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