THE COSTS OF “AT-RISK” DRINKING & SCREENING FOR UNHEALTHY USE OF

ALCOHOL IN A 15 MINUTE PATIENT VISIT

Dangerous Alcohol Use

WARNING!

The following presentation is heavy on definitions

Outline

Learning ObjectivesMini-lecture!

Learn some facts, grow together and individually.Cases!

Apply knowledge, save lives.

Learning Objectives

By the end of this presentation, we should be able to: Identify “at-risk” drinking, alcohol abuse, and alcohol

dependence Explain the USPSTF recommendations re: screening

for unsafe alcohol use Use a one question screening test to ID patients likely

to be at-risk drinkers

THIS IS THE PERCENTAGE OF

AMERICAN ADULTS WHO ARE AT-RISK

DRINKERS

WHAT IS 28%

“At-risk” Drinking

Per the CDC: Averaged daily limits:

On average, more than 2 drinks/day for men, more than 1/day for women

OR

Binge Drinking: More than 5 drinks/occasion for men, more than 4

drinks/occasion for women

What is a “Drink”?

“At-Risk” for what?

Many potential adverse outcomesPrimarily, increased risk of having an “alcohol

use disorder” The point at which the patient’s drinking begins to

cause distress or harm DSM IV:

Alcohol Abuse Alcohol Dependence

Alcohol Abuse

The 5 “R’s

Alcohol Dependence

At-Risk drinking - Risks

Immediate: Accidental injury Increased risk for

violence Risky sexual behaviors Alcohol poisoning Legal repercussions

Long-term: Neurologic

Dementia, stroke CV

MI, HTN, a. fib, myopathy

Psychiatric Depression, suicidality

GI Cirrhosis, pancreatitis

Oncologic Mouth, esophagus, liver,

colon, and breast CA risk with with EtOH intake

At-Risk Drinking - Costs

Attributable to excess alcohol consumption: ~ 80,000 deaths annually 1.2 million ED visits Total estimated cost of $223.5 BILLION to the

economy $24.6 billion spent on health care

So what now!?

The U.S. Preventative Services Task Force recommends screening for alcohol misuse in adults in the primary care setting (Grade B). Screening tools:

AUDIT-C CAGE Single-item screening

Single-Item Screening

Validated by National Institute for Alcohol Abuse and Alcoholism

One question: “How many times in the past year have you had more

than…” “…5 drinks a day” – men “…4 drinks a day” – women

Positive if answer > 0 82% sensitive and 79% specific for at-risk drinking

If positive, next step is to assess weekly average

LET’S DO SOME CASES!

Case #1 - AB

AB is a 25 year-old medical student who presents to the Health Plan to establish primary care CC: None PMH, PSH, FH all unremarkable SH:

Tobacco: non-smoker EtOH: Drinks “I don’t know… maybe 10 drinks a week?”

When asked Single-Item Screen, states that he drinks more than 5 “official drinks” at least one night every weekend.

Otherwise doing well – no EtOH-related incidents in past year

Case #1 - AB

What do we make of AB’s alcohol use?

How worried are we?

What do you want to do next?

Case #2 - WW

WW is an 55 year-old, recently divorced, electrician who presents to your office with a CC of insomnia HPI: Has had trouble sleeping since the divorce two

months ago. Falls asleep quickly after taking an Ambien, but wakes multiple times throughout the night. With each waking, he mixes a vodka and soda containing 4 oz. of liquor to help him fall back asleep. He has been doing this “pretty much every night” for at least the past month.

Case #2 - WW

Assuming he wakes up twice on average, how many drinks a day is WW consuming?

What questions do we want to ask to better assess WW’s alcohol use?

What do we want to do next?

Case #3 - HS

HS is a 45 year-old male new to your office. He is here to establish care. CC: None PMH: Obesity PSH, FH unremarkable SH: Works at nearby nuclear power plant, father of 3.

Tobacco: non-smoker EtOH: “Has a few every night after work” – goes to a bar

with friends for several hours most nights of the week When asked how many nights in the past year he’s

consumed more than 5 drinks, he shrugs, saying “Most?”

Summary

Unhealthy use of alcohol (including alcohol use disorders) is common, and is associated with significant personal, physical, and economic costs

The USPSTF recommends that we screen our patients for unhealthy use – can be done with a single question

Thank You

References

Centers for Disease Control and Prevention (CDC). Alcohol-Related Disease Impact (ARDI). Atlanta, GA: CDC.

Bouchery EE, Harwood HJ, Sacks JJ, Simon CJ, Brewer RD. Economic costs of excessive alcohol consumption in the United States, 2006 . Am J Prev Med 2011;41:516–24.

Dawson DA, Grant BF, LI T-K. Quantifying the risks associated with exceeding recommended drinking limits. Alcohol Clin Exp Res 2005;29:902–908

NIAAA Clinicians Guide: Helping Patients Who Drink Too Much: http://pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/guide.pdf

Smith PC, Schmidt SM, Allensworth-Davies D, Saitz RS.Primary care validation of a single-question alcohol screening test. Gen Intern Med. 2009;24(7):783.\

Hasin DS, Stinson FS, Ogburn E, Grant BF. Prevalence, Correlates, Disability, and Comorbidity of DSM-IV Alcohol Abuse and Dependence in the United States: Results From the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry. 2007;64(7):830-842. doi:10.1001/archpsyc.64.7.830