Andy is 36, is usually fit and well and you rarely see him. But he’s come in because he’s struggling to sleep and is asking if he can have a few sleeping
tablets ‘just to re-set things’. He says he gets to sleep fine, but wakes often and does not feel like he has much restful sleep and feels groggy in
the morning. His mood seems low and he says he’s had some arguments with his wife over Christmas. It quickly becomes clear that his alcohol intake
is likely to be the major problem. He had always drunk quite heavily at the weekend, getting through at least 2 bottles of wine, but his weekly drinking
has steadily increased to the point where he rarely has a night without alcohol and often drinks 2-3 glasses of wine or beer per night. He has now
got into a vicious cycle of having an increasingly large night-cap as well to try to help him sleep. It’s always difficult to estimate home measures,
but he is drinking 40+ units/week. He has no symptoms that suggest dependence.
Another option would be to bring him back for a session of brief structured advice, as recommended by NICE. It is recommended this should take 5-15 minutes and should be based on the FRAMES model:
Give feedback on the risks and negative consequences of alcohol use. Seek the client's reaction and listen.
Emphasize that the individual is responsible for making his/her own decision about his/her alcohol use.
Give straightforward advice on modifying alcohol use.
Give menus of options to choose from, fostering the client’s involvement in decision-making.
Be empathic, respectful, and non-judgmental.
Express optimism that the individual can modify his or her alcohol use if they choose.
I hope those few pointers will give you some tools for tackling excess alcohol consumption, and if you want further training, options for e-learning courses on alcohol identification and brief advice (IBA) can be found here: https://www.alcohollearningcentre.org.uk/eLearning/IBA/alcohol-iba-in-primary-care-e-learning-course/