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NHG-Standaard Problematisch alcoholgebruik (derde herziening)

L. Boomsma, I.M. Drost, I.M. Larsen, J.J.H.M. Luijkx, G.J. Meerkerk, N. Valken, M.M. Verduijn, J. Burgers, G. van der Weele, M. Sijbom

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Boomsma LJ, Drost IM, Larsen IM, Luijkx JJHM, Meerkerk GJ, Valken N, Verduijn M, Burgers JS, Van der Weele GM, Sijbom M. Dutch College of General Practitioners’ guideline Problem drinking (third revision). Huisarts Wet 2014;57(12):638-46.
The Dutch College of General Practitioners’ guideline “Problem drinking” provides recommendations for general practitioners about how to recognize and manage problem drinking, including withdrawal symptoms and acute alcohol intoxication. Problem drinking is defined as a drinking pattern that leads to physical symptoms and/or mental health or social problems and hinders the adequate management of existing problems. The amount of alcohol consumed is not the main criterion. Alcohol use disorder is diagnosed when problem drinking meets the DSM-5 criteria for this disorder. Acute alcohol withdrawal syndrome can occur when an individual acutely stops or significantly reduces his/her alcohol consumption after prolonged use. Symptoms range from insomnia and irritability to tachycardia, fever, anxiety, and seizures. The guideline distinguishes between problem drinking in adolescents and adults because of several typical differences: adolescents usually have a shorter history of drinking, and more often have a pattern of binge drinking and several specific factors that influence the continued use of alcohol (such as peer pressure). The guideline also pays specific attention to acute alcohol intoxication, because of the increased incidence of this problem in the Netherlands.
The GP should ask patients about their alcohol use whenever there are problems for which there is no direct explanation, because problem drinking often presents with indirect signs. If problem drinking is suspected, the GP should enquire about the frequency of drinking, the amount of alcohol consumed, and explore the role of alcohol in the patient’s life using the principles of motivational interviewing. The guideline provides a number of questions that can be used for this purpose. The GP should check whether the patient fulfils the DSM-5 criteria for alcohol use disorder. In cases of acute alcohol intoxication, physical examination and further investigations should focus on complications, such as diminished consciousness, shock, respiratory depression, hypothermia, and hypoglycaemia.
Treatment consists of education, coaching, and psychosocial support, to diminish problem drinking and its consequences, and thiamine supplementation. In the case of moderate-to-severe withdrawal symptoms, lorazepam or chlordiazepoxide is indicated to prevent seizures. Acute alcohol intoxication without complications should be managed with close observation and appropriate after care.
Referral to a centre for alcohol addiction is indicated if the patient requires more support than the GP can provide; for example, for patients with severe drinking problems, severe psychiatric problems, self-neglect, or an increased risk of Wernicke encephalopathy. Admission to an addiction treatment centre is indicated in the case of severe withdrawal symptoms that are not sufficiently suppressed by medication or if these symptoms occur or can be expected in patients with a poor physical condition. When complications of acute alcohol intoxication occur, immediate referral to a hospital is indicated.

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