Taking a Drinking History

(It is useful to ask the person to fill in this form. You may need to assist them.)

Over the next ______weeks, please write down how much you have to drink each day. Fill out the sheet each night before going to bed.

Look at column number one.

  1. Write down what day it is today.
  2. How many drinks have you had all day today? Record number of standard drinks for each type of drink. If you did not have any beer today, put a dash in that square. If you drank beer write down the number of standard drinks you had.
  3. Use the guide below to calculate how many standard drinks are in each type of beverage

STANDARD DRINKS

A standard drink contains 10 grams of alcohol. Beer, wine and spirits vary in the amount of alcohol they contain.

Sparkling wine
(100ml) / Wine
(100ml) / Light beer
(425ml) / Regular beer
(285ml) / Fortified wine
(60ml) / Spirits
(30ml)

(Standard drinks courtesy of the Drug & Alcohol Services Council, SA, 2003.)

Beverage / Day of the week
___day / ___day / ___day / ___day / ___day / ___day / ___day
Beer
Table Wine
Spirits
Fortified Wine
Other

Adapted from: Dawe, S., Loxton, N. J., Hides, L., Kavanagh, D. J. & Mattick, R. P. 2002, Review of diagnostic screening instruments for alcohol and other drug use and other psychiatric disorders, Monograph series no. 48, 2nd edn, Commonwealth Department of Health and Ageing.

Source: deCrespigny, et al. 2003. Alcohol, Tobacco and Other Drugs Guidelines for Nurses and Midwives: Clinical Guidelines, Flinders University and Drug and Alcohol Services Council, Adelaide. p. 181

ATOD Assessment Form—Alcohol History

The alcohol assessment process should be incorporated into a standard assessment form.

The suggestions that follow assume the usual assessment including general observations, medical, social and mental health history, contact with other services or agencies including alcohol and other drug services.

Recent drinking (last three months, in particular last two weeks)

Alcohol type / How much (gms per day) / How often / How long/ Age commenced / With whom (friends, partner) / Length of last period of abstinence and date

▪Other relevant information (include person’s concerns, pros and cons of use, purpose of use and need it fulfils, wanting to reduce or stop).

Last use: / Date:
Time:
Amount:
Changes in drinking pattern over last two to three weeks:
Blood alcohol level this admission:
Imminent withdrawal (history of seizures, severe withdrawal or Wernicke’s withdrawal symptoms):

Note: Place on Alcohol Withdrawal Scale (AWS) if:

▪Male consuming eight standard drinks (80gms) or more on a regular basis

▪Female consuming six standard drinks (60gms) or more on a regular basis

▪Previous alcohol withdrawal

If score reaches 8 on Alcohol Withdrawal Score contact ATOD team.

Adapted from: deCrespigny, et al. 2003. Alcohol, Tobacco and Other Drugs Guidelines for Nurses and Midwives: Clinical Guidelines, Flinders University and Drug and Alcohol Services Council, Adelaide. p. 182

ATOD Assessment Form—Drug History

(prescribed, illicit, over the counter and tobacco)

Recent drug use (last three months, in particular last two weeks)

Drug used / Days used last month / Average amount per day $ / Route (IV orally) / Date and time last used / Age began regular use/ injecting / Length of person’s abstinence and date

▪Other relevant information (include pros and cons of use, purpose of use and need it fulfils, concerns want to reduce or cease use).

Changes in drug use pattern over last two to three weeks:

Risk factors (e.g. imminent withdrawal, blood-borne viruses, needle or equipment sharing, unsafe sex):

Note: Place on appropriate Drug Withdrawal Assessment Scale if there is suspicion of emergence of drug withdrawal or if there is a past history of withdrawal symptoms and recent use has not decreased.

Adapted from: deCrespigny, et al. 2003. Alcohol, Tobacco and Other Drugs Guidelines for Nurses and Midwives: Clinical Guidelines, Flinders University and Drug and Alcohol Services Council, Adelaide. p. 183

Resource Kit for GP Trainers on Illicit Drug Issues

Part B2 Clinical Process: Assessment