Treating Alcohol Abuse A Collaborative Approach to Care July 14, 2018 * Tex-CHIP Training Series

Role of Nutrition & Lifestyle in Prevention/Management of Alcohol Abuse

Understanding Provider Role in Treating Alcohol Abuse Registered Dietitian’s focus is on the nutrition diagnosis rather than medical or psychiatric diagnosis Nutrition diagnoses are written as a “PES” statement which identifies the nutrition Problem, it’s Etiology, and the Signs/ Symptoms which point to that problem Example: Underweight related to inadequate energy intake as evidenced by BMI of 14 and reported intake of <50% of estimated calorie needs.

Understanding Provider Role in Treating Alcohol Abuse Interventions, goals, and evaluation methods are then tailored to the nutrition diagnosis Example: Educated client on estimated calorie needs Recommended prescription to PCP for oral nutrition supplement once daily to help meet estimated needs Most PES statements in this population are surrounding energy balance, weight status and history, hydration status, and nutrient deficiencies

Considerations when Interacting with Clients Cognitive Considerations: Impaired cognition makes accuracy or dietary recalls questionable Be aware of the emotional fragility of client and caregiver Scope of Practice Considerations: Redirect conversations to stay within bounds of RD’s Scope of Practice Home Life Considerations: Does client have a support system or enablers? Finances, available tools, & surrounding community play large roles in recovery

Considerations when Interacting with Clients Anthropometric Considerations: Collect information on height, weight, weight history, and Body Mass Index Review recent and past lab values to identify any areas of concern (i.e. Liver disease, nutrient deficiencies, anemia, etc.) Conduct a Nutrition-Focused Physical Assessment to help identify malnutrition Nutrition Considerations: Collect a 24-hour dietary recall from client and/or caregiver Include information on vitamin or oral nutrition supplement use

Our Treatment Plan Healthcare Domain: Nutrition Provider: Dietitian Objective: Decrease in alcohol abuse as indicated by client report of: Reduction in frequency and volume of alcohol consumption as compared to initial assessment and/or last follow-up Improved nutrition status based on weight maintenance and energy and fluid intake meeting >75% of estimated needs Compliance with vitamin and nutrition supplement orders as prescribed by PCP and/or RD   Goals: Abstaining from alcohol Energy and fluid balance by consuming foods and non-alcoholic beverages that provides 90-110% of estimated needs Micronutrient deficiencies corrected, particularly so that serum B-vitamin, iron, and potassium levels are within normal limits Prevent further damage through dietary management as able (i.e. liver disease, hypertension, anemia, etc.) Interventions: Assist client with revisiting coping strategies to manage triggers of alcohol consumption Educate client on estimated calorie and hydration and provide sample culturally-relevant menu plans that meet client’s needs Recommend and/or order prescriptions for multivitamin and/or oral nutrition supplements Offer dietary education on management of complications of alcohol abuse as able

Measuring Outcomes/ Success Weight maintenance or weight gain without increase in consumption of alcohol-containing beverages Increased reports of energy and fluid intake according to 24- hour diet recall or food journal Reports of decreased alcohol intake Patient compliance with supplement use as prescribed Lab values show micronutrient levels improving or within normal limits

Communication from Counselors Helps gauge motivation and readiness to change Provides insight on support system and home life that I may not have received from assessment conversations Offers valuable information on progress being made, resources being sought, and emotional and mental state of client Often times, nutrition status is not top-of-mind for a client seeking or receiving care for alcohol abuse