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Course Details

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Screening, Assessment, and Diagnosis of Alcohol Abuse or Dependence

Description

It is recommended that all patients be screened for alcohol use and potential misuse. In reality, physicians may not screen patients for alcohol misuse due to time constraints, other pressing medical problems, or a lack of competence in properly screening a patient. This course provides a clinical skills overview into how to properly screen, assess, and diagnose a patient with an alcohol use problem.

Need

Alcohol misuse problems, from at-risk drinking to dependence, may go undetected and untreated because not every physician routinely screens patients for alcohol use.

Needs Analysis

(In the spring of 2008, we conducted a focus group with 13 medical school faculty and addiction consultants. The [http://intranet.clinicaltools.com/node/2332)

Brief Summary: results of the focus group shaped our module outline and content. With a rating scale of 1-5, the importance of Detection, Diagnosis, and Assessment was rated 4.75, as was the belief that the average medical student would benefit from additional instruction in this topic. A rating of 4.42 was given on ease of inclusion for this module into the institution's current curriculum and a rating of 4.54 was given for personal willingness to include this module in current teachings. Faculty were very willing to encourage students to learn more about the topic, with a rating of 4.77, and the topic was deemed to align with recommended physician competencies in the area of substance abuse with a rating of 4.54. The most respondents (6) thought that the topic should have 2 hours of lecture time devoted to it. A number of aspects were requested for emphasis, which we took under consideration when creating the course content.

Vision

Physicians in training can complete a screen successfully to make an accurate diagnosis.

Mission

To present learners with key clinical skills in screening patients for alcohol use that will lead to a successful assessment and diagnosis of an alcohol use disorder.

Goal

Learners will be competent in screening patients for alcohol use and properly assessing potential alcohol use disorders.

Learning Objectives

Confidently conduct a basic patient interview assessing for alcohol use disorders
Choose and implement an appropriate screening instrument
Correctly identify the basic criteria and distinguishing factors between abuse and dependence in patients
Outline a preliminary diagnosis for patients with abuse or dependence

Case Studies

Case Study 1: Mike

Educational Objectives

Case Goal: To present physicians-in-training with a patient who is a candidate for alcohol screening. The physician-in-training is expected to choose an appropriate screening instrument and choose an appropriate dialogue with the patient as part of the screening instrument. The physician-in-training also is asked to choose different possible red flags or warning signs of abuse.

Course Objectives Met: (1) and (2)

Expected Diagnosis: Although Mike drinks 2-3 drinks daily, this case does not follow through the entire CAGE to warrant an AUD assessment. This case merely presents ways in which a physician can administer a screening instrument.

Take Home Message/Practice Tip: It is important for all physicians to routinely question patients about alcohol use. In this case, any alcohol use by Mike may affect his post-operative recovery from a torn ACL. Mike should be administered an alcohol screening instrument and his results used accordingly. Proper phrasing of the alcohol screening instrument questions will provide better feedback and more valid results.

Case Specifics

Patient: Mike - 40 YOAM

Case Information: Mike is in the office for a pre-operative screening and has revealed daily alcohol use

Chief Complaint: Pre-operative screening for a torn ACL

Relevant Past Medical, Psychosocial, Family History: Drinks 2-3 drinks every day. No known history

Case Study 2: Tommy

Educational Objectives

Case Goal: Physicians-in-training will be able to detect medical complications from alcohol use and devise a plan for the patient to decrease alcohol use.

Course Objectives Met: (1), (3), and (4)

Expected Diagnosis: Alcohol abuse. Tommy has gastritis, exacerbated by the fact he drinks.

Take Home Message/Practice Tip: Tommy needs to commit to a plan where he eliminates alcohol from his daily routine. Tommy has a medical complication (gastritis) which exacerbates the need to decrease/abstain from alcohol use. Moderation may be a good middle ground step in achieving overall abstinence in the patient. Tommy's work environment perpetuates drinking, and he is reluctant to totally abstain. Creating a treatment plan which at least decreases alcohol use will help Tommy eventually achieve sobriety.

Case Specifics

Patient: Tommy - 34YOWM

Case Information: Tommy is a 34 year old bartender who has worked at the same bar for 5 years and has been a bartender for 10 years.

Chief Complaint: Pains in stomach

Relevant Past Medical, Psychosocial, Family History: 2 year old daughter, Living with child's mother. Tommy does 4-5 shorts 1-2 times a week at work

Case Study 3: Walt

Educational Objectives

Case Goal: Physicians-in-training will be able too effectively assess and diagnose an older patient with an alcohol use problem.

Course Objectives Met: (1) and (2)

Expected Diagnosis: At risk for alcohol abuse.

Take Home Message/Practice Tip: Alcohol affects older adults differently as they have had changes in their ability to metabolize alcohol. This has negatively affected Walt's blood pressure and should be dealt with accordingly. Walt came in with high blood pressure, which is a common symptom among older adults. However, it is important not to immediately attribute a common symptom with the most common diagnosis. By getting a more thorough case history, you can more accurately diagnose the underlying issue. Contributing health factors throughout the aging process can cause differences in how alcohol is metabolized and actually cause alcohol to affect the body more strongly than in earlier years.

Case Specifics

Patient: Walt - 64YOWM

Case Information: Walt is a 64 year old former factory worker, now retired. He has come in for his annual physical and has had no physical complaints to acknowledge.

Chief Complaint: Came in for annual physical

Relevant Past Medical, Psychosocial, Family History: Married with grandchildren not in immediate area. Blood pressure results are high (160/100). A glass of wine 5 times a week