PLAB 2 Alcohol Stations: Mastering AUDIT and Brief Advice

Alcohol-related scenarios are among the most dependable stations in PLAB 2. They are cheap for the GMC to write, quick to act out, and they light up all three marking domains at once — data gathering (a structured alcohol history), clinical management (screening tools, brief advice, safe signposting) and interpersonal skills (staying non-judgemental with a patient who may be defensive). Whether the camouflage is deranged liver function tests, gastritis, a fall, insomnia or 'high blood pressure', the engine underneath is the same conversation. This guide gives you the numbers, the scripts and the station-by-station approach so that when the examiner says 'Mr Jones has been drinking more since he lost his job', you know exactly what to do next.

Why Alcohol Stations Keep Appearing in PLAB 2

Alcohol misuse is genuinely common in UK practice — a substantial proportion of adults in England drink above the UK guideline of 14 units per week, and harmful drinking hides behind ordinary presentations. The GMC loves these stations because they test whether a safe doctor can:

• Screen sensitively without making the patient feel accused

• Quantify drinking accurately (can you actually calculate units?)

• Use validated tools (AUDIT, SADQ) and act on the score

• Deliver brief advice and agree a plan rather than lecture

• Recognise dependence red flags and the emergencies — withdrawal seizures, delirium tremens and Wernicke's encephalopathy

• Handle ethical twists: confidentiality, capacity, children at home, DVLA duties

Step 1: Walk In Knowing the Numbers

Examiners expect UK-standard facts at your fingertips. Memorise this table before anything else.

Unit arithmetic drill (do this until it is automatic): four pints of lager, five nights a week = 4 × 3 units = 12 units/night = 60 units/week. You will look hugely competent doing this live on PLAB 2 — and hugely incompetent if you avoid it.

Step 2: The Structured Alcohol History

Open without judgement

'I ask everyone who comes here a couple of lifestyle questions — do you drink alcohol at all?'

Normalising the question prevents the patient from feeling targeted. Then quantify:

• What do you drink (beer/wine/spirits)?

• How much on a typical day? How many days a week?

• Occasional heavy days? (6+ units in one session = binge)

• When — evenings only, or earlier in the day?

Then covertly screen for dependence features:

• Tolerance — needing more for the same effect

• Withdrawal — morning shakes, sweating, anxiety that settles with the first drink

• Loss of control — can't stop once started; failed attempts to cut down

• Salience/craving — drinking dominates thoughts and the day

• Continued use despite harm — gastritis, LFTs, falls, relationship strain

• Morning drinking to steady nerves — a classic PLAB 2 clue hidden in the brief

Never forget the surrounding screen: mood and suicide risk (alcohol and depression travel together), other substances, smoking, safeguarding of children at home, employment, driving, and social support.

Know AUDIT's skeleton

You will not read all ten questions in 8 minutes, but knowing the structure lets you mine the same information conversationally:

A patient describing blackouts, morning drinking and a concerned spouse is scoring themselves into the dependence zone before you even total the numbers.

Step 3: The Four Station Archetypes

Archetype A — The disguised screen

Dermanged LFTs / hypertension / insomnia / recurrent falls. Take the lifestyle history, land on alcohol, quantify units, calculate the weekly total, and explain what it means. Finish with brief advice and a plan.

Archetype B — The brief intervention

The station is the conversation. Use the FRAMES skeleton:

• Feedback — share the units and score: 'That is around 50 units a week — about three to four times the recommended limit.'

• Responsibility — 'It is completely your decision what you do with this; I am here to help.'

• Advise — a clear, short recommendation to cut down, with one concrete benefit.

• Menu — offer options: cutting down gradually, alcohol-free days, an app/diary, local alcohol service.

• Empathy — reflective listening, not lecturing.

• Self-efficacy — 'Have you cut down before? What worked?'

'Your score suggests drinking at a level that can quietly affect your liver, blood pressure and mood. The good news is that reducing it now makes a real difference. How would you feel about aiming for three alcohol-free days a week?'

Roll with resistance using OARS (Open questions, Affirmations, Reflective listening, Summaries):

'You are not sure it is worth changing — tell me what drinking does for you?'

Agree a SMART goal, give a leaflet, and arrange follow-up.

Archetype C — The dependent drinker

Morning drinking, shakes, withdrawal, previous detox. This patient needs:

1. Formal severity assessment — mention SADQ

2. Referral to community alcohol services for medically assisted withdrawal

3. A word on management so you sound safe: chlordiazepoxide reducing regimen (typically over 1–2 weeks) in a supervised setting, thiamine replacement, and relapse prevention options — acamprosate, oral naltrexone, supervised disulfiram, plus psychosocial support such as Alcoholics Anonymous

4. Red-flag safety netting — shakes, sweating, confusion, hallucinations or a fit after stopping = urgent medical review

Know when withdrawal should happen as an inpatient: previous withdrawal seizures or delirium tremens, poly-substance dependence, unstable medical or psychiatric illness, pregnancy, no social support or homelessness, significant liver disease.

Archetype D — The third-party twist

A wife is worried about her husband's drinking, or an adult child asks you to 'do something'. Balance confidentiality with risk: you cannot discuss a competent adult's health without their consent, but you can listen, give general information, signpost Al-Anon/carers' support, and — where there is serious risk to the patient or others, such as continuing to drive with alcohol dependence — consider disclosure in the public interest. Encourage the relative to bring the patient in; offer to invite him for a general health check.

Step 4: The Emergencies — Do Not Miss These

For any harmful or dependent drinker with poor nutrition, mention oral thiamine prophylaxis — it is an easy management mark candidates routinely drop.

Step 5: Ethics Corner (The Marks Nobody Else Collects)

• Capacity: an intoxicated patient should not make major, irreversible decisions while acutely drunk — defer, review sober.

• DVLA: alcohol dependence is a notifiable condition. Advise the patient of their duty to inform the DVLA, and know that if they refuse and continue driving against advice, disclosure to the DVLA may be justified in the public interest.

• Safeguarding: children in a household with heavy drinking — explore and escalate appropriately.

• Advocacy over paternalism: the plan belongs to the patient; you advise, they decide.

Step 6: An 8-Minute Timeline That Works

The Mistakes That Fail Good Candidates

1. Judgemental openings — 'Do you have a drinking problem?' invites denial; normalise instead.

2. Avoiding unit maths — vague quantities look evasive; the examiner wants the number.

3. Prescribing detox to a hazardous drinker — AUDIT 8–15 needs brief advice, not chlordiazepoxide. Match intervention to score.

4. Forgetting depression and suicide screening — a very common paired mark.

5. No safety-netting — failing to say 'if you develop shakes, confusion or fits, seek urgent help' in a dependent drinker is a genuine safety mark lost.

6. Ignoring thiamine — two seconds: 'I would also start thiamine to protect your memory and nerves.'

7. Lecturing — ten minutes of monologue (even in 8 minutes) scores badly on interpersonal skills; elicit, reflect, agree.

8. Missing safeguarding and DVLA when the brief hints at children or driving.

How to Practise Before Exam Day

• Drill the numbers: flashcards for AUDIT zones, SADQ bands, 14 units, unit conversions — instant recall only.

• Practice the arithmetic out loud with a partner giving you odd quantities (3 large wines and 2 pints, 4 nights a week...).

• Run timed 8-minute circuits: alternate archetypes A–D so no variant surprises you.

• Use AI patient simulators for repetitions: the value is volume — face defensive, evasive, tearful and angry drinkers until none of them rattle you, then refine your phrasing by reviewing transcripts.

• Record yourself: the phrase 'I ask everyone this' should sound effortless, not scripted.

Final Take-Home Checklist

• 14 units/week, spread over 3+ days — same advice for men and women; none in pregnancy

• AUDIT: 8–15 brief advice · 16–19 extended intervention · 20+ assess for dependence (SADQ)

• Morning shakes + morning drink = dependence until proven otherwise

• Dependent drinker = referral, chlordiazepoxetine-based withdrawal (supervised), thiamine, relapse-prevention options, AA

• Confusion + ataxia + eye signs = Wernicke's = IV thiamine now

• Non-judgemental, quantified, scored, agreed, safety-netted — every single alcohol station

Alcohol stations reward preparation disproportionately: the content is finite, the scripts are learnable, and the domains overlap perfectly. Master AUDIT, own your unit arithmetic, rehearse the resistant patient — and one of the most predictable 8 minutes of your PLAB 2 becomes one of the most comfortable.

Good luck — and remember: feedback, responsibility, advice, menu, empathy, self-efficacy.