IntroductionNHS England funding of Alcohol Care Teams (ACT) within acute hospitals targets the increased identification of alcohol dependence (AD). Previous research1 estimates that our centre ...experiences ~11,000 AD admissions annually, yet just 1367 were coded with AD in 2021, suggesting significant under-detection of AD, limiting opportunities to support clinical needs and access to specialist treatment. Universal screening (US) of admissions can increase detection of alcohol use disorders (AUD), including AD, allowing ACTs to provide specialist care during an individual’s hospital admission. As one of few Trusts using US, we report our initial experience.MethodThe Fast Alcohol Screening Tool (FAST2) is a validated, 4 question screening tool with a score of ≥3 indicating possible AUD. A recent study3 examining the utility of FAST cut-scores versus full AUDIT ≥20 (i.e. AD) identified FAST≥5 as the optimal score for probable AD requiring clinical assessment. In 2022 FAST was added to the electronic assessment system allowing nurses across the Trust to screen all adult emergency and elective admissions (excluding maternity). Scores and ward location are visible to ACT via electronic dashboard, allowing ACT staff to respond proactively to those FAST≥5. We reviewed referral data to ACT before and after implementation of US using FAST.ResultsIn 2 years prior to US, 1620 patients with suspected AUD were referred to ACT (mean 68/month). In 6 months after US introduction we identified 2,344 patients with possible AUD (FAST 3–4; mean 391/month) and 737 with AD (FAST≥5; mean 123/month) – a doubling of referrals to the ACT and together comprising 9% of all admissions. 44 wards utilised FAST with only 2 reporting no FAST+ve cases. The majority of FAST≥5 scores were identified on the acute assessment unit. We also found large increases in screening in elective surgery, ENT and cardiology wards, all of which generated few referrals pre-US. Following ACT review we identified 82 patients (11.1%) who were incorrectly scored, potentially leading to both inappropriate referrals and missed intervention opportunities. An ongoing ACT-led, pan-Trust nurse education programme should mitigate this in future.ConclusionUS has increased the number of ACT referrals and revealed a broader distribution of AUD/AD across the Trust, often in areas with historically few referrals or ACT in-reach. US has allowed the Trust to increase identification of people at risk, intervene in their care, and better utilise resources. The ACT-led education programme will maintain and improve US.ReferencesRoberts E, Morse R, Epstein S, Hotopf M, Leon D, Drummond C. The prevalence of wholly attributable alcohol conditions in the United Kingdom hospital system: a systematic review, meta-analysis and meta-regression. Addiction. 2019;114(10):1726–37.Hodgson R, Alwyn T, John B, Thom B, Smith A. The Fast Alcohol Screening Test. Alcohol and Alcoholism. 2002;37(1):61–6.Phillips T, et al. FASTER Access to Alcohol Treatment Study (IRAS: 275280, CPMS: 44867) funded by the Office of Police and Crime Commissioner and NIHR Yorkshire and The Humber Clinical Research Network.
Chronic use of alcohol and its withdrawal impairs the delicate balance between GABAergic and glutamatergic systems. This imbalance includes changes in GABA receptors – importantly in GABAA subtypes – ...and glutamate receptors, especially in NMDA subtypes. A better comprehension of the different roles of GABAAR and NMDAR subunits could be helpful to define new strategies to counteract the deleterious effects observed during alcohol withdrawal. Taurine, a sulfonated amino acid, has been proposed to attenuate alcohol withdrawal symptoms due to its neuromodulatory properties. In this study, we evaluated the correlations between GABAAR and NMDAR subunits in the hippocampus of rats chronically treated with alcohol or in alcohol withdrawal, and the effects of taurine treatment on these parameters. Male Wistar rats received alcohol (2 g/kg) or water by oral gavage (control), 2 × /day, for 28 days. From day 29 to day 33, withdrawal rats received water instead of alcohol and all groups were reallocated to receive 100 mg/kg taurine or saline intraperitoneally (i.p.), once a day. On day 34, rats were euthanized and the hippocampus was dissected for GABAAR α1, α4, δ, and γ2 and NMDAR GluN2A and GluN2B subunits mRNA expression determination by RT qPCR. There were no differences between groups in the studied GABAAR and NMDA subunits. However, we observed a correlation of α1 and γ2 subunits induced by taurine, while in the alcohol group there was a correlation between α4 and GluN2A. In the group treated with alcohol and taurine, we observed an extra correlation, between α1 and GluN2A. After 5 days of withdrawal, a correlation observed in the control group, between δ and GluN2A, was reestablished. The correlation found between subunits suggests a neuroadaptation of GABAergic and glutamatergic systems in withdrawal rats. Results from this study contribute to the elucidation of the mechanisms beyond neuroadaptations observed in alcohol use and withdrawal.
•Chronic alcohol and withdrawal disrupt GluN2A/2B subunits co-expression.•Chronic alcohol increases GABAAR α4 and NMDAR GluN2A subunits co-expression.•Taurine increases α1 and γ2 mRNA GABAAR expression in alcohol and control rats.•Five days of withdrawal restores some correlations between GABAAR and NMDAR subunits.
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