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How Professionals Screen For Risky Alcohol Use

December 19, 2018

With the parties, charcuterie platters and twinkling lights of the holiday season comes an increase in alcohol consumption.

Adding to the typical warnings about drinking and driving, however, is the heightened responsibility for front-line clinicians to screen for risky drinking and signs of alcohol use disorder, or AUD, according to Dr. J. Craig Allen, director of Rushford at Hartford HealthCare.

There is a marked increase in alcohol use disorder in patients having behavioral health conditions, and the stress of the holiday season only exacerbates both in certain populations, Dr. Allen said.

“There are simple, quick screening tools to identify risky alcohol use,” he said, noting that tools can be as basic as a few pointed questions to discover how often the person drinks alcohol and how much they drink.

From 2002 to 2013, he said, high-risk drinking among females in the United States jumped 58 percent, with a spike in alcohol use disorder noted among women of 83.7 percent in the same time period. In the decade from 2007 to 2017, there was a 35 percent increase in deaths attributed to alcohol. In women, the increase was 85 percent.

“This is clearly an issue, one that was outlined in a 2016 surgeon general’s report entitled ‘Facing Addiction in America,’” Dr. Allen said.

Hartford HealthCare providers follow the National Institutes of Health guidelines to identify heavy drinking. For men, “at-risk” or “heavy” drinking is defined as more than four drinks on a single day or more than 14 per week. For women, the number is more than three drinks on a single day or more than seven per week. High-risk drinking means the person is at enhanced risk for having or developing an AUD and/or the physical results of alcohol exposure like hypertension, liver disease, gastrointestinal issues and cancers.

Other techniques to detect use or manage treatment of alcohol use disorder are biochemical tests that can identify drinking through urine or blood samples.

Treatment of alcohol use disorder should include pharmacologic intervention as recommended by the American Psychiatric Association guidelines issued last January, Dr. Allen said. This strategy, combined with therapy, is employed in all Medication Assisted Treatment Close to Home (MATCH) programs in place across the Behavioral Health Network.

For clients with alcohol use disorder who are not open to treatment, he suggested “motivational interviewing” and harm-reduction as strategies to meet the client where they’re at and engage them in discussion about a healthier lifestyle.

“We know that 29 percent of adults will have alcohol use disorder in their lifetime and that carries a host of related medical concerns,” Dr. Allen said. “But, in our field, the impact on psychiatric illness and suicide warrants a best practice of universal screening. Once identified with AUD, we know that best outcomes result from concurrent treatment of co-occurring disorders.”

For more information on the MATCH program at Hartford HealthCare, click here.