1. Treating Alcohol Abuse
A Collaborative Approach to Care
July 14, 2018 * Tex-CHIP Training Series

2. Role of Nutrition & Lifestyle in Prevention/Management of Alcohol Abuse

3. Understanding Provider Role in Treating Alcohol Abuse
Registered Dietitian’s focus is on the nutrition diagnosis rather than medical or psychiatric diagnosis
Nutrition diagnoses are written as a “PES” statement which identifies the nutrition Problem, it’s Etiology, and the Signs/ Symptoms which point to that problem
Example:
Underweight related to inadequate energy intake as evidenced by BMI of 14 and reported intake of <50% of estimated calorie needs.

4. Understanding Provider Role in Treating Alcohol Abuse
Interventions, goals, and evaluation methods are then tailored to the nutrition diagnosis
Example:
Educated client on estimated calorie needs
Recommended prescription to PCP for oral nutrition supplement once daily to help meet estimated needs
Most PES statements in this population are surrounding energy balance, weight status and history, hydration status, and nutrient deficiencies

5. Considerations when Interacting with Clients
Cognitive Considerations:
Impaired cognition makes accuracy or dietary recalls questionable
Be aware of the emotional fragility of client and caregiver
Scope of Practice Considerations:
Redirect conversations to stay within bounds of RD’s Scope of Practice
Home Life Considerations:
Does client have a support system or enablers?
Finances, available tools, & surrounding community play large roles in recovery

6. Considerations when Interacting with Clients
Anthropometric Considerations:
Collect information on height, weight, weight history, and Body Mass Index
Review recent and past lab values to identify any areas of concern (i.e. Liver disease, nutrient deficiencies, anemia, etc.)
Conduct a Nutrition-Focused Physical Assessment to help identify malnutrition
Nutrition Considerations:
Collect a 24-hour dietary recall from client and/or caregiver
Include information on vitamin or oral nutrition supplement use

7. Our Treatment Plan Healthcare Domain: Nutrition Provider: Dietitian
Objective:
Decrease in alcohol abuse as indicated by client report of:
Reduction in frequency and volume of alcohol consumption as compared to initial assessment and/or last follow-up
Improved nutrition status based on weight maintenance and energy and fluid intake meeting >75% of estimated needs
Compliance with vitamin and nutrition supplement orders as prescribed by PCP and/or RD
Goals:
Abstaining from alcohol
Energy and fluid balance by consuming foods and non-alcoholic beverages that provides % of estimated needs
Micronutrient deficiencies corrected, particularly so that serum B-vitamin, iron, and potassium levels are within normal limits
Prevent further damage through dietary management as able (i.e. liver disease, hypertension, anemia, etc.)
Interventions:
Assist client with revisiting coping strategies to manage triggers of alcohol consumption
Educate client on estimated calorie and hydration and provide sample culturally-relevant menu plans that meet client’s needs
Recommend and/or order prescriptions for multivitamin and/or oral nutrition supplements
Offer dietary education on management of complications of alcohol abuse as able

8. Measuring Outcomes/ Success
Weight maintenance or weight gain without increase in consumption of alcohol-containing beverages
Increased reports of energy and fluid intake according to 24- hour diet recall or food journal
Reports of decreased alcohol intake
Patient compliance with supplement use as prescribed
Lab values show micronutrient levels improving or within normal limits

9. Communication from Counselors
Helps gauge motivation and readiness to change
Provides insight on support system and home life that I may not have received from assessment conversations
Offers valuable information on progress being made, resources being sought, and emotional and mental state of client
Often times, nutrition status is not top-of-mind for a client seeking or receiving care for alcohol abuse