Who are the addicts Screening Why screen universally Drinking and drug use are common often go undetected can increase risks to safety and health problems Routine screening for other potential medical problems eg cancer diabetes hypertension Why not for alcohol and drug us ID: 707322
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Slide1
How To Do…
ScreeningSlide2
Screening: Why do SBIRT?
“Who are the addicts?”Slide3
Screening: Why screen universally?
Drinking and drug use…
are common
often go undetected
can increase risks to safety and health problems
Routine screening for other potential medical problems (e.g. cancer, diabetes, hypertension). Why not for alcohol and drug use?
*People are more open to change than we might expect.Slide4
Criteria for Screening
Significant morbidity/mortality
High prevalence
Long asymptomatic periodValid, feasible screening testEarly intervention better (than later)
Available and effective treatmentsSlide5
Screening: Benefits
Detect
current health problems related to at-risk alcohol and drug use
Detect alcohol and drug use patterns that can increase risk of future injury/illnessIntervene and educate about risky alcohol
and drug usePrevent medical and prescribing errors Slide6
Targeted InterventionSlide7
Drinkers who screen positive may meet criteria for…
Alcohol Misuse (at-risk drinking)
hazardous drinking (no consequences yet)
harmful drinking (consequences experienced)
Alcohol AbuseAlcohol DependenceSlide8
What is Alcohol Dependence?
DSM-IV-TR Criteria
Evidence of tolerance or symptoms of withdrawal
Sweating, increased pulse rate, hand tremor, anxiety, nausea
A prior patient history that includes a pattern of compulsive use, high levels of alcohol intake, and increased alcohol-related problems
Devoting substantial periods of time to obtaining and consuming alcohol
Often drinking more than intended to
Unsuccessful efforts to cut-down or control intake
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth edition. Test Revision (DSM-IV-TR). Arlington, VA: American Psychiatric Association, 2000.Slide9
What is Alcohol Abuse?
DSM-IV-TR Criteria
Diagnosed after the absence of alcohol dependence as been established
A maladaptive pattern of use leading to significant clinical impairments within the past 12mos., including one or more of the following:
Failure to fulfill role obligations
Recurring use of alcohol in hazardous situations
Recurring alcohol-related legal problems
Continued alcohol use despite recurrent interpersonal problems
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth edition. Test Revision (DSM-IV-TR). Arlington, VA: American Psychiatric Association, 2000.Slide10
The medical setting is a good home for screening & intervention
Alcohol & drug use contributes to injury & illness
Alcohol & illicit drugs interact with prescribed medications
Alcohol & drug use affects families & communities
Early intervention may reduce health consequences and save health care dollarsFor many patients, SBI alone may be sufficient Slide11
Patients
Are
Open to Discussing Their Substance Use to Help Their Health
Survey on Patient Attitudes:
Agree/Strongly Agree
“If my doctor asked me how much I drink, I would give an honest answer.”
92%
“If my drinking is affecting my health, my doctor should advise me to cut down on alcohol.”
96%
“As part of my medical care, my doctor should feel free to ask me how much alcohol I drink.”
93%
Disagree/Strongly Disagree
“I would be annoyed if my doctor asked me how much alcohol I drink.”
86%
“I would be embarrassed if my doctor asked me how much alcohol I drink.”
78%
Source: Miller, PM, et al. Alcohol & Alcoholism; 2006
Adapted from The Oregon SBIRT Primary Care Residency Initiative training curriculum (www.sbirtoregon.org
)Slide12
Introduction to Screening
Hello, I’m ______, a Health Promotion Advocate here at ____.
As a part of your medical team, my job is to ask all patients some personal questions to help you get the best care possible.
You do not have to answer them if you feel uncomfortable.Slide13
It’s Useful to Clarify
W
hat is One Drink!Slide14
How Much
I
s “One Drink”?
12-oz glass of beer (one can)
5-oz glass of wine
(5 glasses in one bottle)
1.5-oz spirits
80-proof
1 jigger
Equivalent to 14 grams pure alcoholSlide15Slide16
NIAAA Definitions for Unhealthy Drinking
At-risk for increase in illness & injury
men: >14 drinks/wk or 5+ drinks/occasion
women: >7 drinks/wk or 4+ drinks/occasionelders (+ 65): >7 drinks/week or 2+ drink/day
pregnant women: any use of alcoholSlide17
Brief Alcohol and Drug Screening Questions
Alcohol:
Frequency
On average, how many days per week do you drink alcohol?
(
beer, wine, liquor
)
Alcohol: Quantity
On a typical day when you drink, how many drinks do you have?
Heavy Episodic Drinking (HED)
In the last month: What is the maximum number of drinks you had in a 2-hour period?
Drugs
: Any
Use
In the past year: How many times have you used an illegal drug, or used a prescription medication for nonmedical reasons?Slide18Slide19
Validated Screening Instruments
Reimbursement requires using validated screening instruments
AUDIT, AUDIT-C
DASTSlide20
The AUDIT
Developed by WHO
Evaluated over 20 yrs
Accurate measure of risk across gender, age, & cultures
3 domains of drinking
Scores 8 > indicate risky drinking (give BNI)
Scores 20 > may indicate need for treatmentSlide21
AUDIT-C
(shorter version)Slide22
The DASTSlide23Slide24
Enter scores into electronic medical records for billingSlide25
Transition to Brief Intervention
Thanks so much for answering those questions.
I was wondering if it would be okay if we talked a little bit more about _____?