Center for Addiction Medicine

05/07/2007 - Helping Patients Who Drink too Much "Part II"

If you aren’t already doing so, please consider incorporating alcohol screening and intervention into your medical practice, as you are in a prime position to make a difference.
 
                Why should health care professional screen for problem drinking?

 ·          At-risk drinking and alcohol problems are common. Some three in 10 American adults drink at levels that elevate their risk for physical, mental health, and social problems.  Of these heavy drinkers, about 25 percent currently have alcohol abuse or dependence. 

 ·          Heavy drinking often goes undetected. In a recent study of primary care practices, for example, patients with alcohol dependence received the recommended quality of care, including assessment and referral to treatment, only about 10 percent of the time.

 ·          Patients are likely to be more receptive, open, and ready to change than you expect. Most patients do not object to being screened for alcohol use by clinicians and are open to hearing advice afterward. 

 You are in a prime position to make a difference. Clinical trials have demonstrated that brief interventions can promote significant, lasting reductions in drinking levels in at-risk drinkers who aren’t alcohol dependent.  Some drinkers who are dependent will accept referral to addiction treatment programs.
 Some tips for incorporating alcohol screening into your practice:

 1. Decide on a screening method

A couple of methods for screening are readily available for health care providers: a single question about heavy drinking days to use during a clinical interview and a written self-report instrument, the AUDIT, which is available at www.niaaa.nih.gov/guide.

 The single interview question can be used at any time, either in conjunction with the AUDIT or alone. Some practices may prefer to have patients fill out the AUDIT before they see the clinician. It takes less than 5 minutes to complete and can be copied or incorporated into a health history.

 2. Think about clinical indications for screening

Key opportunities include:

 - As part of a routine examination

 - Before prescribing a medication that interacts with alcohol

 - In the emergency department or urgent care center

 - When seeing patients who are pregnant or trying to conceive
are likely to drink heavily, such as smokers, adolescents, and young adults
have health problems that might be alcohol induced, such as cardiac arrhythmia, dyspepsia, liver disease, depression or anxiety, insomnia, trauma
have a chronic illness that isn’t responding to treatment as expected, such as chronic pain, diabetes, gastrointestinal disorders, depression, heart disease or hypertension
 
3. Set up your practice to simplify the process

Decide who will conduct the screening (you, other clinical personnel, receptionist)

Use preformatted progress notes

Use computer reminders (if using electronic medical records)

Keep a guide and referral information in your examination rooms

Monitor your performance through practice audits

• previous news item
• back to news list