head and neck squamous cell carcinomas, chronic consumption has a significant effect on post-operative morbidity and mortality among surgical patients (Lansford et al., 2008). Management of alcohol withdrawal in this patient group can be a time consuming process, associated with prolonged in-patient stays, intensive care requirements and the potential risk of serious adverse events (Lansford et al., 2008). Consequently, risk stratification through prompt assessment and appropriate clinical management is key to delivering safe and effective care. 1.1 Key aims and objectives Effectively assess and identify head and neck cancer patients at increasing and higher risk of alcohol withdrawal Effectively assess and identify head and neck cancer patients who are drinking high levels of alcohol which could potentially be harmful to their well being Implement a validated and evidence based assessment tool for use in head and neck cancer care Promote best practice across the Yorkshire Cancer Network in the delivery of safe and effective clinical management of patients at risk of alcohol withdrawal page 5 of 18

6 2 Assessment of Alcohol Use 2.1 Assessment Assessment Intervention Rationale Assessment of alcohol consumption and the implications for the patient s safety when admitted to hospital or when treatment commences Ask all patients about alcohol consumption, using a validated screening tool to identify patients at risk e.g. The AUDIT tool. Provide information to patients about the health risks associated with excessive drinking Identify patients who may be at risk of alcohol withdrawal on admission to hospital, or whose treatment may be affected by their use of alcohol Identify those patients that need referral to Alcohol Misuse / Addiction Services page 6 of 18

7 2.2 Alcohol Unit Conversion Chart This tool has been adapted from the NHS website and can be used by healthcare professionals to identify the amount of alcohol units consumed by individuals. Each of these drinks is one unit of alcohol. Half pint of regular beer, lager or cider 1 very small glass of wine 1 single measure of spirits 1 small glass of sherry 1 single measure of aperitifs...and each of these is more than one unit A pint of regular beer, lager or cider A pint of strong / premium beer, lager or cider Alcopop or a 275ml bottle of regular lager 440ml can of regular lager or cider 440ml can of super strength lager 250ml glass of wine (12%) Bottle of wine (12%) The NHS recommends that the maximum weekly alcohol consumption is 21 units for males and 14 units for females. page 7 of 18

8 2.3 Audit-C This is a validated alcohol screening tool used to identify increasing and higher risk drinkers. It is recommended that the AUDIT-C or full AUDIT tool should be used as part of the pretreatment holistic assessment to prevent complications post treatment. Questions How often do you have a drink containing alcohol? How many units of alcohol do you drink on a typical day when you are drinking? Scoring system Never Monthly or less 2-4 times per month 2-3 times per week 4+ times per week Your score How often have you had 6 or more units if female, or 8 or more if male, on a single occasion in the last year? Never Less than monthly Monthly Weekly Daily or almost daily Scoring: A total of 5+ indicates increasing or higher risk drinking. An overall total score of 5 or above is AUDIT-C positive. 2.4 Remaining AUDIT questions Questions How often during the last year have you found that you were not able to stop drinking once you had started? How often during the last year have you failed to do what was normally expected from you because of your drinking? How often during the last year have you needed an alcoholic drink in the morning to get yourself going after a heavy drinking session? How often during the last year have you had a feeling of guilt or remorse after drinking? Scoring system Never Never Never Never Less than monthly Less than monthly Less than monthly Less than monthly Monthly Monthly Monthly Monthly Weekly Weekly Weekly Weekly Daily or almost daily Daily or almost daily Daily or almost daily Daily or almost daily Your score page 8 of 18

9 How often during the last year have you been unable to remember what happened the night before because you had been drinking? Have you or somebody else been injured as a result of your drinking? Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested that you cut down? Never No No Less than monthly Monthly Weekly Yes, but not in the last year Yes, but not in the last year Daily or almost daily Yes, during the last year Yes, during the last year Scoring: 0 7 Lower risk, 8 15 Increasing risk, Higher risk, 20+ Possible dependence The health care professional carrying out the assessment will complete either the AUDIT-C or the full AUDIT and refer to the appropriate service according to local alcohol assessment and detoxification pathways, where implemented (See appendix 1 for implemented local pathways). page 9 of 18

10 3 Clinical Management Following Assessment 3.1 Negative Screening (AUDIT-C score < 5) Patients who score less than 5 on the AUDIT-C tool are deemed AUDIT-C negative. This patient group require no further clinical intervention. Reinforcement of safe drinking should be delivered throughout the patient pathway. If alcohol misuse is suspected, despite negative screening, it is still important to observe for relevant clinical signs and treat as necessary. It may be useful to ask relatives and friends for information, with consent. If in doubt, seek advice from medical staff or local misuse/addiction service or refer to section Positive Screening (AUDIT-C score > 5) Patients who score more than 5 on the AUDIT-C tool are deemed AUDIT-C positive. This includes patients drinking at increasing and high risk levels and also those potentially alcohol dependent. Patients who are drinking more than 6 units (women) or 8 units (men) daily or almost daily with an AUDIT-C score of 5 or above should be treated as potentially dependent. According to local alcohol and detoxification pathways, referral to specialist services may be made at this point Clinical management for patients drinking at increasing and high risk levels or who are potentially dependent includes Brief interventions and advice For patients identified as potentially dependent on alcohol, reducing and/or stopping drinking prior to surgery is preferable. Some patients may feel confident to reduce / stop drinking without specialist support. These patients should be given information about alcohol including health risks, how to cope with symptoms of withdrawal and local service details. Clinical markers Biochemistry markers may be elevated in patients drinking excessively, these include GGT, LFT s and MCV. It is recommended that an alcohol blood set be requested for suspected increasing or higher risk patients. Following these interventions, if high risk of alcohol withdrawal is suspected, advice from specialist services and/or medically assisted alcohol detoxification may be recommended. In these cases, clinical management should be in accordance to local trust policy. Further guidance is available from NICE, (NICE, 2010). page 10 of 18

11 4 Alcohol withdrawal assessment and clinical management 4.1 The Clinical Institute Withdrawal Assessment Alcohol Revised (CIWA-AR) The CIWA-AR scale is a validated assessment tool that can be used to quantify the severity of alcohol withdrawal syndrome, and to monitor and medicate patients through withdrawal (NICE, 2010). Insert patient details/id label here: Date Assess and rate each of following: Time NAUSEA /VOMITING (0-7) (0) No nausea and no vomiting, (1) Mild nausea, no vomiting, (3) Intermittent nausea, dry heaves, (7) Constant nausea, frequent dry heaves and vomiting, TREMOR (0-7) (0)No tremor, (1) Not visible but can be felt at fingertip, (4) Moderate with arms not extended, (7) Severe even with arms not extended PAROXYSMAL SWEATS (0-7) (0)No sweat visible, (1) Barely perceptible sweating, palms moist, (4) Beads of sweat obvious on forehead, (7) Drenching sweats ANXIETY (0-7) (0)No anxiety, (1) Mildly anxious, (4)Moderately anxious or guarded so anxiety is inferred, (7) Equivalent to acute panic states as in severe delirium/acute schizophrenic reactions AGGITATION (0-7) (0)Normal activity, (1) Somewhat more than normal activity, (4) Moderately fidgety and restless, (7) Paces back and forth or constantly thrashes about TACTILE DISTURBANCES (0-7) (0)None, (1) Very mild itching, pins and needles or numbness, (4)Moderately severe hallucinations, (7) Continuous hallucinations AUDITORY HALLUCINATIONS (0-7) (0)Not present, (1)Very mild harshness or ability to frighten, (4) Moderately severe hallucinations, (7) Continuous hallucinations VISUAL HALLUCINATIONS (0-7) (0)Not present, (1) Very mild sensitivity, (4) Moderately severe hallucinations, (7) Continuous hallucinations HEADACHE, FULLNESS IN HEAD (0-7) (0)Not present, (1) Very mild, (4) Moderately severe, (7) Extremely severe ORIENTATION/CLOUDING SENSORIUM (0-4) (0)Orientated and can do serial additions, (1) Cannot do serial additions or uncertain about date, (2) Disorientated for date by no more than 2 calendar days, (3) Disorientated by more than 2 calendar days, ***VALID (4) Disorientated ON DATE for OF place PRINTING and/or ONLY person - all guidelines available at *** page 11 of 18

12 TOTAL SCORE Record action taken (i.e. amount chlordiazepoxide given/when next score due) It can be used in the acute setting when withdrawal is suspected or elective admission is indicated for detoxification prior to treatment for a head and neck cancer. 4.2 Detoxification prescription regimes Fixed dose or symptom triggered dosing regimes may be used, this is dependent on local policy and should be in accordance with NICE guidelines, (NICE, 2010). 4.3 Exceptional cases Where safe medically assisted alcohol withdrawal detoxification is indicated but cannot be carried out prior to surgical treatment, prophylactic post-surgical detoxification is suggested (Kuo et al., 2007, Neyman et al., 2005 and Weinfield et al., 2000). page 12 of 18

13 5 Wernickes Encephalopathy Wernickes encephalopathy is a serious neurological disorder caused by a thiamine deficiency due to reduced dietary intake and alcohol-induced impaired absorption. Clinical abnormalities may develop acutely or evolve over several days. These can be:- triad of confusion, cerebellar ataxia, ocular signs (ocular abnormalities include nystagmus, oculomotor palsies especially of sixth cranial nerve, ophthalmoplegia). A confusional state accompanied by apathy, drowsiness, disorientation and amnesia may also lead to stupor or coma (NICE, 2010). 5.1 Prophylaxis Head and neck cancer patients may be more susceptible to developing Wernickes Encephalopathy, due to the potential high risk factors often associated with this patient group, such as:- alcohol-related liver disease medically assisted withdrawal from alcohol (planned / unplanned) acute alcohol withdrawal malnourishment or risk of malnourishment due to weight loss in past year reduced BMI loss of appetite nausea and vomiting a general impression of malnourishment, hospitalised for acute illness hospitalised for co-morbidity or another alcohol issue. (NICE, 2010) For high risk patients, the prophylactic use of Thiamine is recommended (NICE, 2010). For dosing please refer to local trust policy. 5.2 Treatment Wernickes Encephalopathy is a medical emergency. If untreated, it may lead to death or Korsakoffs syndrome (permanent anterograde amnesia, usually irreversible). This requires urgent medical treatment. Please refer to local trust policy. page 13 of 18

14 6 Key recommendations Local policies should be updated in accordance with the Alcohol-use disorders guidelines (NICE, 2010). Develop links with local community addiction teams in order to promote safe and effective management of this patient group. Implement care pathways between primary and secondary care, enabling safe delivery of services. Health care professionals who care for people in acute alcohol withdrawal should be skilled in the assessment and monitoring of withdrawal symptoms and signs (NICE, 2010). page 14 of 18

15 7 References Kuo, Y., Jeng, S., Lin, K., Hou, S., Su, C., Chien, C., Hsueh, K and Huang, E. (2007). Microsurgical Tissue Transfers for Head and Neck Reconstruction in Patients with Alcohol Induced Mental Disorder. Annals of Surgical Oncology. 15 (1) pp Lansford, C.D., Guerriero, C.H., Kocan, M.J., Turley, R., Groves, M.W., Bahl, V., Abrahamse, P., Bradford, C.R., Chepeha, D.B., Moyer, J., Prince, M.E., Wolf, G.T., Aebersold, M.L. & Tekons, T.N. (2008). Improved Outcomes in Patients with Head and Neck Cancer using a Standardised Care Protocol for Post-operative Alcohol Withdrawal. Archives of Otolaryngology Head and Neck Surgery 134 (8) pp National Institute for Clinical Excellence. NICE. (2010). Alcohol-use disorders: Diagnosis and clinical management of alcohol-related physical complications. DOH, London. National Institute for Clinical Excellence. NICE. (2004) Improving Outcomes Guidance in Head and Neck Cancer. The Manual. DOH, London Neyman, K.M., Gourin, C.G. and Terris, D.J. (2005). Alcohol Withdrawal Prophylaxis in Patients undergoing Surgical Treatment of Head and Neck Squamous Cell Carcinoma. The Laryngoscope. 115 pp Sullivan, J.T., Sykora, K., Schneiderman, J., Naranjo, C.A and Sellers E.M. (1989). Assessment of Alcohol Withdrawal: the revised clinical withdrawal assessment for alcohol scale (CIWA-AR). British Journal of Addiction. 84 (11) pp [Accessed online] Weinfield, A.B., Davison, S.P., Mason, A.C., Manders, E.K. and Russavage, J.M. (2000). Management of Alcohol Withdrawal in Microvascular Head and Neck Reconstruction.The Journal of Reconstructive Microsurgery. 16 (3) pp page 15 of 18

16 8 Appendix 8.1 Implemented pathways for Alcohol Assessment and Detoxification WISMS pathway page 16 of 18

17 page 17 of 18

18 8.1.2 York pathway page 18 of 18

Assessment and management of alcohol dependence and withdrawal in the acute hospital

Assessment and management of alcohol dependence and withdrawal in the acute hospital Assessment and management of alcohol dependence and withdrawal in the acute hospital Concise guidance to good practice series June 01 CONCISE GUIDANCE Clinical Medicine 01, Vol 1, No : 71 Assessment Main

More information

Glasgow Assessment and Management of Alcohol

Glasgow Assessment and Management of Alcohol Glasgow Assessment and Management of Alcohol If you would like further information or advice on the alcohol screening and withdrawal management guideline(gmaws) please contact your local acute addiction

More information

Alcohol Liaison Service. Alcohol Withdrawal. Information

Alcohol Liaison Service. Alcohol Withdrawal. Information Alcohol Liaison Service Alcohol Withdrawal Information Alcohol withdrawal If you are dependent on alcohol and suddenly stop drinking, there are a series of symptoms that you may experience. These include:

More information

ALCOHOL DETOXIFICATION (IN-PATIENTS) PRESCRIBING GUIDELINE

ALCOHOL DETOXIFICATION (IN-PATIENTS) PRESCRIBING GUIDELINE ALCOHOL DETOXIFICATION (IN-PATIENTS) PRESCRIBING GUIDELINE Authors Sponsor Responsible committee Ratified by Consultant Psychiatrist; Pharmacist Team Manager Medical Director Medicines Management Group

More information

Version 2 This guideline describes how to manage patients who are showing signs and symptoms of alcohol withdrawal and Wernicke s Encephalopathy.

Version 2 This guideline describes how to manage patients who are showing signs and symptoms of alcohol withdrawal and Wernicke s Encephalopathy. Title of Guideline (must include the word Guideline (not protocol, policy, procedure etc) Contact Name and Job Title (author) Directorate & Speciality A Guideline for the Management of Acute Alcohol Withdrawal

More information

GUIDELINES FOR COMMUNITY ALCOHOL DETOXIFICATION IN SHARED CARE

GUIDELINES FOR COMMUNITY ALCOHOL DETOXIFICATION IN SHARED CARE GUIDELINES FOR COMMUNITY ALCOHOL DETOXIFICATION IN SHARED CARE Dr Millicent Chikoore MBBS MRCPsych Dr O Lagundoye MBBS MRCPsych Community based alcohol detoxification is a safe and effective option for

More information

Supported Alcohol Withdrawal Treatment Information

Supported Alcohol Withdrawal Treatment Information Supported Alcohol Withdrawal Treatment Information Alcohol Liaison Service What is Alcohol Withdrawal Syndrome? If you are dependent on alcohol and suddenly stop drinking or you are admitted to hospital

More information

Alcohol Identification and Brief Advice

Alcohol Identification and Brief Advice Alcohol Identification and Brief Advice Alcohol Identification and Brief Advice (IBA) is an evidence based brief intervention directed at people drinking at increasing and higher risk levels who are not

More information

Alcohol Withdrawal. Mild Withdrawal Moderate Withdrawal Severe Withdrawal. Mild anxiety Malaise Marked anxiety

Alcohol Withdrawal. Mild Withdrawal Moderate Withdrawal Severe Withdrawal. Mild anxiety Malaise Marked anxiety Alcohol Withdrawal Recognition and Assessment Alcohol withdrawal may be a presenting feature or occur as an unexplained development in a patient who has been admitted for other reasons and deprived of

More information

THE BASICS. Community Based Medically Assisted Alcohol Withdrawal. World Health Organisation 2011. The Issues 5/18/2011. RCGP Conference May 2011

THE BASICS. Community Based Medically Assisted Alcohol Withdrawal. World Health Organisation 2011. The Issues 5/18/2011. RCGP Conference May 2011 RCGP Conference May 2011 Community Based Medically Assisted Alcohol Withdrawal THE BASICS An option for consideration World Health Organisation 2011 Alcohol is the world s third largest risk factor for

More information

Chapter 7. Screening and Assessment

Chapter 7. Screening and Assessment Chapter 7 Screening and Assessment Screening And Assessment Starting the dialogue and begin relationship Each are sizing each other up Information gathering Listening to their story Asking the questions

More information

Guidance for the Detoxification of Alcohol Dependent Patients in Community or Outpatient Settings

Guidance for the Detoxification of Alcohol Dependent Patients in Community or Outpatient Settings Title: Identifier: Replaces: Guidance for the Detoxification of Alcohol Dependent Patients in Community or Outpatient Settings NHSG/Guid/Detox_ADP/MGPG663 N/A - New document Across NHS Boards Organisation

More information

Alcohol Withdrawal in the AMU. Dr Ewan Forrest Glasgow Royal Infirmary

Alcohol Withdrawal in the AMU. Dr Ewan Forrest Glasgow Royal Infirmary Alcohol Withdrawal in the AMU Dr Ewan Forrest Glasgow Royal Infirmary The Society for Acute Medicine, 7 th International Conference, 3-4 October 2013 AWS: The Scale of the Problem Hospital Admissions (England):

More information

REFERENCE. Admit to: Program/Service: Diagnosis: Droplet/ Contact Airborne/ Contact

REFERENCE. Admit to: Program/Service: Diagnosis: Droplet/ Contact Airborne/ Contact Weight (kg) REFER TO THE ALLERGY SCREEN IN MEDITECH FOR ALLERGY INFORMATION To complete the order form, fill in the required blanks and/or check the appropriate boxes. To delete orders, draw one line through

More information

Does This Hospital Serve Cocktails? Alcohol Withdrawal: A Nursing Perspective. Written and presented by: Susan Laffan, RN, CCHP-RN, CCHP-A

Does This Hospital Serve Cocktails? Alcohol Withdrawal: A Nursing Perspective. Written and presented by: Susan Laffan, RN, CCHP-RN, CCHP-A Does This Hospital Serve Cocktails? Alcohol Withdrawal: A Nursing Perspective Written and presented by: Susan Laffan, RN, CCHP-RN, CCHP-A Disclaimer: This speaker has no financial disclaimers to report.

More information

Phenobarbital in Severe Alcohol Withdrawal Syndrome. Jordan Rowe Pharm.D. Candidate UAMS College of Pharmacy

Phenobarbital in Severe Alcohol Withdrawal Syndrome. Jordan Rowe Pharm.D. Candidate UAMS College of Pharmacy Phenobarbital in Severe Alcohol Withdrawal Syndrome Jordan Rowe Pharm.D. Candidate UAMS College of Pharmacy Disclosure: No relevant financial relationship exists. Objectives 1. Describe the pathophysiology

More information

Alcoholism and Problem Drinking

Alcoholism and Problem Drinking Page 1 of 5 Alcoholism and Problem Drinking Alcoholism is a word which many people use to mean 'alcohol dependence' (alcohol addiction). Some people are 'problem drinkers' without being dependent on alcohol.

More information

Alcohol Dependence Inpatient management of Alcohol Withdrawal

Alcohol Dependence Inpatient management of Alcohol Withdrawal NHS Fife Community Health Partnerships Addiction Services Alcohol Dependence Inpatient management of Alcohol Withdrawal Intranet Procedure No A9 Author Dr. A. Baldacchino Copy No Lead Clinician Implementation

More information

A Guide to Alcoholism and Problem Drinking

A Guide to Alcoholism and Problem Drinking A Guide to Alcoholism and Problem Drinking Alcoholism is a word which many people use to mean alcohol dependence (alcohol addiction). Some people are problem drinkers without being dependent on alcohol.

More information

Alcoholism and Problem Drinking

Alcoholism and Problem Drinking Page 1 of 5 Alcoholism and Problem Drinking Alcoholism is a word which many people use to mean alcohol dependence (alcohol addiction). Some people are problem drinkers without being dependent on alcohol.

More information

MANAGEMENT OF ALCOHOL PROBLEMS ON PSYCHIATRIC WARDS

MANAGEMENT OF ALCOHOL PROBLEMS ON PSYCHIATRIC WARDS MANAGEMENT OF ALCOHOL PROBLEMS ON PSYCHIATRIC WARDS This guideline is primarily intended to assist in the medical management of alcohol dependent patients admitted to psychiatric inpatient units. For a

More information

Live Person Simulation Scenario Psychiatric and Mental Health Nursing (Sandra)

Live Person Simulation Scenario Psychiatric and Mental Health Nursing (Sandra) 1 Live Person Simulation Scenario Psychiatric and Mental Health Nursing (Sandra) I. Scenario Title: Assessment Interview & Medication Administration for a Client with Clinical Depression & Alcohol Abuse

More information

SPECIFICATION FOR THE LOCAL COMMISSIONED SERVICE FOR THE MANAGEMENT ALCOHOL MISUSE

SPECIFICATION FOR THE LOCAL COMMISSIONED SERVICE FOR THE MANAGEMENT ALCOHOL MISUSE SPECIFICATION FOR THE LOCAL COMMISSIONED SERVICE FOR THE MANAGEMENT OF ALCOHOL MISUSE Date: March 2015 1 1. Introduction Alcohol misuse is a major public health problem in Camden with high rates of hospital

More information

Managing Patients with Alcohol Withdrawal

Managing Patients with Alcohol Withdrawal Managing Patients with Alcohol Withdrawal Clinical Institute Withdrawal Assessment of Alcohol Scale, revised (CIWA-Ar) Department of Medicine Regulated Health Professionals Developed by: Tammy Datars/Crystal

More information

Alcohol and Dependence

Alcohol and Dependence The facts about... Alcohol and Dependence Five key things you need to know A glass of wine with dinner, a beer after work, a cocktail in the sunshine on holiday. Alcohol makes an appearance in so many

More information

CAGE. AUDIT-C and the Full AUDIT

CAGE. AUDIT-C and the Full AUDIT CAGE In the past have you ever: C tried to Cut down or Change your pattern of drinking or drug use? A been Annoyed or Angry because of others concern about your drinking or drug use? G felt Guilty about

More information

Alcohol. Problems with drinking alcohol

Alcohol. Problems with drinking alcohol Alcohol Alcoholism is a word which many people use to mean alcohol dependence (alcohol addiction). Some people are problem drinkers without being dependent on alcohol. If you are alcohol- dependent then

More information

Alcohol use disorders: sample chlordiazepoxide dosing regimens for use in managing alcohol withdrawal

Alcohol use disorders: sample chlordiazepoxide dosing regimens for use in managing alcohol withdrawal Alcohol use disorders: sample chlordiazepoxide dosing regimens for use in managing alcohol withdrawal February 2010 NICE clinical guidelines 100 and 115 1 These sample chlordiazepoxide dosing regimens

More information

AUDIT. The Alcohol Use Disorders Identification Test: Interview Version

AUDIT. The Alcohol Use Disorders Identification Test: Interview Version AUDIT The Alcohol Use Disorders Identification Test: Interview Version Read questions as written and record answers carefully. Begin the AUDIT by saying Now I am going to ask you some questions about your

More information

Alcohol and Sensible Drinking

Alcohol and Sensible Drinking Page 1 of 5 Alcohol and Sensible Drinking See your doctor or practice nurse if you are drinking above the safe limits and are finding it difficult to cut down. What are the recommended safe limits of alcohol

More information

Outpatient Treatment of Alcohol Withdrawal. Daniel Duhigg, DO, MBA

Outpatient Treatment of Alcohol Withdrawal. Daniel Duhigg, DO, MBA Outpatient Treatment of Alcohol Withdrawal Daniel Duhigg, DO, MBA DSM V criteria for Alcohol Withdrawal A. Cessation or reduction of heavy/prolonged alcohol use B. 2 or more of the following in hours to

More information

Alcohol Identification and Brief Advice (IBA) in Buckinghamshire

Alcohol Identification and Brief Advice (IBA) in Buckinghamshire Alcohol Identification and Brief Advice (IBA) in Buckinghamshire A resource for frontline health and multi-agency professionals to identify and respond to alcohol consumption above recommended levels This

More information

Trust Guideline for the Management of: Acute Alcohol withdrawal (excluding pregnancy)

Trust Guideline for the Management of: Acute Alcohol withdrawal (excluding pregnancy) A clinical guideline recommended for use In: By: For: Key words: Written by: Supported by: Medical and Surgical Wards All Medical Staff Adult Alcohol dependent patients Alcohol, Withdrawal, Detoxification

More information

ARTICLE #1 PLEASE RETURN AT THE END OF THE HOUR

ARTICLE #1 PLEASE RETURN AT THE END OF THE HOUR ARTICLE #1 PLEASE RETURN AT THE END OF THE HOUR Alcoholism By Mayo Clinic staff Original Article: http://www.mayoclinic.com/health/alcoholism/ds00340 Definition Alcoholism is a chronic and often progressive

More information

2.6.4 Medication for withdrawal syndrome

2.6.4 Medication for withdrawal syndrome .6.3 Self-medication Self-medication presents a risk during alcohol withdrawal, particularly when there is minimal supervision (low level and medium level 1 settings). Inform patients of the risk of selfmedication

More information

Adjunctive psychosocial intervention. Conditions requiring dose reduction. Immediate, peak plasma concentration is reached within 1 hour.

Adjunctive psychosocial intervention. Conditions requiring dose reduction. Immediate, peak plasma concentration is reached within 1 hour. Shared Care Guideline for Prescription and monitoring of Naltrexone Hydrochloride in alcohol dependence Author(s)/Originator(s): (please state author name and department) Dr Daly - Consultant Psychiatrist,

More information

Alcohol-use disorders: alcohol dependence. Costing report. Implementing NICE guidance

Alcohol-use disorders: alcohol dependence. Costing report. Implementing NICE guidance Alcohol-use disorders: alcohol dependence Costing report Implementing NICE guidance February 2011 (February 2011) 1 of 37 NICE clinical guideline 115 This costing report accompanies the clinical guideline:

More information

Prescribing for substance misuse: alcohol detoxification

Prescribing for substance misuse: alcohol detoxification Prescribing for substance misuse: alcohol detoxification POMH-UK Quality Improvement Programme. Topic 14a: baseline Prepared by the Prescribing Observatory for Mental Health-UK for Kent and Medway NHS

More information

Symptom-Triggered Alcohol Detoxification: A Guideline for use in the Clinical Decisions Unit of the Emergency Department.

Symptom-Triggered Alcohol Detoxification: A Guideline for use in the Clinical Decisions Unit of the Emergency Department. Symptom-Triggered Alcohol Detoxification: A Guideline for use in the Clinical Decisions Unit of the Emergency Department. Dr Eugene Cassidy, Liaison Psychiatry; Dr Io har O Sulliva, E erge cy Department,

More information

Development and Implementation of an Evidence-Based Alcohol Withdrawal Order Set. Kathleen Lenaghan MSN, RN-BC

Development and Implementation of an Evidence-Based Alcohol Withdrawal Order Set. Kathleen Lenaghan MSN, RN-BC Development and Implementation of an Evidence-Based Alcohol Withdrawal Order Set Kathleen Lenaghan MSN, RN-BC 1 2 Genesis Medical Center Davenport, Iowa Objectives Identify the process of developing and

More information

Review Group: Mental Health Operational Medicines Management Group. Signature Signature Signature. Review Date: December 2014

Review Group: Mental Health Operational Medicines Management Group. Signature Signature Signature. Review Date: December 2014 Mental Health NHS Grampian Mental Health Service Staff Guidance For The Prescribing Of Vitamin Supplementation During In-Patient Admission (Mental Health) For Alcohol Withdrawal Co-ordinators: Consultant

More information

New York State Office of Alcoholism & Substance Abuse Services Addiction Services for Prevention, Treatment, Recovery

New York State Office of Alcoholism & Substance Abuse Services Addiction Services for Prevention, Treatment, Recovery New York State Office of Alcoholism & Substance Abuse Services Addiction Services for Prevention, Treatment, Recovery USING THE 48 HOUR OBSERVATION BED USING THE 48 HOUR OBSERVATION BED Detoxification

More information

Pharmacological Management of Acute Alcohol Withdrawal and Relapse Prevention in alcohol Use disorders in the Community

Pharmacological Management of Acute Alcohol Withdrawal and Relapse Prevention in alcohol Use disorders in the Community Pharmacological Management of Acute Alcohol Withdrawal and Relapse Prevention in alcohol Use disorders in the Community Policy Descriptor This policy sets out the standards and procedures that all staff

More information

Prevention and treatment of alcohol misuse

Prevention and treatment of alcohol misuse Prevention and treatment of alcohol misuse Liz Burns Public Health Development Advisor elizabeth.burns@mhsc.nhs.uk Alison Rodriguez alison.rodriguez@mhsc.nhs.uk Head of Service Community Alcohol Team and

More information

Factsheet. Alcohol-Related Brain Damage (ARBD) What Is It? The different forms of ARBD. What is ARBD?

Factsheet. Alcohol-Related Brain Damage (ARBD) What Is It? The different forms of ARBD. What is ARBD? Factsheet What is ARBD? Alcohol-related brain damage (ARBD), or alcoholrelated brain injury (ARBI), is an umbrella term for the damage that can happen to the brain as a result of long-term heavy drinking.

More information

guideline for identification and treatment of alcohol abuse/dependence in primary care

guideline for identification and treatment of alcohol abuse/dependence in primary care guideline for identification and treatment of alcohol abuse/dependence in primary care This guideline is informational in nature and is not intended to be a substitute for professional clinical judgment.

More information

Alcohol Use Disorders Information for Patients and Carers

Alcohol Use Disorders Information for Patients and Carers Alcohol Liaison Service Alcohol Use Disorders Information for Patients and Carers Information Drinking too much alcohol greatly increases your risk of serious health problems. Many different health problems

More information

Title Alcohol Withdrawal Management Guidelines

Title Alcohol Withdrawal Management Guidelines Document Control Title Alcohol Withdrawal Management Guidelines Author Consultant Physicians, Core Medical Trainee and Glossop Ward Manager Directorate Version Date Issued Status 0.1 Dec Draft Initial

More information

Management of alcohol withdrawal including the Symptom triggered CIWA score

Management of alcohol withdrawal including the Symptom triggered CIWA score Management of alcohol withdrawal including the Symptom triggered CIWA score Classification: Policy Lead Author: Ruth Brown Alcohol specialist Nurse Additional author(s): Hailey Pennington Authors Division:

More information

Quality and Patient Safety Division

Quality and Patient Safety Division Commonwealth of Massachusetts Board of Registration in Medicine Quality and Patient Safety Division Advisory Alcohol Screening and Management Protocols July 2013 Background The Quality and Patient Safety

More information

Management of benzodiazepine misuse

Management of benzodiazepine misuse York Service Management of benzodiazepine misuse Version 2 JT July 2013 page 1 background Note: not all those who use benzodiazepines are dependent, and not all those who are dependent will benefit from

More information

Assessment of depression in adults in primary care

Assessment of depression in adults in primary care Assessment of depression in adults in primary care Adapted from: Identification of Common Mental Disorders and Management of Depression in Primary care. New Zealand Guidelines Group 1 The questions and

More information

Alcohol information. A standard drink contains about 10g of alcohol takes a healthy liver about 1 hour to remove alcohol from the body.

Alcohol information. A standard drink contains about 10g of alcohol takes a healthy liver about 1 hour to remove alcohol from the body. Alcohol information Facts about alcohol use Alcohol (grog) is the most widely used recreational drug in Australia NT drinks 70% more and WA 25% more than the rest of Australia Alcohol related deaths for

More information

Lorraine Wilson, 74 years of age, is admitted. Alcohol Withdrawal. During Hospitalization. Early recognition and consistent intervention are critical.

Lorraine Wilson, 74 years of age, is admitted. Alcohol Withdrawal. During Hospitalization. Early recognition and consistent intervention are critical. 1.9 h o u r s Continuing Education Withdrawal During Hospitalization Early recognition and consistent intervention are critical. Overview: For a chronic drinker, sudden alcohol withdrawal because of an

More information

Alcohol Addiction. Introduction. Overview and Facts. Symptoms

Alcohol Addiction. Introduction. Overview and Facts. Symptoms Alcohol Addiction Alcohol Addiction Introduction Alcohol is a drug. It is classed as a depressant, meaning that it slows down vital functions -resulting in slurred speech, unsteady movement, disturbed

More information

TAMESIDE & GLOSSOP NATIONAL ENHANCED SERVICE FOR ALCOHOL MISUSERS

TAMESIDE & GLOSSOP NATIONAL ENHANCED SERVICE FOR ALCOHOL MISUSERS TAMESIDE & GLOSSOP NATIONAL ENHANCED SERVICE FOR ALCOHOL MISUSERS THE NEW G.P. CONTRACT The new GP contract Provision of specialist services Minor surgery; depression; drug dependency Payments Accreditation

More information

Screening and brief intervention for alcohol use in general practice and the potential role of digital technologies in optimising delivery

Screening and brief intervention for alcohol use in general practice and the potential role of digital technologies in optimising delivery Presentation to Imperial College London Wednesday 10 th December 2014 Screening and brief intervention for alcohol use in general practice and the potential role of digital technologies in optimising delivery

More information

Medicines To Treat Alcohol Use Disorder A Review of the Research for Adults

Medicines To Treat Alcohol Use Disorder A Review of the Research for Adults Medicines To Treat Alcohol Use Disorder A Review of the Research for Adults Is This Information Right for Me? Yes, this information is right for you if: Your doctor* said you have alcohol use disorder

More information

Alcohol related ataxia. Information for patients Neurology

Alcohol related ataxia. Information for patients Neurology Alcohol related ataxia Information for patients Neurology page 2 of 8 What is ataxia? Ataxia means lack of co-ordination, and is the result of damage to a part of the brain called the cerebellum which

More information

Alcohol Withdrawal Syndrome & CIWA Assessment

Alcohol Withdrawal Syndrome & CIWA Assessment Alcohol Withdrawal Syndrome & CIWA Assessment Alcohol Withdrawal Syndrome is a set of symptoms that can occur when an individual reduces or stops alcoholic consumption after long periods of use. Prolonged

More information

ALCOHOL ASSESSMENT AND DETOXIFICATION POLICY FOR INPATIENTS

ALCOHOL ASSESSMENT AND DETOXIFICATION POLICY FOR INPATIENTS ALCOHOL ASSESSMENT AND DETOXIFICATION POLICY FOR INPATIENTS Version: 3 Ratified by: Date ratified: November 2015 Title of originator/author: Title of responsible committee/individual: Senior Managers Operational

More information

`çããçå=jéåí~ä= aáëçêçéêëw=^åñáéíó=~åç= aééêéëëáçå. aêk=`=f=lâçåü~ jéçáå~ä=aáêéåíçê lñäé~ë=kep=cçìåç~íáçå=qêìëí=

`çããçå=jéåí~ä= aáëçêçéêëw=^åñáéíó=~åç= aééêéëëáçå. aêk=`=f=lâçåü~ jéçáå~ä=aáêéåíçê lñäé~ë=kep=cçìåç~íáçå=qêìëí= `çããçå=jéåí~ä= aáëçêçéêëw=^åñáéíó=~åç= aééêéëëáçå aêk=`=f=lâçåü~ jéçáå~ä=aáêéåíçê lñäé~ë=kep=cçìåç~íáçå=qêìëí= Overview: Common Mental What are they? Disorders Why are they important? How do they affect

More information

Alcohol-use disorders overview

Alcohol-use disorders overview Alcohol-use disorders overview A NICE pathway brings together all NICE guidance, quality standards and materials to support implementation on a specific topic area. The pathways are interactive and designed

More information

3 rd most deprived area Registered population 240,000 Young population Growth of 30,000 in next 5 years Highest increase will be in working age 34%

3 rd most deprived area Registered population 240,000 Young population Growth of 30,000 in next 5 years Highest increase will be in working age 34% THCAT 3 rd most deprived area Registered population 240,000 Young population Growth of 30,000 in next 5 years Highest increase will be in working age 34% Bangladeshi (much higher in under 20s) Recent data

More information

Specialized terms used in this workbook and their meanings:

Specialized terms used in this workbook and their meanings: Glossary Specialized terms used in this workbook and their meanings: Absorption: The way alcohol enters the bloodstream. Alcohol is absorbed into the blood through the stomach and small intestine. Addiction:

More information

SCOTTISH PRISON SERVICE DRUG MISUSE AND DEPENDENCE OPERATIONAL GUIDANCE

SCOTTISH PRISON SERVICE DRUG MISUSE AND DEPENDENCE OPERATIONAL GUIDANCE SCOTTISH PRISON SERVICE DRUG MISUSE AND DEPENDENCE OPERATIONAL GUIDANCE 1 P a g e The following Operational Guidance Manual has been prepared with input from both community and prison addictions specialists

More information

Box 1: Screening and brief interventions ASSESS elicit patient s concerns how does alcohol fit in? ELICIT AND RECORD typical day s drinking maximum in a day alcohol related physical, emotional and social

More information

STANDARD OPERATING PROCEDURE. Administration of High Dose Muscular Vitamin Supplements for Undergoing Alcohol

STANDARD OPERATING PROCEDURE. Administration of High Dose Muscular Vitamin Supplements for Undergoing Alcohol STANDARD OPERATING PROCEDURE Administration of High Dose Muscular Vitamin Supplements for Undergoing Alcohol DOCUMENT CONTROL: Version: 2 Ratified by: Clinical Effectiveness Committee Date ratified: 03

More information

Locally Enhanced Service for a practice-based Alcohol Monitoring, Withdrawal and Detoxification Service

Locally Enhanced Service for a practice-based Alcohol Monitoring, Withdrawal and Detoxification Service 08/09 Locally Enhanced Service for a practice-based Alcohol Monitoring, Withdrawal and Detoxification Service Reference: LES24 Contents: 1. Finance Details 2. Service Aims 3. Service Criteria 4. Ongoing

More information

Please make an appointment with the nurse for a new patient medical within one month of joining the practice.

Please make an appointment with the nurse for a new patient medical within one month of joining the practice. New Patients If you are registering with us as a new patient, please be aware we will need to ask you to provide evidence of identification (ID) as part of the registration process. A combination of two

More information

Alcohol Withdrawal. Introduction. Blood Alcohol Concentration. DSM-IV Criteria/Alcohol Abuse. Pharmacologic Effects of Alcohol

Alcohol Withdrawal. Introduction. Blood Alcohol Concentration. DSM-IV Criteria/Alcohol Abuse. Pharmacologic Effects of Alcohol Pharmacologic Effects of Alcohol Alcohol Withdrawal Kristi Theobald, Pharm.D., BCPS Therapeutics III Fall 2003 Inhibits glutamate receptor function (NMDA receptor) Inhibits excitatory neurotransmission

More information

Alcohol use screening tool

Alcohol use screening tool Alcohol use screening tool Supporting Guidance These screening questions should be completed in relation to all young people identified as previously, currently or who are suspected of using alcohol and

More information

Alcohol Units. A brief guide

Alcohol Units. A brief guide Alcohol Units A brief guide 1 2 Alcohol Units A brief guide Units of alcohol explained As typical glass sizes have grown and popular drinks have increased in strength over the years, the old rule of thumb

More information

Alcohol treatment Information for service users Page

Alcohol treatment Information for service users Page South London and Maudsley NHS Foundation Trust Alcohol treatment Information for service users Page This leaflet tells you what you can expect during treatment for problems related to using alcohol. It's

More information

Estover Surgery New Patient Questionnaire

Estover Surgery New Patient Questionnaire Date of Completion: Personal Details Title: Mr Mrs Miss Ms Dr Other (please circle) Name: Date of Birth: Mobile Number: Home Telephone Number: Work Telephone Number: Contact Email Address: Marital Status:

More information

Treatment of Alcoholism

Treatment of Alcoholism Treatment of Alcoholism Why is it important Prevents further to body by getting people off alcohol. Can prevent death. Helps keep health insurance down. Provides assistance so alcoholics don t t have to

More information

ALCOHOLISM, ALCOHOL DEPENDENCE AND THE EFFECTS ON YOUR HEALTH.

ALCOHOLISM, ALCOHOL DEPENDENCE AND THE EFFECTS ON YOUR HEALTH. ALCOHOLISM, ALCOHOL DEPENDENCE AND THE EFFECTS ON YOUR HEALTH. Alcoholism also known as alcohol dependence is a disabling ADDICTIVE DISORDER. It is characterized by compulsive and uncontrolled consumption

More information

1 GUIDE TO ALCOHOLISM

1 GUIDE TO ALCOHOLISM 1 GUIDE TO ALCOHOLISM Understanding Alcoholism While a glass of wine with dinner or a couple of beers while watching the big game may seem like a harmless way to unwind, for 14 million Americans, it is

More information

Acute alcohol withdrawal

Acute alcohol withdrawal A NICE pathway brings together all NICE guidance, quality standards and materials to support implementation on a specific topic area. The pathways are interactive and designed to be used online. This pdf

More information

Facts About Alcohol. Addiction Prevention & Treatment Services

Facts About Alcohol. Addiction Prevention & Treatment Services Facts About Alcohol Addiction Prevention & Treatment Services Table of Contents Facts about alcohol: What is harmful involvement with alcohol?... 2 What is alcohol dependence?... 3 What Is BAC?... 4 What

More information

Alcohol Withdrawal Syndromes

Alcohol Withdrawal Syndromes Alcohol Withdrawal Syndromes Should You Treat This Patient s Alcohol Withdrawal With Benzodiazepines?! Meta-analysis of RCTs of benzodiazepines for the treatment of alcohol withdrawal! 11 RCTs identified,

More information

Alcohol. Alcohol INFORMATION SHEET. Page 1 of 18

Alcohol. Alcohol INFORMATION SHEET. Page 1 of 18 Alcohol INFORMATION SHEET Page 1 of 18 Contents Drinking problem?... 3 Units of alcohol... 3 Units and drinks... 4 Why drink?... 5 Hangovers... 6 Getting help... 7 Am I drinking too much? (AUDIT)... 9

More information

Berkshire West CCGs Alcohol Treatment Pathway for Nalmefene (Selincro) Primary Care Guidance

Berkshire West CCGs Alcohol Treatment Pathway for Nalmefene (Selincro) Primary Care Guidance Berkshire West CCGs Alcohol Treatment Pathway for Nalmefene (Selincro) Primary Care Guidance Nalmefene (trade name Selincro) was given approval by NICE in November 2014 and should be available to use with

More information

SUBSTANCE USE DISORDER SOCIAL DETOXIFICATION SERVICES [ASAM LEVEL III.2-D]

SUBSTANCE USE DISORDER SOCIAL DETOXIFICATION SERVICES [ASAM LEVEL III.2-D] SUBSTANCE USE DISORDER SOCIAL DETOXIFICATION SERVICES [ASAM LEVEL III.2-D] I. Definitions: Detoxification is the process of interrupting the momentum of compulsive drug and/or alcohol use in an individual

More information

Symptom Based Alcohol Withdrawal Treatment

Symptom Based Alcohol Withdrawal Treatment Symptom Based Alcohol Withdrawal Treatment -Small Rural Hospital- Presenter CDR Dwight Humpherys, DO dwight.humpherys@ihs.gov Idaho State University Baccalaureate Nursing Program Lake Erie College of Osteopathic

More information

Alcohol Risk Assessment

Alcohol Risk Assessment Alcohol Risk Assessment NHS Health Check Challenges Don Lavoie Alcohol Programme Manager What I hope to cover Why Alcohol - what is the problem? What can Health Check do about it? How do you do it? What

More information

Alcohol management York Service Alcohol management - medically assisted alcohol withdrawal and supported reduction

Alcohol management York Service Alcohol management - medically assisted alcohol withdrawal and supported reduction Alcohol management York Service Alcohol management - medically assisted alcohol withdrawal and supported reduction Version 4 JT January 2014 page 1 Alcohol Management York Service assessment of alcohol

More information

Alcohol Awareness Month October 2013. Chad Asplund, MD, FACSM Medical Director, Student Health Georgia Regents University

Alcohol Awareness Month October 2013. Chad Asplund, MD, FACSM Medical Director, Student Health Georgia Regents University Alcohol Awareness Month October 2013 Chad Asplund, MD, FACSM Medical Director, Student Health Georgia Regents University Alcohol Statistics According to the Office of Juvenile Justice and Delinquency

More information

Luton Alcohol Strategy 2012-2015

Luton Alcohol Strategy 2012-2015 Luton Drug & Alcohol Partnership Luton Alcohol Strategy 2012-2015 The Luton alcohol strategy for 2012 2015 reflects the increasing emphasis on working in partnership to reduce alcohol related harm to young

More information

ALCOHOL ASSESSMENT AND DETOXIFICATION POLICY FOR INPATIENTS

ALCOHOL ASSESSMENT AND DETOXIFICATION POLICY FOR INPATIENTS ALCOHOL ASSESSMENT AND DETOXIFICATION POLICY FOR INPATIENTS Version: 2 Ratified by: Date ratified: April 2015 Title of originator/author: Title of responsible committee/individual: Date issued: April 2015

More information

Alcohol, drugs and older people

Alcohol, drugs and older people Alcohol, drugs and older people This leaflet is for older people (defined as those aged 55 or over) who are worried about their use of alcohol, illegal drugs and/or prescribed/over-the-counter medications.

More information

Alcohol misuse: support and advice from the pharmacy team. A CPPE distance learning programme

Alcohol misuse: support and advice from the pharmacy team. A CPPE distance learning programme Alcohol misuse: support and advice from the pharmacy team A CPPE distance learning programme December 2015 Contents About CPPE distance learning programmes About this learning programme Introduction to

More information

Comprehensive Behavioral Care, Inc. Level of Care Guidelines Substance Abuse Adult

Comprehensive Behavioral Care, Inc. Level of Care Guidelines Substance Abuse Adult Comprehensive ehavioral Care, Inc. delivery system that does not include sufficient alternatives to a particular LOC and a particular patient. Therefore, CompCare considers at least the following factors

More information

Alcohol withdrawal A challenge in caring for patients after heart surgery

Alcohol withdrawal A challenge in caring for patients after heart surgery Abteilung Praxisentwicklung Pflege Alcohol withdrawal A challenge in caring for patients after heart surgery Wolfgang Hasemann, RN, PhD Deborah Leuenberger, MScN.cand. June 2015 Content Alcohol consumption

More information

ALCOHOL & YOU GET THE FACTS YOU NEED TO MAKE INFORMED DECISIONS ABOUT ALCOHOL

ALCOHOL & YOU GET THE FACTS YOU NEED TO MAKE INFORMED DECISIONS ABOUT ALCOHOL ALCOHOL & YOU GET THE FACTS YOU NEED TO MAKE INFORMED DECISIONS ABOUT ALCOHOL 2 Alcohol & You drinkaware.ie 3 ABOUT DRINKAWARE HOW MUCH AM I DRINKING? Drinkaware is an independent not-for-profit organisation,

More information

Alcohol: The good, the bad and

Alcohol: The good, the bad and Alcohol: The good, the bad and the Clare Wilhelm, Ph.D. Portland VA Medical Center Oregon Health & Science University Supported by VA Career Development Grant (BX001294) Overview Alcohol statistics the

More information

NHS FORTH VALLEY. Alcohol Dependence: Community Management of Alcohol Withdrawal

NHS FORTH VALLEY. Alcohol Dependence: Community Management of Alcohol Withdrawal NHS FORTH VALLEY Alcohol Dependence: Community Management of Alcohol Withdrawal Approved 14 / 11 / 2012 Version 2 Date of First Issue April 2008 Review Date 28 / 11 / 2014 Date of Issue 28 / 11 / 2012

More information

Title: How to manage risky drinkers in Primary Health Care. Authors: Acknowledgements:

Title: How to manage risky drinkers in Primary Health Care. Authors: Acknowledgements: Title: How to manage risky drinkers in Primary Health Care Authors: Acknowledgements: This guide has been writen in accordance with the criteria of the PHEPA Training Programme on identification and brief

More information

GP-led services for alcohol misuse: the Fresh Start Clinic

GP-led services for alcohol misuse: the Fresh Start Clinic London Journal of Primary Care 2011;4:11 15 # 2011 Royal College of General Practitioners GP Commissioning GP-led services for alcohol misuse: the Fresh Start Clinic Johannes Coetzee GP Principle, Bridge

More information