I n t e g r i t y - S e r v i c e - E x c e l l e n c e Headquarters U.S. Air Force 1 Clinical Assessment of Alcohol Use

I n t e g r i t y - S e r v i c e - E x c e l l e n c e 2 Clinical Assessment Standardized Screening Tools Clinical Interview Physical Exam & Lab Tests

I n t e g r i t y - S e r v i c e - E x c e l l e n c e 3 Standardized Screening Tools AUDIT AUDIT-C CAGE DSM Screener MAST UNCOPE Refer to Alcohol Screening Tools Chart for comparison of various tools

I n t e g r i t y - S e r v i c e - E x c e l l e n c e 4 Clinical Interview: Basics Pattern of use: Frequency, duration, quantity, etc. Negative consequences of use, if any: Physical, Medical, Psychological, Emotional, Legal, Social, Familial, Relational, Occupational, Financial Substance Abuse criteria Substance Dependence criteria

I n t e g r i t y - S e r v i c e - E x c e l l e n c e 5 Alcohol Abuse Criteria: Diagnosis met by meeting one or more of these four criteria Recurrent inability to meet role obligations at work, school, or home Recurrent use in situations where it was physically dangerous to do so Recurrent alcohol-related legal problems Recurrent social or interpersonal problems caused or exacerbated use

I n t e g r i t y - S e r v i c e - E x c e l l e n c e 6 Dependence Criteria: Diagnosis met by meeting three or more of these seven criteria Presence of tolerance Presence of withdrawal symptoms Often consume more than intended Persistent desire/unsuccessful efforts to reduce use Much time spent obtaining, using, or recovering Important activities given up or reduced due to use Continued use despite knowledge use is causing or aggravating physical or psychological problem

I n t e g r i t y - S e r v i c e - E x c e l l e n c e 7 Clinical Interview What follows is a series of questions offered as examples of potential clinical interview questions Providers are free to use some, all, or none of these questions, and can choose to add questions of their own

I n t e g r i t y - S e r v i c e - E x c e l l e n c e 8 Clinical Interview Do you drink? How often do you drink? How many days per week do you drink on average? How much do you drink per occasion? [or When you drink, how many drinks do you consume on average?] Do you ever drink more than [4 drinks for women or 5 drinks for men] in one setting? If yes, how often do you drink that much or more? Describe a typical drink (i.e., type of alcohol and quantity of serving)

I n t e g r i t y - S e r v i c e - E x c e l l e n c e 9 Clinical Interview How often do you drink to the point of intoxication? How many drinks does it take for you to feel intoxicated? Does it take more alcohol for you to become intoxicated now than in the past? Do you ever feel sick when you stop drinking? Do you need to continue drinking to avoid feeling sick? What is the longest period you’ve gone without drinking in the past year?

I n t e g r i t y - S e r v i c e - E x c e l l e n c e 10 Clinical Interview Has drinking ever caused you problems of any kind? Have you ever had legal problems due to alcohol? Have you ever had financial problems due to alcohol? Have you ever had any relationship problems due to alcohol?

I n t e g r i t y - S e r v i c e - E x c e l l e n c e 11 Clinical Interview Have you ever had problems at work because of alcohol? Have you ever been late to work because of your drinking? Have you ever missed a day of work due to drinking? Have you ever received disciplinary action because of your drinking? Has your work ever suffered because you were intoxicated or had a hangover at work?

I n t e g r i t y - S e r v i c e - E x c e l l e n c e 12 Clinical Interview Have you ever felt the need to cut down on your drinking? Has anyone ever complained to you about your drinking? Has anyone ever criticized you because of your drinking? Have you ever been angry or irritated by comments or questions about your drinking? Have you ever felt guilty about your drinking or about something you did while drinking? Have you ever felt the need for a morning drink to get you going?

I n t e g r i t y - S e r v i c e - E x c e l l e n c e 13 Clinical Interview Have you ever suffered an injury while drinking? Have you ever driven a vehicle after drinking? Have you ever been arrested for driving under the influence of alcohol? Have you ever been arrested for any other reason because of your drinking?

I n t e g r i t y - S e r v i c e - E x c e l l e n c e 14 Physical Exam & Lab Tests Physical findings are often nonexistent or minimal in the early stages of alcoholism or alcohol abuse Lab tests are also often normal until later stages of illness

I n t e g r i t y - S e r v i c e - E x c e l l e n c e 15 Physical Exam Findings Jaundice Spider angiomas Palmar erythema Gynecomastia Testicular atrophy Splenomegaly Multiple recent bruises Multiple healed injuries Enlarged liver Hardened liver Ascites Tremor Peripheral neuropathy Hypo/hyperreflexia Decreased motor strength

I n t e g r i t y - S e r v i c e - E x c e l l e n c e 16 Medical Complications Hepatitis Cirrhosis Pancreatitis Gastritis Ulcers & GI bleeding Anemia Cardiomyopathy Hypertension Wernicke-Korsakoff’s Syndrome Dementia Peripheral neuropathy Cerebellar degeneration Trauma Depression & other psychiatric disorders Fetal Alcohol Syndrome Testicular atrophy Myopathy

I n t e g r i t y - S e r v i c e - E x c e l l e n c e 17 Labs to Consider GGT often an early indicator of heavy alcohol use Sensitivity 40-60% Specificity 90% Returns to normal within a few weeks of sobriety

I n t e g r i t y - S e r v i c e - E x c e l l e n c e 18 CBC Chem 7 LFT’s Bilirubin BUN Creatinine Blood alcohol PT Cholesterol Triglycerides Ca, Mg Albumin, total protein B12, Folate Stool guaiac Urine drug screen Hep B & C Labs to Consider

I n t e g r i t y - S e r v i c e - E x c e l l e n c e 19 Potential Lab Findings ↑ GGT ↑ AST, ALT, LDH ↑ Alk Phos ↑ PT ↑ Amylase ↑ Triglycerides ↑ Bilirubin ↑ Uric Acid ↑ MCV ↓ Hct & Hg ↓ B12 & Folate ↓ Albumin ↓ Total protein ↓ WBC & platelets

I n t e g r i t y - S e r v i c e - E x c e l l e n c e 20 Questions?