January - Shared Care Forum

Last night I visited our local "Substance Misuse Shared Care Forum". The meeting included 2 presentations on detoxification and abstinence and some group work.
I learnt about using AUDIT the "Alcohol Use Disorder Identification Test". This is an easy to use tool which leads to a score. Scoring <8>20 suggests alcohol dependence. Scores of 8-15 and 16-19 suggest hazardous and harmful drinking respectively.
For hazardous drinking interventions suggested were education and reduction, for harmful drinking "brief interventions" were recommended, for dependence then detoxification was recommended.
The "problem" with this is that locally, if we uncover harmful and dependent drinking there are no formal services to support treatment.

Acne - systemic treatments

Confirmation of my reluctance to use minocycline for acne appears in the BMJ - (BMJ 2007;334:154) - the drug is more expensive than its tetracycline relatives and has the adverse reaction of slate gray hyperpigmentation of the skin. It also seems more likely to lead to a lupus like syndrome.
Preferred alternatives are doxycycline 50mg daily (cost£27/6m) and lymecycline 408mg (cost £46/6m). Both of these drugs are once daily preparations and do not need to be taken on an empty stomach.