Assessment and Management of Alcohol Problems in the ED


1 Ask the question

ED staff should routinely enquire and record alcohol intake during the medical and nursing assessments.

2 Assess further

ED staff should decide whether the patient has hazardous drinking, alcohol abuse or alcohol dependency. Look for co-morbid problems: alcohol is a risk factor for a variety of medical problems as well as depression and self-harm.

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3 Give feedback and information about treatment services to hazardous drinkers/alcohol abuse

Hazardous drinkers or those with alcohol abuse but not alcohol dependency should be given feedback about alcohol-related harm and offered their preferred follow-up agency from the menu of options on the alcohol  service patient information leaflet (available in the ED interview room and on the ED Intranet). If there are additional mental health concerns, refer to Psychiatry at CUH.

4 Detoxify and prevent complications of withdrawal in alcohol dependent patients

Alcohol dependent patients should have a full physical assessment, including assessment of severity of alcohol withdrawal, orientation, seizure risk. Detoxification should involve the use of reducing doses of benzodiazepines (to ease withdrawal and to prevent seizures and delirium) and adjunctive parenteral vitamins (to prevent Wernicke-Korsakoff Syndrome).

5 Decide who to admit and where

Some patients may require medical admission (i.e. those with co-morbid medical illness, delirium tremens,, malnutrition, seizure history, absence of social supports). Others may require psychiatric admission (i.e. those with where there is a comorbid acute mental disorder with associated acute risks). Most will be suitable for symptom-triggered detoxification in CDU (see CDU symptom-triggered detox guideline) or discharge home.

6 Give information / refer to aftercare / alcohol treatment services

In addition to detoxification and feedback about alcohol-related harm, all alcohol dependent patients should be offered their preferred follow-up agency from the menu of options on the alcohol service patient information leaflet (available in the ED/CDU and on the ED Intranet). If there are additional mental health concerns, refer to Psychiatry at CUH.

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7 Referral to CUH Social Work


Patient Information Alcohol Misuse

Contacts Numbers

Residential alcohol treatment centres

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Alcohol treatment service


Content by Martin Denny RMN BA CNM2, Dr Íomhar O' Sullivan 02/09/04. Reviewed by M Denny 30/10/2005, ÍOS 21/03/2007, 21/03/2008. Last review Dr ÍOS 7/07/16.