ALCOHOL AND DRUG DEPENDENCY AND ABUSE442 Psychiatric Emergencies
4 Sometimes, alcohol-dependent patients themselves request help or may be
brought in by concerned others to stop drinking.MANAGEMENT1 Refer the patient immediately to the psychiatric team if there is suicidal
ideation or overt depression.
2 Otherwise, refer the patient to the appropriate hospital or community clinic
for outpatient assessment, or
(i) Refer to the social work department or a special alcohol health
worker for a brief intervention programme, including advice and
management on alcohol-related harm to health.
3 Meanwhile, give the patient the telephone number of local support organiza-
tions to contact, such as Alcoholics Anonymous and Al-Anon. These provide
help and advice to both the problem drinker and their family and friends.
4 Always write to or fax the general practitioner (GP) to enlist their help and
support.Opiate and intravenous drug addiction
MANAGEMENT
1 Admit opiate and intravenous drug-use patients under the medical team, if
they present with any of the following addiction-associated emergency
medical complications, apart from simple acute intoxication (usually
managed in the emergency department alone):
(i) Cellulitis or abscess.
(ii) Pulmonary or cerebral infection.
(iii) Septicaemia.
(iv) Bacterial endocarditis.
(v) Hepatitis B, C or D, and, increasingly, human immunodeficiency
virus (HIV) infection.
2 Otherwise, if a regular opiate user requires admission to the emergency
department observation ward, perhaps following an orthopaedic or minor
operative procedure:Table 16.1 CAGE screening questionnaire for alcohol abuseC Have you ever felt you should Cut down on your drinking?
A Have people Annoyed you by criticizing your drinking?
G Have you ever felt bad or Guilty about your drinking?
E Have you ever had a drink as an Eye-opener first thing in the morning
to steady your nerves or help get rid of a hangover?“Yes” to two or more indicates probable chronic alcohol abuse or dependence.