Alcohol problems

DGRefHelp - NHS Dumfries & Galloway
NHS Dumfries and Galloway
  • Alcohol misuse is a major health issue in Scotland, with high rates of hospital admissions and mortality.
  • Alcohol withdrawal syndrome (AWS) occurs after abrupt cessation or reduction in heavy, prolonged drinking.
  • Symptoms usually begin within 6–8 hours, peak at 10–30 hours, and last 3–7 days.
  • Features include tremor, sweating, insomnia, agitation, nausea, and autonomic disturbance.
  • Severe cases may develop seizures or delirium tremens (DTs), which can be fatal if untreated.
  • Wernicke’s encephalopathy is a medical emergency: confusion, ataxia, and eye signs may be present, but many cases do not show the full triad. If suspected please refer to the emergency department as IV thiamine may be required

Assessment

History & screening

  • Ask about alcohol intake (units per day, units per week, pattern of drinking and how long for).
  • FAST screening tool (validated by NICE) is recommended: see below

Blood tests

FBC, U&E, LFTs including GGT and AST

FAST tool

Question Responses (score)
1) How often do you have six or more units on one occasion?
  • Never (0)
  • Less than monthly (1)
  • Monthly (2)
  • Weekly (3)
  • Daily or almost daily (4)
2) How often during the last year have you been unable to remember what happened the night before because you had been drinking?
  • Never (0)
  • Less than monthly (1)
  • Monthly (2)
  • Weekly (3)
  • Daily or almost daily (4)
3) How often during the last year have you failed to do what was normally expected of you because of drinking?
  • Never (0)
  • Less than monthly (1)
  • Monthly (2)
  • Weekly (3)
  • Daily or almost daily (4)
4) Has a relative, friend, doctor or other health worker been concerned about your drinking or suggested you cut down?
  • No (0)
  • Yes, but not in the last year (2)
  • Yes, in the last year (4)

FAST — Score Interpretation and Suggested Action

Total FAST score Interpretation Suggested action
0–2 Low risk No further action required
3–8 Hazardous drinking Advise on low-risk drinking; offer information/leaflet
9–16 Probable dependence Consider referral to SDAS/third sector and offer support options

 

Primary care management

  • Prescribe Thiamine 50mg TDS until the patient has been abstinent for 6 months and have resumed a balanced diet
  • Advise reduce alcohol slowly but not to stop (explain risks of sudden cessation)
  • Do not prescribe benzodiazepines in primary care due to risk of drinking on top. If a detox is required, refer to SDAS.
  • Signpost to local support i.e. With You / ADS if a detox is not required.  
  • Fast score: 3-8. Nalmefene is a licensed treatment option which can be considered by GPs to support reduction of hazardous drinking.

Patient self referral:

With You (3rd sector support)

  • Dumfries: 79 Buccleuch Street, DG1 2AB — Tel: 01387 263208
  • Stranraer: 32 Charlotte Street, DG9 7EF — Tel: 01776 705907

ADS (Alcohol and Drugs Support)

  • Dumfries: 79 Buccleuch Street, DG1 2AB — Tel: 01387 259999
  • Castle Douglas: 225 King Street, DG7 1DT — Tel: 01556 503550
  • Stranraer: 32 Charlotte Street, DG9 7EF — Tel: 01776 702626

Specialist Drug and Alcohol Service (SDAS)

  • Dumfries: Lochfield Road Primary Care Centre, 12-28 Lochfield Road, DG2 9BH - Tel 01387 244555
  • Stranraer: Innistaigh, Dalrymple Street, DG9 7DQ - Tel: 01387244555

AA (Alcoholics Anonymous)

  • Freephone: 0800 9177 650

Young people (<18 years)

  • ISSU18 (via CAMHS) Tel: 01387 244662 Email: dumf-uhb.CAMHS-mail@nhs.scot

Who to refer

Emergency admission if:

  • Seizures, uncontrollable vomiting, hallucinations, acute confusion, severe tremor, autonomic disturbance, reduced consciousness.
  • Suspected Wernicke’s encephalopathy.  

Specialist Drug & Alcohol Service (SDAS):

  • Patients with probable dependence (FAST ≥9).
  • Patients needing specialist input or already on opiate substitute therapy.
  • Pregnancy with alcohol dependence (urgent).
  • Any patients being referred should have U&E, LFTs including AST and GGT, FAST score and ECG if over 45 within a month of referral date.

Other services:

  • Alcohol-related liver disease → gastro/hepatology.
  • Mental health complications or suicidality → Community Mental Health Team.
  • With You -
    • FAST score 3+ where abstinence is not wanted
    • Patients with dependence to any substance which isn't opiates or alcohol
  • ADS - 1:1 counselling

Family and friend support:

Editorial Information

Last reviewed: 20/08/2025

Next review date: 20/08/2027

Author(s): Sam Nairn.

Version: 1.0