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Patients with undetected drinking problems commonly present in primary care or hospital settings because of the physical or psychiatric complications of alcohol. Patients with, for example, depressive illness or peptic ulcer will not improve if treatment is directed to these diagnoses without attention to the underlying alcohol misuse. Ways of improving recognition include the following:

• Taking a drinking history as a routine part of medical or nursing assessment.

• Screening questionnaires such as CAGE:

Have you ever felt you ought to Cut down on your drinking? Have people Annoyed you by criticizing your drinking? Have you ever felt Guilty about your drinking?

Have you ever had a drink first thing in the morning (an 'Eye-opener') to steady your nerves or get rid of a hangover?

Two or more positive replies indicate a possible drinking problem, but must be followed up by direct enquiry. Brief counselling by trained nurses is effective in persuading general medical patients identified in this way to reduce their drinking.

• Laboratory tests: a raised blood level of liver enzymes, the most sensitive being gamma glutamyltranspeptidase (gamma GT) (over 40 iu/litre), and/or macro-cytosis (mean corpuscular volume (MCV) over 96 fl) are suggestive of high alcohol intake. However, both tests may also give abnormal results in other illnesses unrelated to alcohol, so they are not in themselves diagnostic.

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