Alcohol dependence — assessment and safe management

PLAB 2 & PRES 3 · psychiatry · hard · 8 minutes

Candidate brief

You are a doctor in a GP practice. Mr Michael O’Brien, 46, has attended because his partner is concerned about his alcohol use. A recent AUDIT-C screening score was 11 out of 12. Assess his alcohol use, associated risks and readiness to change, then explain an appropriate management plan. No physical examination is required, but verbalise any assessments or investigations you would perform.

What examiners look for

Alcohol dependence is more than drinking above a weekly guideline. Look for craving, impaired control, tolerance, withdrawal, morning drinking and continued use despite harm. AUDIT-C is a screening test. Suspected dependence requires fuller assessment, including withdrawal severity, previous seizures or delirium tremens, mental and physical health, safeguarding and social support. Never advise a physically dependent patient to stop alcohol abruptly without assessing withdrawal risk. Severe withdrawal can cause seizures, hallucinations and delirium tremens. A previous withdrawal seizure makes this patient unsuitable for a simple brief intervention or unsupported home detoxification. Arrange urgent assessment for medically assisted withdrawal using the appropriate local pathway. Detoxification is only the first stage. Long-term treatment may include psychological support, relapse-prevention work, peer or family support and appropriate anti-craving medication. Assess nutrition and thiamine deficiency. Confusion, ataxia or eye signs may indicate Wernicke’s encephalopathy and require urgent treatment. Use non-judgemental, motivational communication. Agree practical next steps even when the patient is not yet ready to commit to abstinence.

Guideline references

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