Alcohol use Assessment Questionnaire

Questions Your Doctor May Ask - and Why!

During a consultation, your doctor will use various techniques to assess the symptom: Alcohol use. These will include a physical examination and possibly diagnostic tests. (Note: A physical exam is always done, diagnostic tests may or may not be performed depending on the suspected condition) Your doctor will ask several questions when assessing your condition. It is important to openly share any pertinent information to help your doctor make an accurate diagnosis.

It is also very important to bring an up-to-date list of all of your all medical conditions, medications including dosages, and names of numbers of any specialist you see.

Create your printable checklist by answering questions that your doctor may ask below:

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Alcohol history
Why: document age started drinking, type of alcohol preferred, daily alcohol consumption, days per week alcohol is consumed.
If answer yes to two of the following 4 questions, suggestive of a problem drinker
- 1. Have you ever felt you should cut down on your drinking?
- 2. Have people annoyed you by criticising your drinking?
- 3. Have you ever felt bad or guilty about your drinking?
- 4. Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?
- Effect of alcohol abuse on relationships, occupation and finances?
- Is there a history of absenteeism?
- Is there a family history of alcohol problems?
- Is there a family history of depression or anxiety?
- Do you use alcohol? If so how much and what type?
  Why: This is a solid starting point for you health professional to begin from in assessing your alcohol use. How much alcohol you use assists in assessing whether you abuse alcohol or have (or are at risk of) alcohol dependence. The type of alcohol can be important as different common alcoholic drinks have different concentrations of alcohol, plus some types of alcohol have been shown in moderation to have health benefits. It is vitally important that you are honest when answering these questions.
- Do you take any medications, and if so what are they?
  Why: Some medications have the ability to increase or decrease the effects of alcohol.
- Have you ever had any liver disease such as hepatitis or cirrhosis?
  Why: Liver disease can impair your body's ability to appropriately metabolize and handle alcohol as well as the potentially toxic substance which is digested to form.
1. Symptoms of withdrawal if alcohol dependent
  Why: e.g. tremor, hallucinations, delirium tremens.
2. Tiredness
  Why: due to effect of alcohol itself, insomnia associated with alcohol or due to anemia.
3. Heartburn or indigestion
4. Abdominal pain
  Why: suggesting possible pancreatitis, alcoholic hepatitis, gastritis, reflux oesophagitis, peptic ulcers.
5. Diarrhea
  Why: due to alcohol, fatty stools from alcoholic pancreatitis.
6. Symptoms of heart disease as a complication of alcohol
  Why: e.g. arrhythmias, congestive cardiac failure.
7. "Blackouts"
8. Memory problems
  Why: suggestive of possible alcoholic dementia or pellagra.
9. Impotence
10. Leg numbness- suggesting peripheral neuropathy
11. Testicular atrophy in men
12. Amenorrhea, infertility, spontaneous abortion in women
13. Depressive symptoms
14. Insomnia

Conditions listing medical symptoms: Alcohol use:

The following list of conditions have 'Alcohol use' or similar listed as a symptom in our database. This computer-generated list may be inaccurate or incomplete. Always seek prompt professional medical advice about the cause of any symptom.

Select from the following alphabetical view of conditions which include a symptom of Alcohol use or choose View All.

View All A C D F H L M N O P

Conditions listing medical complications: Alcohol use:

The following list of medical conditions have 'Alcohol use' or similar listed as a medical complication in our database.

» Next page: Types of Alcohol use

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