Red flag symptoms: Alcoholism

  • Evidence of current intoxication
  • Tremor
  • Malnutrition
  • Memory loss
  • Stigmata of liver disease
  • Depressed mood
  • Irritability
  • Capillarisation of facial skin and conjunctivae

Click here to browse our resource of Red Flag alert symptoms

An NHS report has revealed that the number of prescription items dispensed in primary care to treat alcohol dependency has increased by 20 per cent in the past four years.

A large number of alcoholics go unrecognised in primary care because they are able to conceal the symptoms and, initially, they can physically cope with increasing amounts of alcohol.

Hazardous or at-risk drinking is defined by the SIGN guidelines as regularly consuming more than five units per day for men and more then three units per day for women.

For a man regularly consuming more than five units per day, his risk of liver disease, hypertension and some cancers is doubled.

Harmful drinking is when the pattern of alcohol consumption causes damage to physical or mental health.

Alcohol abuse is likely to present with social and psychiatric decline. A patient may be depressed, anxious or irritable. It is important to remember psychiatric and social issues may also be a cause of alcohol abuse. There may even be evidence of current intoxication. Neurological symptoms include memory loss, tremor and neuropathy.

Physical symptoms may include signs of malnutrition, evidence of liver damage, bruises or other signs of frequent falls, cardiac arrhythmias, or excessive capillarisation of facial skin and conjunctivae.

Most patients can undergo detoxification safely and effectively in the community. There is evidence that patients actually prefer this and it is certainly cost-effective compared with in-patient detoxification.

If it is necessary to refer a patient, consider who best to refer them to, for example, to a psychiatrist or a lay service such as Alcoholics Anonymous.

Alcoholism can lead to a variety of serious consequences, including pancreatitis, gastritis and cirrhosis.

It is important to treat the problem as early as possible. GPs can offer the initial discussion and support, and advise on ways to reduce drinking. Counselling can also be offered in primary care and referral to secondary care or a lay service if needed. It is also important to consider the patient's family.

Differential diagnoses

  • Problem drinking
  • Depression
  • Anxiety
  • Drug abuse


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