1. Screening for Alcohol Use and Alcohol Use Disorder in Psychiatric Inpatient Settings Michael M. Miller, MD, FASAM, FAPA National Association of Psychiatric Health Systems National SBIRT ATTC American Hospital Association November 25, 2013

2. Michael M. Miller, MD, FASAM, FAPA mmiller@rogershospital.org Medical Director Herrington Recovery Center at Rogers Memorial Hospital Oconomowoc, Wisconsin Clinical Adjunct Associate Professor University of Wisconsin School of Medicine and Public Health Assistant Clinical Professor Medical College of Wisconsin, Dept of Psychiatry & Behavioral Health Past President and Board Chair American Society of Addiction Medicine (ASAM) Director American Board of Addiction Medicine (ABAM) Past Chair Hospital Accreditation Program PTAC, The Joint Commission

5. Why? We have to. It will improve the quality of the care we offer. It can lower costs by identifying a variable that adversely affects treatment adherence and outcomes and this affects costs in an era of accountability for costs and outcomes.

6. What can it “find”? Unhealthy Alcohol Use – Sub-diagnostic – At Risk Use, Harmful Use Alcohol Use Disorder – Diagnosable, codeable, treatable – Mild, Moderate, Severe in DSM-5

7. heavy severe consumption none consequences Risky: At Risk of Harms Low risk use Alcohol Use Disorders Abstinence Alcohol Abuse Problems = Harmful Alcoholism Dependence Unhealthy Use The Spectrum of Alcohol Use

8. Levels of USE none TREATMENT INTENSITY Risky Use Use Abstinence / Non-Use 305.00 Problem Use 303.90 “Broadening the Base of Treatment” IOM Report--1990

9. What are we assessing/treating? What might we intervene upon? Types of Drinkers: Alcohol Dependent (DSM-5 A.U.D Moderate/Severe) ~ 5 % ~ 25% ~ 70% Risky or Harmful Prevalence in US: No intervention Intervention Goal: Low Risk or Abstinent Brief Intervention Referral to treatment

10. It’s Good to Identify Both Heavy Drinkers – associated with increased probability of adverse health status. – Illnesses – Injuries Addicted Drinkers – a primary health condition which can go unidentified but which needs primary treatment.

11. To Oversimplify Alcohol Use Disorder is present in: – 10% of the public – 20% of general medical outpatients – 30% of general medical inpatients – 40 to 45% of psychiatric inpatients – 60 to 80% of surgical trauma inpatients (ICU)

12. Tobacco is #1 But Alcohol Ain’t Trivial Highest prevalence among psychiatric inpatients: tobacco use disorder Greatest potential to save lives: tobacco use disorder Greatest moral imperative: assist psychiatric patients to stop smoking BUT….. alcohol use is a significant factor on the overall health of psychiatric patients and affects adherence to pharmacological and psychosocial treatments, engagement, and retention And thus…. affects probability of re-admission

13. Some Interesting Titles Subdiagnostic alcohol use by depressed men and women seeking outpatient psychiatric services. Satre DD, Chi FW, Eisenrath S, Weisner C. Alcoholism: Clin. Exper. Res. 35:695-702 (2011) Impediments to screening for hazardous alcohol use and dependence in general hospital psychiatric inpatients. Hulse GK Aust N Z Jour Psychiatry. 35:606-12 (2001)

14. Some Interesting Titles Risky use and misuse of alcohol, drugs and cigarettes detected by screening questionnaires in a clinical psychosis unit. [Sweden] Cruce G, Nordstrom LG, Ojehagen A. Nordic Journal of Psychiatry. 61:92-99 (2007) Alcohol use disorders in schizophrenia. [Sweden] Jones RM et al. Journal of Clinical Psychiatry. 72:775-79 (2011) “Cormorbid AUDs in schizophrenia are associated with increase morbidity, more inpatient treatment, and violent offending. It is of clinical importance to identify those with schizophrenia who may go on to develop an AUD.”

15. 800-767-4411 rogershospital.org Thank you! Michael M. Miller, MD, FASAM, FAPA mmiller@rogershospital.org