At the conclusion of this presentation, you will be able to: Discuss reasons to screen for alcohol use.
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1 A New Comprehensive Alcohol Screening Tool to Guide Primary Care Practice Jon Glover, LCSW Behavioral Health Project Specialist MetaStar Objectives At the conclusion of this presentation, you will be able to: Discuss reasons to screen for alcohol use. Recognize the difference between screening for dependency and at-risk use. Identify the level of alcohol use that responds best to brief interventions in primary care. Determine the right level of intervention for patients based on the results of their alcohol screening. MetaStar represents Wisconsin in Lake Superior Quality Innovation Network. 1
2 The CDC s Guide Planning and Implementing Screening and Brief Interventions for Risky Alcohol Use A Step-by-Step Guide for Primary Care Practices 2 Levels of Alcohol Use About 29 percent of the population drink in the at-risk category. Four percent of the population Drink at the dependent level. 25 percent of the population drink at non-dependent level. 3
3 Wisconsin Statistics 4 Binge Drinking Statistics 5
4 Adult Binge Drinking in Wisconsin Maximum Number of Alcoholic Drinks on One Occasion Among Wisconsin Adult Binge Drinkers 6 Alcohol-Related Fatal Falls host.madison.com/ct/news/local/health-med-fit/losing-their-footing-more-wisconsin-seniors-aredrinking-falling-and/article_35c6584e-8c2e-11e7-9f44-9f4244b5c44a.html 7
5 Healthy Wisconsin Priority Wisconsin Alcohol Use Rankings 45 for chronic drinking (8+/week for women or 15+/week for men) 48 for excessive drinking (binge and chronic use) 48 for women who either binge drink or engage in chronic drinking (8+/week) 49 for binge drinking 50 for percentage of adults 65 and older who either binge drink or engage in chronic drinking (8+/week) 8 Healthy Wisconsin Goal Goal: Reduce Binge and Heavy Drinking Objective 1: Reduce Binge Drinking Objective 2: Reduce Alcohol-related Deaths 9
6 Why Address Alcohol Misuse? 10 Immediate Health Risks of Alcohol Consumption Motor vehicle crashes Pedestrian injuries Drowning Falls Property crimes Homicide & suicide Unintended firearm injuries Immediate Health Risks Unprotected sex / sexually transmitted diseases and unintended pregnancy Assaults & sexual assaults Child abuse & neglect Intimate partner violence Fires Depressed mood Alcohol poisoning 11
7 Long Term Health Risks of Alcohol Consumption Long Term Health Risks Gastric distress Chronic depression Hypertension Neurologic damage Cardiovascular disease Pancreatitis Liver damage Alcoholism Cancer Fetal alcohol spectrum disorders Diabetes 12 The Screening Tools 13
8 Familiar Alcohol Screening Tools CAGE: Cut down / Annoyed / Guilty / Eye Opener AUDIT-C: Frequency / Amount / Binge use AUDIT: (Full Screen) Focuses on negative consequences / results of alcohol use 14 CDC Recommendations Single Question: Binge drinking focus US AUDIT 1-3: Frequency / Amount / Binge Use US AUDIT: (Full Screen) Focuses on negative consequences / results of alcohol use 15
9 AUDIT1-3 vs AUDIT-C AUDIT1-3 How often do you have a drink containing alcohol? Never [0] 2-3 times a week [4] Less than monthly [1] 4-6 times a week [5] Monthly [2] Daily [6] Weekly [3] How many standard drinks containing alcohol do you have on a typical day? 1 drink [0] 5-6 drinks [4] 2 drinks [1] 7-9 drinks [5] 3 drinks [2] 10 or more drinks [6] 4 drinks [3] How often do you have X (5 for men, 4 for women and men over age 65) drinks on one occasion? Never [0] 2-3 times a week [4] Less than monthly [1] 4-6 times a week [5] Monthly [2] Daily [6] Weekly [3] Scoring: Sum total, ranges from 0 to 18 Women, men 65+ yo: greater than or equal to 7 is positive for risky drinking Men <65 yo: greater than or equal to 8 is positive for risky drinking AUDIT-C How often do you have a drink containing alcohol? Never [0] 2-3 times/week [3] Monthly or less [1] 4+ times/week [4] 2-4 times/month [2] How many standard drinks containing alcohol do you have on a typical day? 1 or 2 [0] 7,8 or 9 [3] 3 or 4 [1] 10 or more [4] 5 or 6 [2] How often do you have six or more drinks on one occasion? Never [0] Weekly [3] Less than monthly [1] Daily or Almost daily [4] Monthly [2] Scoring: Sum total, ranges from 0 to 12. Women: greater than or equal to 3 is positive for risky drinking Men: greater than or equal to 4 is positive for risky drinking **Can lead to more false positives because not calibrated for US alcohol content** 16 AUDIT-C Weaknesses Weaknesses: 1. Uses international units of alcohol (10 grams) instead of US units of alcohol (14 grams). 2. Is not aligned with the National Institute on Alcohol Abuse and Alcoholism (NIAAA) guidelines. 3. Does not reflect age-related differences 4. Shown to produce up to 20 percent false positive responses. (Delaney KE, Lee AK, Lapham GT, Rubinsky AD, Chavez LJ, Bradley KA. Inconsistencies between alcohol screening results based on AUDIT-C scores and reported drinking on the AUDIT-C questions: prevalence in two US national samples. Addiction Science & Clinical Practice 2014; 9:2) 17
10 Advantages of the US AUDIT 1-3 Advantages: 1. Developed by the same researchers who developed the original AUDIT for the World Health Organization (WHO) for international use. 2. Adjusted to reflect US standard alcohol unit. 3. Adjusted to correlate directly with the NIAAA guidelines for alcohol consumption in the US. 4. Scoring reflects age-related differences. 5. Eliminates the issue of false positives. 18 How to Use the New US AUDIT Tool 19
11 NIAAA Guidelines for Low Risk Alcohol Consumption The US AUDIT Questions 1-3 (Pre-screen) 21
12 The US AUDIT Questions Scoring the US AUDIT 23
13 Scores and Suggested Interventions 0-6/7 Suggests abstinence or drinking below low-risk guidelines 7/8-15 Suggests drinking above recommended guidelines Suggests drinking above guidelines and experiencing alcohol-related harm 25 + Suggests alcohol dependence symptoms Suggestion: Education regarding risky drinking limits Suggestion: Brief intervention Suggestion: Brief intervention and follow up Suggestion: Referral to specialized alcohol treatment may be required Personal communications from John C. Higgins-Biddle, principal author of the CDC s US Audit and co-author of the WHO AUDIT manual (2001). 24 The SBIRT Approach Screening, Brief Intervention and Referral to Treatment (SBIRT) 1. Identify whether or not the patient is drinking at low-risk recommendations. (Screen) 2. Educate the patient regarding the negative impact risky alcohol use could have on their health and assist them in setting a goal to reduce their use. (Brief Intervention) 3. Encourage the patient to consider changing this behavior with your support and a referral to specialty care. (Brief Intervention and a Referral for Treatment) 25
14 Who are these patients? 26 ACEs Adverse Childhood Experiences 1. Nearly two-thirds (64 percent) of adults have at least one. 2. If you have one, there s an 87 percent chance that you have two or more. 3. They cause adult onset of chronic disease. 4. The more ACEs you have, the greater the risk for chronic disease, mental illness, violence and being a victim of violence. 5. Childhood adversity contributes to most of our major chronic health, mental health, economic health and social health issues. 27
15 ACEs Adverse Childhood Experiences 28 Sweet Side Love You're I still get got love tough defensive all you confused as baby steel at 'cause every and with you anger turn I know keep and your pride chin up So You're Don't much don't mean overly abuse ever to sensitive feel do on the like such cruel and you're a little overly things good child concerned you enough do So You I've you don t seen don't always your always sweet show show side your your sweet sweet side side 29
16 Questions? Jon Glover, LCSW Behavioral Health Project Specialist MetaStar represents Wisconsin in Lake Superior Quality Innovation Network. 30 This material was prepared by the Lake Superior Quality Innovation Network, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The materials do not necessarily reflect CMS policy. 11SOW-WI-G
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