Transcript Overview of Screening and Brief Office Intervention

A Brief Office Intervention
for Alcohol Abuse
F. David Schneider, MD, MSPH
University of Texas Health Science Center
at San Antonio
Alcohol Related Deaths
 Nearly
100,000 deaths annually
 15 to 30 years of life lost per
death
Prevalence
 20%
of adults in Family Practices
 25% of general hospital inpatients
 1/3 of emergency room visits
Alcohol Related Morbidity
How would you see alcohol and
other drug problems present in
a family practice office?
Alcohol Related Morbidity
What laboratory
abnormalities might you
find?
How do you screen for it?
1. You ASK about it
2. CAGE Questions
Screening
CAGE Questions
Cut down
Annoyed
Guilty
Eye opener
Interpreting the CAGE
1 positive = at risk
2 positives = abuse
3 or 4 positives = dependence
Diagnosis
Use
Consequences
Repetition
Diagnosis
Continuum of
Substance Abuse
Use
Abstinence
Abuse
Misuse
Dependence
Brief Intervention
Components:
 Present
findings objectively
 Offer advice about safe consumption
and change
 Assess readiness to change
 Negotiate goals and strategies
 Arrange for follow-up
Brief Intervention
Benefits:
Cheap
Short (10-15 minutes)
It works
WEEP Intervention
Worried
(concerned)
Evidence
Education and Empowerment
Plan
WEEP Intervention
Worried
(concerned)
“I’m concerned about your
drinking.”
WEEP Intervention
Worried
(concerned)
Evidence
“Because your liver function
tests are elevated...”
WEEP Intervention
Worried
(concerned)
Evidence
Education and Empowerment
“If you continue to drink, your liver will
become scar tissue and stop working.
But you can stop drinking and it will
get better.”
WEEP Intervention
Worried
(concerned)
Evidence
Education and Empowerment
Plan
Trial of abstinence
AA
Close physician follow-up
Individualizing the
Treatment Plan
1. Assess readiness to change
Stages of Change Model
Precontemplation
“Denial”
Contemplation
“Ambivalence”
Preparation
Relapse
Action
Maintenance
Assessing Readiness
to Change
 Ask
about their perception of
the problem?
“Do you think you drink too much?”
 Assess
motivation
“Do you WANT to stop?”
“Do you think you CAN stop?”
Individualizing the
Treatment Plan
1. Assess readiness to change
2. Decide if this patient needs
inpatient or outpatient
treatment
Inpatient vs Outpatient
Who needs inpatient care?
Inpatient vs Outpatient
Who needs inpatient care?
 Long
term drinking
 Comorbid illnesses
 Early symptoms of withdrawal
 History of DTs or seizures
 No social support
Individualizing the
Treatment Plan
1. Assess readiness to change
2. Decide if this patient needs
inpatient or outpatient
treatment
3. Look at patient’s social and
financial resources
Set goals
 Abstinence
vs controlled drinking
 Set stop date
 AA meeting(s)
 Counseling
 Follow up visit
Helpful Web Sites
 PREVLINE:
http://www.health.org/
 NIAAA: http://www.niaaa.nih.gov/
 SAMSA: http://www.samhsa.gov/
 CSAP: http://www.samhsa.gov/csap
 CSAT: http://www.samhsa.gov/csat