1. A Brief Office Intervention for Alcohol Abuse F. David Schneider, MD, MSPH University of Texas Health Science Center at San Antonio

2. Alcohol Related Deaths l Nearly 100,000 deaths annually l 15 to 30 years of life lost per death

3. Prevalence l 20% of adults in Family Practices l 25% of general hospital inpatients l 1/3 of emergency room visits

4. Alcohol Related Morbidity How would you see alcohol and other drug problems present in a family practice office?

5. Alcohol Related Morbidity What laboratory abnormalities might you find?

6. How do you screen for it? 1. You ASK about it 2. CAGE Questions

7. Screening CAGE Questions l C l Cut down l A l Annoyed l G l Guilty l E l Eye opener

8. Interpreting the CAGE 1 positive = at risk 2 positives = abuse 3 or 4 positives = dependence

9. Diagnosis l U l Use l C l Consequences l R l Repetition

10. Diagnosis Abstinence Misuse Dependence Continuum of Substance Abuse Use Abuse

11. Brief Intervention Components: l Present findings objectively l Offer advice about safe consumption and change l Assess readiness to change l Negotiate goals and strategies l Arrange for follow-up

12. Brief Intervention Benefits: l Cheap l Short (10-15 minutes) l It works

13. WEEP Intervention l W l Worried (concerned) l E l Evidence l EE l Education and Empowerment l P l Plan

14. WEEP Intervention l W l Worried (concerned) “I’m concerned about your drinking.”

15. WEEP Intervention l W l Worried (concerned) l E l Evidence “Because your liver function tests are elevated...”

16. WEEP Intervention l W l Worried (concerned) l E l Evidence l EE l 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.”

17. WEEP Intervention l W l Worried (concerned) l E l Evidence l EE l Education and Empowerment l P l Plan 4Trial of abstinence 4AA 4Close physician follow-up

18. Individualizing the Treatment Plan 1. Assess readiness to change

19. Stages of Change Model Precontemplation “Denial” Contemplation “Ambivalence” Preparation Action Maintenance Relapse

20. Motivation for Change Contemplation Action Termination Prochaska’s Stages of Behavior Change Precontem- Preparation Maintenance plation

21. Assessing Readiness to Change l Ask about their perception of the problem? “Do you think you drink too much?” l Assess motivation “Do you WANT to stop?” “Do you think you CAN stop?”

22. Individualizing the Treatment Plan 1. Assess readiness to change 2. Decide if this patient needs inpatient or outpatient treatment

23. Inpatient vs Outpatient Who needs inpatient care?

24. Inpatient vs Outpatient Who needs inpatient care? l Long term drinking l Comorbid illnesses l Early symptoms of withdrawal l History of DTs or seizures l No social support

25. 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

26. Set goals l Abstinence vs controlled drinking l Set stop date l AA meeting(s) l Counseling l Follow up visit

27. Helpful Web Sites l PREVLINE: http://www.health.org/ l NIAAA: http://www.niaaa.nih.gov/ l SAMSA: http://www.samhsa.gov/ l CSAP: http://www.samhsa.gov/csap l CSAT: http://www.samhsa.gov/csat