Alcohol use disorder

Alcohol misuse is strongly associated with health problems, disability, death, accident, injury, social disruption, and violence. In the United States, roughly 88,000 (approximately 62,000 men and 26,000 women) alcohol-related deaths occur annually, making excessive alcohol consumption the third leading cause of preventable death. In 2012, alcohol-impaired driving fatalities accounted for 10,322 deaths (31% of overall driving fatalities). Primary care physicians are often the only medical professionals that an at-risk drinker will encounter, placing them in a prime position to help prevent premature morbidity and mortality from alcohol use. Incorporating annual screening for alcohol misuse into primary care practices will aid in detecting risky or hazardous alcohol use before the onset of abuse, dependency, physical and social injury.

AFMC created the Arkansas Substance Abuse Resource Guide to help you identify the resources available in your county. The guide can be accessed online or downloaded as a PDF using the links below.

Download the Arkansas Substance Abuse Resource Guide (this link takes you to PreventionWorksAR.com, an affiliate AFMC site)

Strategies for success

Management of patients' high-risk alcohol use and alcohol abuse disorder

  • Keep accurate records to include history and physical examination.
  • Screen for alcohol misuse annually. (single question screening)
  • Utilize formal screening tools such as Audit, Audit-C, CRAFFT, NIAAA to identify risky/hazardous drinking and alcohol use disorder (AUD).
  • Provide brief intervention counseling to patients identified with high-risk alcohol use and AUD (15 to 30-minute counseling or 30-minute or more counseling).
  • Direct and coordinate consults and referrals with other care providers and treatment centers as needed.
  • Provide follow-up care.
  • Commend and encourage patients who are successful in efforts to reduce or stop alcohol consumption.
  • Continue to support patients who are not successful in efforts to reduce or stop alcohol consumption.

Know the facts about alcohol

  • Approximately 30 percent of adults in the United States consume alcohol at a level that increases their risk for physical, mental and social problems.
  • Approximately 20 percent of patients who present to a primary care physician will have high-risk alcohol use or AUD.
  • The primary care physician may be the only physician that a high-risk drinker will encounter.
  • Each year about 88,000 deaths are attributed to alcohol consumption.
  • 1 in 10 deaths in the 20-64 age range are related to alcohol use or complications thereof.
  • In many cases counseling for alcohol-related disorders can be accomplished in an outpatient clinical environment.
  • Medications for select patients can be of help for the treatment of alcohol-related disorders.
  • High-risk drinking is identified by:
    • Men under 65 years of age: No more than four “standard” drinks per day or 14 drinks per week
    • Men over 65 years of age: No more than three “standard” drinks per day or seven drinks per week
    • Women (all): No more than three “standard” drinks per day or seven drinks per week

Improve office systems

  • Using an electronic medical record (EMR) when screening for high-risk alcohol will assist in the identification and management of patients with AUD.
  • Patients with high-risk alcohol use and AUD benefit from a medical home in which the primary care provider directs care and coordinates consults with other care providers as needed.
  • Provide staff education - defining high-risk alcohol use and AUD.
  • Provide staff education - parameters for men and women to identify high-risk drinking.
  • Educate non-physician staff on screening as part of an office visit intake.
  • Utilize facility locator for treatment centers and community outreach.

Educate patient and family about high-risk alcohol use and AUD

  • Keep accurate records to include history and physical examination.
  • What counts as a drink?
  • How many drinks are in common containers?
  • What’s your drinking pattern?
  • Times to avoid alcohol: planning to drive a vehicle or operate machinery, taking medications that interact with alcohol, managing a medical condition that may worsen with alcohol consumption, pregnant or trying to become pregnant.
  • Can you “hold your liquor?” Answering yes may put you at greater risk.
  • What’s “heavy” or “at-risk” drinking?
  • What’s the harm?
    • Injuries associated with drinking
    • Health problems
    • Birth defects
    • Alcohol use disorders
  • Assist patients with a written plan for change.
  • Assist patients with a plan for change by utilizing technology.
    • Complete a change plan on the Rethinking Drinking Web site; email it to a personal account for weekly reviews
    • Store goals and strategies in mobile device
    • Set up automated reminders
    • Create motivating passwords
  • Involve patients with strategies for cutting down.
    • Keep track - utilize drinking tracker
    • Count and measure
    • Set goals
    • Pace and space
    • Include food
    • Find alternatives
    • Avoid triggers
    • Plan to handle urges
    • Plan to say, “No thanks”

Web resources

Provider resources

AAFP

Agency for Healthcare Research and Quality

CDC - Centers for Disease Control and Prevention

NCQA - National Committee for Quality Assurance

  • National Committee for Quality Assurance, Healthcare Effectiveness Data and Information Set (HEDIS) accessed from  on June 18, 2014.
  • Arpana, Agrawal, Heath, AC, Lynskey, MT. DSM-IV to DSM-5: The impact of proposed revisions on diagnosis of alcohol use disorders. Addiction 2011 November, 106(11), 1935-194

NHTSA - National Highway Traffic Safety Administration

Arkansas Office of Drug Abuse and Prevention

  • PreventionworksAR.com: http://www.preventionworksar.org/
  • Tools

 Substance Abuse and Mental Health Services Administration (SAMSAH)

Department of Family Medicine at OHSU

United States Prevention Task Force

VA - Veteran Affairs

Other resources

Patient resources