From Clinicaltools.com

The Role of the Physician in Alcohol Abuse Detection and Treatment

Description

(Steve draft) A physician's professional role is to help their patients be healthy, thus a natural window exists to include information about their patient's alcohol use in order to determine if it may be negatively effecting their health.

As a primary source of alcohol use disorder identification, physicians serve a vital role in alcohol detection and patient treatment. A combination of knowledge and practice, including proper communication skills, must be available to students in order to fully aid patients in treatment and recovery.

URL

The Role of the Physician in Alcohol Abuse Detection and Treatment (Draft)

Need

Physicians-in-training, as well as practicing physicians, report low satisfaction with treating patients for substance abuse disorders. By changing student attitudes towards patients who abuse alcohol, we can increase the number of patients who receive adequate care for alcohol use disorders.

Needs Analysis

(In the spring of 2008, we conducted a focus group with 13 medical school faculty and addiction consultants. The results of the focus group shaped our module outline and content.)

Brief Summary: With a rating scale of 1-5, the importance of "Role of the Physician" as a topic are to be covered was rated 4.54, as was the implication that the average medical student would benefit from additional instruction in this topic and the willingness of faculty to encourage students to learn more about the topic. The willingness to include this module in current teaching was rate 4.00 and the ease of fitting the module into the institution's current curriculum was rated 3.83. The topic was deemed to align with recommended physician competencies in the area of substance abuse with a rating of 3.90. The highest number of respondents (4) were evenly split between devoting up to half an hour and an hour of lecture time to the topic. A number of aspects of the topic were requested for emphasis and these areas were taken under consideration when devising the course.

Vision

Physicians-in-training know how to screen effectively and interpret screening results to form a diagnosis.

Mission

To demonstrate the important role that physicians play in addressing alcohol use disorders in patients.

Goal

Through this course, students will understand how their role as a physician can influence patients who misuse alcohol, learn effective communication skills, and gain clinical skills in interviewing and working as part of a multi-disciplinary team.

Learning Objectives

Describe how to confidently interview patients for alcohol use
Develop a screening or treatment plan that coordinates patient care with other health professionals
Describe treatment confidentiality in multiple contexts with multiple parties.
Learn interviewing techniques to assist screening of patients who are reluctant to disclose alcohol use.

Case Study 1: Tim

Case Focus: Tim is presented in five different, consecutive pages. Tim is introduced in a section titled "Multidisciplinary Teamwork" and follows a page about referral for treatment. Because of the length of this case, Tim's history is thoroughly presented, along with sample patient/doctor dialogue to motivate Tim and seek treatment for his alcohol misuse.

Case Goal: Physicians-in-training will apply their knowledge to assess for alcohol use and work as part of a multidisciplinary team, utilizing the strengths of each contributory member, in order to refer to specialist treatment.

Course Objectives Met: 1, 2

Patient: Tim - 32YOWM

Chief Complaint: Self-realized alcohol use problem coupled with court-ordered treatment due to DUI
Narrative: Tim is a 32 year old construction worker who has received his second DUI. In order to get his license back, he must got through court-ordered treatment for his alcohol use. He's been referred to you because of suspected withdrawal symptoms.
Alcohol Use: 4 drinks about 4 nights a week; once a month drinks 6+ drinks in one sitting. Drives under the influence, scored 24 on AUDIT
AUD Diagnosis: Alcohol dependent
Relevant Past Medical, Psychosocial, Family History: Single father, Tim's mother takes care of grandchild while Tim's at work. Tim is in need of specialist treatment because of high level of alcohol use. Because of family obligations and trouble with the law, Tim is open to alcohol treatment and shows a willingness to attempt sobriety.
Take Home Message: Physicians-in-training should work with other healthcare professionals to obtain treatment for alcohol users if warranted. In this case, Tim agrees to continue outpatient treatment in conjunction with pharmacological treatment for his withdrawal symptoms. Tim is personally motivated to seek treatment, and the physicians-in-training should pick up on this and interview Tim using this motivational information. This case also touches on follow-up appointments and discussing treatment progression with specialists.
Practice Tip: A solid professional support system can help patients seek appropriate treatment for alcohol use disorders.
URL's: Beginning of Tim's case

Case Study 2: Rosa

Case Focus: Rosa is presented in 5 different, consecutive pages under a section titled "Reluctant Patients". This case provides sample dialogue of how physicians can interact with patients who are combative or reluctant to acknowledge the presence of an AUD.

Case Goal: To present physicians-in-training with a case study involved a patient who is reluctant to acknowledge an alcohol use disorder.

Course Objectives Met: 4

Patient: Rosa - 26YOHF

Chief Complaint: Self-described depression. Seeks treatment
Narrative: Rosa is a 26 year old office clerk at the courthouse downtown. At times, she's reported crying, sleeplessness, and headaches. She's had to miss work periodically because she's been unmotivated to go in and feeling very lethargic, but she quickly rebounds and returns to work as upbeat as ever the next day.
Alcohol Use: She drinks two times a week, consuming 3 standard drinks at a time, but indulges in 6 or more drinks once a month during parties. AUDIT score of 14.
AUD Diagnosis: At risk for alcohol abuse. Needs to overcome reluctance to treatment; achieved by simple first steps such as changing social situations where drinking is more prevalent
Relevant Past Medical, Psychosocial, Family History: Single, multiple friends she spends most of her time with.
Take Home Message: Not all patients will accept that they have a drinking problem. Rosa's case presents a patient reluctant to acknowledge a problem. The physician wisely suggests that Rosa try simple steps to slowly decrease alcohol consumption, putting these changes in context of helping her depression. It is not explicitly stated whether Rosa's drinking is a cause of her depression.
Practice Tip: By focusing on the problem from multiple angles, it may help the patient approach change more willingly. Give them options, small steps which they can accomplish and make them feel as if they can get a handle on the situation. Also, by not forcing them to change their patterns too drastically, the slow change may be more successful.
URL's: Beginning of Rosa's case