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 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”