1. Copyright Alcohol Medical Scholars Program1 Screening and Brief Interventions for Heavy Drinking Laura Jean Bierut, MD Alcohol Medical Scholars

2. Copyright Alcohol Medical Scholars Program2 Ms. Jones is a 38 yo high school teacher Recurrent abdominal pains Job related stress and anxiety Intermittent insomnia Irritability Gastritis on gastroscopy Intermittent hypertension

3. Copyright Alcohol Medical Scholars Program3 Drinking-Healthy or Harmful? Alcohol at low doses may have a beneficial effect. At higher doses, individuals are at greater risk for traumatic accidents and alcohol related problems. Estimated that 20% of patients in a general medical practice are drinking at hazardous levels.

4. Copyright Alcohol Medical Scholars Program4 Alcohol Dependence Alcohol Dependence is a clinical syndrome in which there are are a cluster of alcohol related symptoms. Alcohol Dependence has the signs of tolerance, withdrawal, and compulsive use. Despite alcohol related problems, an individual continues to use alcohol.

5. Copyright Alcohol Medical Scholars Program5 “At Risk Drinking” “At Risk Drinking” is a level of alcohol consumption that is directly harmful, or is correlated with a greater risk of health problems. Men: > 14 drinks per week 5 or more drinks per occasion Women: > 7 drinks per week 4 or more drinks per occasion

6. Copyright Alcohol Medical Scholars Program6 Assessment All patients in medical settings need to be evaluated for their alcohol use. Amount and frequency used must be assessed. Many screening tools for alcohol related problems are available.

7. Copyright Alcohol Medical Scholars Program7 Screening for “At Risk Drinking” and Alcohol Dependence How often do you have a drinking containing alcohol? How many drinks containing alcohol do you have on a typical day when you are drinking? How often do you have 6 or more drinks on one occasion?

8. Copyright Alcohol Medical Scholars Program8 Brief Intervention Most often used in non alcohol dependent subjects Generally 4 or fewer sessions Session lasts from a few minutes to an hour Conducted by non-addiction specialist

9. Copyright Alcohol Medical Scholars Program9 Goal of Brief Intervention Goal is to moderate drinking not abstinence

10. Copyright Alcohol Medical Scholars Program10 Elements of Brief Intervention Feedback Advice Commitment Tracking

11. Copyright Alcohol Medical Scholars Program11 Feedback Health care providers need to give feedback to patients regarding their drinking. Levels considered moderate drinking. Any medical consequences of drinking Any laboratory findings consistent with hazardous drinking.

12. Copyright Alcohol Medical Scholars Program12 Advice Explicit advice to reduce drinking. Guidelines for “low-risk” drinking. Goal can be written in the form of a prescription.

13. Copyright Alcohol Medical Scholars Program13 Commitment Brief intervention emphasizes the individual’s responsibility and choice for reducing drinking. “No one can make you change. What you do about your drinking is up to you.”

14. Copyright Alcohol Medical Scholars Program14 Tracking Follow up may take the form of telephone calls, repeat office visits, or laboratory tests. Assessment of progress. Ongoing support. Identification of further problems.

15. Copyright Alcohol Medical Scholars Program15 Brief Physician Advice for Problem Alcohol Drinkers Setting: Primary care practices Design: Randomized control trial Participants: Patients screened for problem drinking Intervention: 2 brief (15 minute) sessions

16. Copyright Alcohol Medical Scholars Program16 Effectiveness For non-alcohol dependent subjects, brief intervention reduces total amount of drinking and binge drinking.