From Clinicaltools.com

Screening, Assessment, and Diagnosis of Alcohol Abuse or Dependence

Description

(Steve draft) Once realized as a physician they can make a difference, how do they go about identifying which of their patient's health is being negatively effect.

When interacting with a patient at risk for or diagnosed with an alcohol use disorder, the physician's role is not only confined to screening and providing brief interventions. The physician's role also includes listening, interviewing, proper communication with the patient, and coordination with other health professionals involved in patient care.

URL

Screening, Assessment, and Diagnosis of Alcohol Abuse or Dependence (Draft)

Need

Although routine screening of all adults and adolescents for the continuum of alcohol use problems is currently recommended, it often does not occur, and thus alcohol misuse problems are often left untreated. Physicians-in-training need to know how to screen and how to translate screening results into a diagnosis.

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

The CTI Solution.

The solution is to learn how to effectively screen, assess and diagnose each of their patient's alcohol use.

To provide physicians-in-training with the skills to screen patients and the background understanding and other clinical skills to translate the screen results into a diagnosis.

Goal

As a result of completing this course, medical students will be able to confidently assess and screen individuals for alcohol use disorders.

Learning Objectives

Properly conduct a basic patient interview assessing for alcohol use disorders
Describe screening instruments and know how to screen and interpret the results
Correctly identify the basic criteria and distinguishing factors between abuse and dependence
Establish a preliminary diagnosis for patients with abuse or dependence and outline a plan for treatment

Case Study 1: Mike

Case Focus: Mike is presented in 3 different, non-consecutive pages. Mike's case is intermixed with factual information on tips for screening and using screening results. Mike's case is used to provide physicians-in-training with the opportunity to choose an appropriate screening test and approach the patient with the results. Mike is then referred to again in the next section on "Assessment" to identify possible warning signs of alcohol misuse.

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, 2

Patient: Mike - 40YOAM

Chief Complaint: Pre-operative screening for a torn ACL
Narrative: Mike is in the office for a pre-operative screening and has revealed daily alcohol use
Alcohol Use: 2-3 drinks every day
AUD 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.
Relevant Past Medical, Psychosocial, Family History: No known history
Take Home Message: 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.
Practice Tip: Proper phrasing of the alcohol screening instrument questions will provide better feedback and more valid results.
URL's: Meet Mike; Conversing with Mike

Case Study 2: Tommy

Case Focus: Tommy is presented in 6 different, consecutive pages. Tommy is presented in his own section as a thorough case study, including dialogue and a "What Would You Do" clinical question. Tommy's case focuses on tolerance, medical complications (gastritis), and work/social barriers to decreasing alcohol use.

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, 4

Patient: Tommy - 34YOWM

Chief Complaint: Pains in stomach
Narrative: 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.
Alcohol Use: 4-5 shots 1-2 times a week
AUD Diagnosis: Alcohol abuse. Tommy has gastritis, exacerbated by the fact he drinks.
Relevant Past Medical, Psychosocial, Family History: 2 year old daughter, Living with child's mother
Take Home Message: 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.
Practice Tip: 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.
URL's: Tommy's Case

Case Study 3: Walt

Case Focus: Walt is presented in 5 different, consecutive pages in his own section. Walt is presented immediately following a section on "Diagnosis" and illustrates that a thorough case history can help in the assessment and diagnosis of a possible AUD.

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, 2

Patient: Walt - 64YOWM

Chief Complaint: Came in for annual physical
Narrative: 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.
Alcohol Use: A glass of wine 5 times a week
AUD Diagnosis: At risk for alcohol abuse.
Relevant Past Medical, Psychosocial, Family History: Married with grandchildren not in immediate area. Blood pressure results are high (160/100).
Take Home Message: 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.
Practice Tip: 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.
URL's: Walt's Case