1. ED Screening for At-Risk Drinkers

2. UNIVERSAL SCREENING WIDENS THE NET ABSTAINERS & MILD DRINKERS (70%) MODERATE (20%) at risk drinkers SEVERE (10%) Primary Prevention Brief Intervention Specialized Treatment

3. Preface for Screening Questions I am going to ask you some personal questions that I ask all my patients.I am going to ask you some personal questions that I ask all my patients. Your responses will be confidential.Your responses will be confidential. These questions help me to provide the best possible care.These questions help me to provide the best possible care. You do not have to answer them if you are uncomfortable.You do not have to answer them if you are uncomfortable.

4. The Health Promotion Approach Do you wear seat belts?Do you wear seat belts? Are you safe in your current relationship?Are you safe in your current relationship? Do you smoke?Do you smoke? Do you drink?Do you drink? Do you use non-prescription drugs?Do you use non-prescription drugs?

5. Remember that a “standard drink” consists of:

6. Biological Measures –Blood Alcohol Level (BAL) 0.015 mg% = 1 drink (14 gms) –a standard drink is metabolized in 60-90 minutes in an average person –3-4 standard drinks over 1- 2 hours to get to 0.08 mg% (women) –5-6 standard drinks to get to 0.08 mg% (men) Mortality/1000 0 10 20 30 40 50 0 1-100 101-250 251-400 >400 Weekly alcohol consumption (g) Violent death Other causes of death 7-17 drinks per wk

7. Screening Questions: In the last 30 days   On average, how many days per week do you drink alcohol ( beer, wine, liquor )?   On a typical day when you drink, how many drinks do you have?   What is the maximum number of drinks you had on any given occasion during the last month?

8. CAGE Screening Questions: In the last year…  Have you ever felt that you should Cut down on your drinking?  Have people Annoyed you by criticizing your drinking?  Have you ever felt bad or Guilty about your drinking?  Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (Eyeopener)?  cut point=1, sensitivity=.67, specificity=.82

9. TWEAK (validated for women) How many drinks can you hold? (Tolerance)How many drinks can you hold? (Tolerance) Have close friends or relatives worried… ? (W)Have close friends or relatives worried… ? (W) Do you drink when you first get up? (Eye opener)Do you drink when you first get up? (Eye opener) Has a friend told ‘x’ you could not remember? (Amnesia)Has a friend told ‘x’ you could not remember? (Amnesia) Do you feel the need to cut down on your drinking? (Kut)Do you feel the need to cut down on your drinking? (Kut) Cut point=2, sensitivity=.73; specificity=.90Cut point=2, sensitivity=.73; specificity=.90

10. Biological Measures Blood Alcohol Level/BreathalyzerBlood Alcohol Level/Breathalyzer MCV (Mean Corpuscular Volume)MCV (Mean Corpuscular Volume) GGT (Gamma-Glutamyl Transferase)GGT (Gamma-Glutamyl Transferase) CDT (Carbohydrate-Deficient Transferrin)CDT (Carbohydrate-Deficient Transferrin) Urine Toxicology ScreensUrine Toxicology Screens