Talking About Social Habits: Alcohol Consumption
Social habits are a part of life. They are what people do every day that is NOT related to a work profession.
Social habits are activities that people are involved in, either alone or with other people.
When examining a patient, the social habits that you should focus on deal with alcohol, tobacco and recreational drug use.
Why focus on alcohol?
Along with tobacco, alcohol is one of the most socially accepted products that people can drink in many cultures today.
Having said that, alcohol is not permissible in Islam and several other faiths. It is important to note that within a multicultural, multiethnic society, alcohol in some form will be present.
Alcohol consumption can contribute to and lead to many medical conditions. Alcohol consumption can impair judgement and result in tragedy.
In order to help your patient, you should ask questions about alcohol consumption.
How to ask
It is important to phrase your questions carefully.
Before asking, you should always mention that confidentiality is important.
Your answers are confidential. They can help me find out what is wrong with you so I can give you better treatment.
Then, you can start telling your patient that you need to ask about alcohol use.
First off, I’d like to ask you about alcohol use.
Do you use tobacco products?
If yes >How much do you drink in a week?
If no > Thank you.
Have you used tobacco products in the past?
If yes > For how long did you use them?
This information can help with diagnosing substance abuse problems.
When to ask
You can ask the alcohol related questions towards the end of your interview with the patient.
However, if there are conditions that you think might be related to the patient’s health from the beginning, then you can ask them when you think is best.
Grouping social habit questions together is a good idea because then you can remember to ask them easily, all at one time.
Alcohol Guidelines
The Center for Disease Control (CDC) in the United States and the National Health Service (NHS) in the United Kingdom all have guidelines about accepted alcohol content.
According to the CDC:
Women 1 alcoholic drink or less per day
Men 2 alcoholic drinks or less per day
According to the NHS:
Women and men should have no more than 14 alcoholic drinks (units) per week.
The guidelines are pretty similar: no more than 2 alcoholic drinks per day.
Each organization has more information about the details. Please check the links above.
Substance Abuse
One of the biggest problems with alcohol is that it is addicting.
This can lead to substance abuse that can last for years, and lead to health problems.
Liver disease
Heart disease
Stomach illnesses
Cancers
Accidents – drinking and driving
CAGE Questions
In the United States, the term CAGE Question is sometimes used.
CAGE questions are used as a screening tool, not a diagnosis tool, for alcoholism.
Yes answers to these questions can lead you – the doctor – to asking more questions and/or providing counseling.
Have you felt the need to CUT down on your drinking?
Have other people ANNOYED you by criticizing your drinking?
Have you ever felt GUILTY about drinking?
Have you ever felt the need for a drink first thing in the morning (EYE-opener)?
For more information on CAGE questions, please look here.
Counseling on Alcohol
If you determine that your patient has some issues with alcohol abuse, then it is important to offer some help.
I understand that you like alcohol. However, as you have some serious medical issues going on, it is important to start thinking about cutting down on it.
The above sentence is an example for you; you can change things around to suit the situation.
If you would like some help, we have a good program in this clinic/hospital that can help you.
If a patient really wants to continue to drink alcohol, then you can simply advise the patient that it will continue to either (A) cause or make the health problem to worsen or (B) cause future health problems.
Cautions
As mentioned above, alcohol may be prohibited in some countries and areas. Asking these questions may offend a patient or a patient’s family, so it is important to ask the help of other doctors and hospital staff about proper protocols.
There may be times that you forget to ask about social history. It is understandable.
For certain population groups, it might be better to ask them so you can help them in the future. Think of it as a preventative step.
University age students, pregnant women, people in jail for any offense are cited as key groups that should be screened for alcohol consumption.
Unfortunately, people sometimes lie to doctors. It is important to offer an environment that is judgement-free and safe for your patient to communicate with you.
Establishing a good rapport at the start of your examination, providing empathy and confidentiality statements, and offering help are good ways to make your chances of an honest answer become stronger.
Final Thoughts
Asking alcohol-related questions can be tricky. In some countries and/or cultures, it is simply not done.
However, when working in the United States, Canada, the United Kingdom, Australia or New Zealand, you will most likely be advised to ask substance abuse questions.
Having a better idea of how to do it – with some helpful language – can make the task easier for you to handle.
