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Alcohol And heAlth ON THE LOOKOUT IDENTIFYING POTENTIAL PROBLEMS In this section we look at when substance misuse staff should recommend that clients see a GP to discuss their symptoms, as well as when wider health professionals should think about referring patients to specialist alcohol services SYMPTOMS OF ALCOHOL-RELATED CONDITIONS HYPERTENSION AND CORONARY HEART DISEASE ALCOHOLIC LIVER DISEASE Hypertension (high blood pressure) itself rarely causes any noticeable symptoms. However, it is a risk factor for a range of other conditions, including coronary heart disease (CHD), the main symptom of which is angina, or chest pain. This can range from mild discomfort to a painful feeling of extreme tightness, while other symptoms of CHD include breathlessness and heart palpitations. If a client reports – or you notice – symptoms of any of these conditions, you should urge them to visit a GP immediately Alcohol-related liver disease often will not show any symptoms – even with cirrhosis – until the very late stages when the liver has already undergone severe damage. At this point the symptoms can include a yellowing of the skin and eyes (jaundice), weight loss, nausea, loss of appetite, feeling tired and weak, bruising easily, itchy skin, swollen ankles, blood in stools or vomiting blood. Healthy Liver Stages of liver damage Fatty Liver Cirrhosis Liver Fibrosis CHRONIC PANCREATITIS The most common symptom is recurrent stomach pain or burning sensation. In later stages, the pain may become constant, and people may also experience nausea, loss of appetite, weight loss and jaundice. Damage to the pancreas can also lead to diabetes, symptoms of which include excessive thirst, tiredness and urinating more frequently. 4 | DDN | Wider Health Series FOR WIDER HEALTH PROFESSIONALS WHEN TO REFER PEOPLE TO SPECIALIST ALCOHOL TREATMENT The World Health Organization has produced an alcohol use disorders identification test (AUDIT) for use by health professionals to assess a client’s risk level for alcohol harm. This has been adopted by Public Health England for use in the UK The AUDIT – which is available to download along with guidance notes – consists of ten questions with a scoring system of zero to four points for each. It recommends that those scoring between eight and 19 be given brief advice to encourage lower consumption, while professionals should consider referring anyone scoring 20 or above to specialist harm assessment. There is also a shorter version called AUDIT-C, available for use in primary care, emergency departments and other settings. Many guidance documents stress the importance of promoting self- belief and the idea that change is possible as a way of motivating people to access help. The Alcohol Concern Blue Light Project Manual contains a specific section on how to build motivation and develop self- belief, as well as a quick guide to identifying possible symptoms of more serious conditions. Many dependent and higher-risk drinkers will also experience mental health problems, and both NICE and Public Health England have produced useful guides to dual diagnosis care frameworks. www.drinkanddrugsnews.com