NICE Guidelines state that staff working in services provided and funded by the NHS who care for people who potentially misuse alcohol should be competent to identify harmful drinking and alcohol dependence (13). They suggest that this should be done using a formal assessment tool such as AUDIT (Alcohol use disorders identification test).
AUDIT enquires about alcohol intake, potential dependence, and alcohol related harm (14). Questions are multiple choice, and this could be completed quickly in the ED, indicating whether the patient may have an alcohol use disorder and may benefit from referral to appropriate services.
For patients with an alcohol use disorder, a thorough risk assessment should be completed including risks of acute intoxication, acute withdrawal, or suicide. Patients in withdrawal with, or at high risk of, complications such as delirium tremens or seizures should be offered admission to hospital for medically assisted alcohol withdrawal (20). Severe alcohol withdrawal has a significant mortality rate if unmanaged.
RCEM recommends documentation of a CIWA score for homeless patients presenting to ED as a result of alcohol. The CIWA-Ar (Clinical Institute Withdrawal Alcohol, revised) scale is a validated 10 item assessment tool used to measure the severity of alcohol withdrawal and monitor patients through treatment (20). It assesses the following domains to generate a final score: nausea and vomiting; tactile disturbance; tremor; auditory disturbance; paroxysmal sweats; visual disturbance; anxiety; headache or fullness in head; agitation; and clouding of sensorium.