Alcohol use disorder — KFP-style written assessment

KFP 1 (10 marks)

A 45-year-old man presents for a routine health check. AUDIT-C score is 7 (positive). Full AUDIT-10 score is 18 (hazardous drinking). He drinks approximately 30 standard drinks per week. He is motivated to reduce but has never tried pharmacotherapy. ^[3]

1. What brief intervention should you deliver? Describe the FRAMES structure. (4)
2. What pharmacotherapy would you offer and what is the evidence? (4) ^[3]
3. What monitoring applies during pharmacotherapy? (2) ^[3]

Model answers

1. Brief intervention using the FRAMES structure: Feedback (his AUDIT score indicates hazardous drinking), Responsibility (the choice to change is his), Advice (clear recommendation to reduce), Menu (of options — reduce, stop, pharmacotherapy, counselling), Empathy (expressed throughout), Self-efficacy (build his confidence). Takes 5-10 minutes.
2. Offer naltrexone 50 mg daily. The JAMA meta-analysis of 118 trials and 20,976 participants found naltrexone 50 mg reduced return to heavy drinking with NNT 11 versus placebo. Acamprosate 666 mg TDS is an alternative (NNT 11 for preventing return to any drinking). ^[3]
3. Monitor LFTs before and during naltrexone (hepatotoxicity risk). Review at 2 weeks for side effects (nausea), then monthly. Assess adherence and drinking at each visit. Naltrexone is contraindicated with opioids — confirm he is not taking any. ^[3]