Clinical presentations where the role of alcohol should be considered

Hazardous drinking and alcohol dependence present in many ways. The following presentations should alert clinicians to the possibility that alcohol may be involved:

Social

• marital disharmony and domestic violence
• neglect of children
• criminal behaviour such as driving offences, breach of the peace, shoplifting
• misuse of the emergency telephone services
• unsafe sex
• financial problems

Occupational

• repeated absenteeism, especially around weekends
• impaired work performance and accidents
• poor employment record

Psychiatric

• amnesia, memory disorders and dementia
• anxiety and panic disorders
• depressive illness
• morbid
• alcoholic hallucinosis
• treatment resistance in other psychiatric illnesses and as a factor in relapse
• repeated self harming

Physical

• multiple acute presentations to A&E with trauma and head injury
• dyspepsia, gastritis, haematemesis
• diarrhoea and malabsorption
• acute and chronic pancreatitis
• liver abnormalities from deranged liver function tests, through hepatitis, to fatty liver and cirrhosis
• cardiac arrhythmias
• hypertension and stroke
• cardiomyopathy
• peripheral neuropathy, cerebellar ataxia
• impotence and problems with libido
• withdrawal seizures and fits starting in middle age
• falls and collapses in the elderly
• blood dyscrasias such as low platelet count and white cell count (neutrophils)
• acne rosacea, discoid eczema, psoriasis, multiple bruising
• cancers of mouth, pharynx, larynx, oesophagus, breast and colon
• acute and chronic myopathies
• unexplained infertility
• gout

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Last modified 16/09/11
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