Taking an alcohol history
Assessing alcohol intake involves asking a patient how many standard drinks they consume on a daily or weekly basis. But many alcohol products do not fit the "standard drink" model. Practitioners often don’t realise that when the patient says they have three glasses of wine over the weekend, they are actually talking about an oversized goblet of fortified wine with 18% alcohol.
These tips might help you to get the real alcohol story from your patient:
Ask about the type of alcohol product, its alcohol content, and the size of glass used
If the patient consumes large bottles (for example 1 litre of Scotch), ask how many days a bottle lasts, and whether they’re shared with others
Ask "what’s the most you have had to drink on any one day in the past month?" Patients tend not to count heavy drinking episodes in their estimate of average weekly consumption, even if these episodes occur frequently
The patient may give vague responses or you may suspect they’re minimising their consumption.
Ask about alcohol consumed in the past week or the past day
Present the patient with a wide range of consumption choice. "Would you say you drink more like one or two beers per night, or eight or ten beers per night?" This lets the patient know you won’t be shocked by heavy consumption
Provide a social or medical excuse for drinking: "Do you ever have a drink to help you sleep at night? Many people have a glass or two to help them sleep" or "Do you ever have a glass of wine with dinner? People often find this helps them digest their meal."
Taking an accurate alcohol history means finding out exactly what is meant when patients say, "I’m just a social drinker."