Signs of Alcoholism

The following questions and flags are taken from the American Society of Addiction Medicine (https://www.asam.org):
1. Have you ever tried to cut down on your drinking?
2. Have you ever felt annoyed when someone talked to you about your drinking?
3. Have you ever felt bad or guilty about your drinking?
4. Have you ever had a drink in the morning to settle yourself down?
5. Has alcohol or drugs ever caused you family problems?
6. Has a physician ever told you to cut down on or quit use of alcohol?
7. When drinking/using drugs, have you ever had a memory loss (blackout)?
If patients answer yes to any one of these questions that’s a red flag for alcoholism. If they answer yes to two questions, that’s probable alcoholism. Make sure you don’t just ask the patient. Ask family members, friends and anyone else who can give you collateral information.

History/Behavioral Observation Red Flags for Adult Alcohol Abuse

1. Tremor/perspiring/tachycardia.
2. Evidence of current intoxication.
3. Prescription drug seeking behavior.
4. Frequent falls; unexplained bruises.
5. Diabetes, elevated BP, ulcers non-responsive to treatment.
6. Frequent hospitalizations.
7. Gunshot/knife wound.
8. Suicide talk/attempt; depression.
9. Pregnancy (screen all).

Laboratory Red Flags for Adult Alcohol/Drug Abuse

1. MCV-over 95
2. MCH-High
3. GGT-High
4. SGOT-High
5. Bilirubin-High
6. Triglycerides-High
7. Anemia
8. Positive UA for alcohol

History/Behavioral Observation Red Flags for Adolescent Alcohol Abuse

1. Physical injuries; MVA, gunshot/knife wound, unexplained or repeated injuries.
   1. Evidence of current use, e.g. dilated/pinpoint pupils, tremors, perspiring,

   tachycardia, slurred/rapid speech.

   1. Persistent cough (cigarette smoking is a risk factor).
   2. Engages in risky behavior, e.g. unprotected sex.
   3. Marked fall in academic/extracurricular performance.
   4. Suicide talk/attempt; depression.
   5. Sexually transmitted diseases.
   6. Staphylococcus infection on face, arms, legs.
   7. Unexplained weight loss.
   8. Pregnancy (screen all).

   Laboratory Red Flags for Adolescent Alcohol/Drug Abuse

   1. Positive UA for alcohol/illicit drugs
   2. Hepatitis A-B-C
   3. GGT-High
   4. SGOT-High
   5. Bilirubin-High

   INTERVIEW questions for suspected alcoholism among adolscents
   Questions to ask the Adolescent Patient

   1. When did you first use alcohol on your own, away from family/caregivers?
   2. How often to you use alcohol? Last use?
   3. How often have you been drunk or high?
   4. Has your alcohol use caused you problems with: your friendships, family, school, community? Have your grades slipped?
   5. Have you had problems with the law?
   6. Have you ever tried to quit/cut down? What happened?
   7. Are you concerned about your alcohol use?

   Questions to ask the Parent/Caregiver

   1. Do you know/suspect your child is using alcohol/other drugs?
   2. Has your child’s behavior changed significantly in the past six months?

   (e.g., sneaky, secretive, isolated, assaultive, aggressive, hostile)

   1. Has school, community or legal system talked to you about your child?
   2. Has there been a marked fall in academic/extracurricular performance?
   3. Do you believe an alcohol/other drug assessment might be helpful? End table 1.5

   What to Do If There are One or More Red Flags
   Once you have one or more red flags, you have several important actions to take.

   1. Advise the patient of the risk.
   2. Advise abstinence or moderation. Men should be advised to drink no more than three drinks at a time and no more than three nights a week. Women should be advised to drink no more than two drinks at a time and no more than three nights per week. More drinking than this will result in progression of the disease. This is a harm reduction approach where you teach a patient how to drink responsibly. This would not be appropriate for someone who has a serious drinking problem. People who are chemically dependent cannot cut down on their use because they are chemically dependent.
   3. Advise against any illegal drug use.   
   4. Schedule a follow-up visit to monitor progress.
      

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