The GP correctly interprets the LFT changes in the context of the current levels of alcohol consumption, which Jennifer has increased and developed physiological tolerance to the units consumed. There's no evidence of physical dependence on alcohol but the strain is starting to show in the test results, with a raised GGT, a high normal ALP and slightly raised ALT. MCV isn't yet raised.

This can help inform the Feedback regarding evidence of harm.

Many GPs will use the FRAMES acronym in structuring alcohol feedback:

• Feedback on the personalised results
• Responsibility is Jennifer's and noone else
• Advice to change behaviour that is producing the evidence of harm
• Menu of choices: cutting down gradually, alcohol-free days, formal alcohol support, Social Prescriber services and Bereavement Counselling
• Empathy for Jennifer's context- this is delivered without any sense of judgement or blame
• Self-efficacy- a sense of agency for Jennifer to have the ability to make a positive change- many with poor lifestyle choices feel they can't control or be able to change

Alcohol consumption is based on the %ABV (Alcohol By Volume) which is present on the packaging. 

Assuming units from a patient's description of glasses or pints can lead to inaccuracies or misinterpretations- a couple of glasses of wine may be two units, or may be the full bottle if drinking at home! If a patient talks about pints, remember this is more than half a litre, so a pint of 4.4% Beer contains 2.5 units of alcohol rather than an assumed two.

The percentage of the alcohol tells us how many units are in a litre, so a 75cL bottle of 12% wine will contain three-quarters of 12 units. This is nine units in each bottle Jennifer is drinking, with the occasional Gin & Tonic as well. Patients will know the %ABV of the alcohol they drink! Know your Units...

Social isolation as a result of Jennifer's grief must also be acknowledged, and the most impactful intervention may be to reduce her feeling of loneliness which is influencing Jennifer's mood and coping strategy through alcohol. This can be achieved through the expertise of Social Prescribers, who will be aware of current services to help reduce isolation, provide social support of befriending, and address the bigger picture of the wider determinants of health. 

Organisations to support those experiencing grief include Cruse Bereavement Care, Sue Ryder, Marie Curie, The Good Grief Trust and the National Bereavement Alliance, who produce a Grief Support Guide documenting these sources of support, information and counselling.