Screening Questions for Alcohol-Related Problems All patients Do you drink alcohol, including beer, wine or distilled spirits? Current drinkers On average, on how many days per week do you drink alcohol?
Two to three times per week Four or more times per week 9. Have you or someone else been injured as a result of your drinking? No Yes, but not in the last year Yes, during the last year Has a relative or friend, or a doctor or other health worker, been concerned about your drinking or suggested you cut down?
Questions 9 and 10 are scored 0, 2, or 4 only. Screening in the Emergency Department—Many of the estimated million emergency department ED visits in the United States each year are related to alcohol use. Up to 31 percent of patients treated in EDs and 50 percent of severely injured trauma patients i.
Patients treated in EDs also are 1. Likewise, Hungerford and colleagues 19 screened a sample of young adults ages 18 to 39 while they were waiting for treatment in the ED.
Most of these patients 87 percent consented to the screening. The high prevalence of alcohol problems and the broad acceptance of screening and brief intervention in this sample show that screening is indeed feasible in an ED setting Yet barriers to screening in an ED setting are clear.
This environment typically is chaotic and time is precious. Emergency practitioners and trauma physicians may believe that interventions for alcoholism are ineffective, or they may lack confidence in their ability or the ability of their staffs to screen patients effectively.
And resources may not be available for conducting screening and brief interventions in the ED In some cases, ethical and insurance issues also present obstacles to screening.
For example, because of existing laws, third-party payers i. This can place a large financial burden on the patient or on the treating hospital if it does not receive payment from the patient or the insurance company.
Another legal issue related to screening for alcohol use in the ED is the possible denial of benefits because the patient was injured while committing a crime. In many States, driving while impaired DWI is a felony, especially if a crash is severe enough to result in the need for medical attention.
Many States classify them as misdemeanors. A number of States, however, classify DWI offenses as felonies under the following circumstances: Many insurance policies will not pay benefits for injuries sustained during the commission of a felony but will provide for injuries sustained in the commission of a lesser crime.
Other policies, however, exclude benefits for injuries sustained in the commission of any criminal act; in these cases, lesser offenses such as public intoxication or illegal consumption of an alcoholic beverage could be used as justification to deny benefits An increase in screening has occurred in trauma centers in recent years, but the practice still is not routine To make screening, intervention, and referral as easy as possible and thereby to promote their use, the American College of Emergency Physicians 23 developed the Alcohol Screening and Brief Intervention Resource Kit for their members.
The kit is available via the Internet and contains an explanation of brief interventions, samples of patient handouts, and information on developing resource lists for individual communities. Screening in Prenatal Care Settings—Women who drink during pregnancy come from all walks of life Anywhere from 14 to Surgeon General recently issued an advisory warning pregnant women and women who might become pregnant to abstain from any alcohol use to eliminate the chance of giving birth to a baby with Fetal Alcohol Spectrum Disorders FASD —a range of preventable birth defects caused by prenatal alcohol exposure Identifying women who are drinking during pregnancy clearly is important Many women alter their drinking once they learn they are pregnant But a woman may have been drinking harmful levels of alcohol prior to learning about her pregnancy, and some injury already could have been done to the fetus.
Asking her about her drinking patterns before she became pregnant would solicit more accurate measures of her first-trimester consumption A woman also may not report her alcohol consumption accurately because she is embarrassed or afraid to admit to drinking while pregnant And popular screening instruments, such as the CAGE, although effective in other populations, may not identify harmful drinking by pregnant women T-ACE has been tested in a wide variety of obstetric practices 32,33 and has proven to be a valuable and efficient tool for identifying a range of alcohol use, including any current prenatal alcohol consumption, prepregnancy risk drinking defined as more than two drinks per drinking dayand lifetime alcohol diagnoses based on the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised How many drinks does it take to make you feel high?
A Have people annoyed you by criticizing your drinking?
C Have you ever felt you ought to cut down on your drinking? Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover? A score of 2 or more is considered positive.
Women who screen positive using the T-ACE or another screening questionnaire, such as the AUDIT, should receive further assessment and brief intervention to help reduce the risk to the developing fetus and to maximize pregnancy outcome.
Screening in the Criminal Justice System—By the end ofabout 1.One of the most serious problems related to alcohol use is underage drinking. People under 21 years old are especially at risk of becoming binge drinkers and damaging their own development.
Traffic collisions, accidental injury and illness, intentional illness and other crime, the need for rehabilitation programs, and suicide are all increased. Exposure to Alcohol Advertisements and Teenage Alcohol-Related Problems.
Jerry L Problems due to alcohol use were assessed with 8 self-report items. 21 Participants indicated how often their alcohol use caused them problems, such as not being able to do their homework, getting into fights, neglecting responsibilities, or causing someone.
Preventing Alcohol Abuse and Related Problems-- A Commentary by NIAAA Director Enoch Gordis, M.D. Prevention encompasses activities or actions ranging from those affecting the whole population through social and regulatory controls to those affecting specific groups, such as adolescents, or the individual.
Paul J. Gruenewald, Ph.D. Regulations on the availability of alcohol have been used to moderate alcohol problems in communities throughout the world for thousands of years. In the latter half of the 20th century, quantitative studies of the effects of these regulations on drinking and related.
Several studies of early and brief physician interventions have demonstrated a reduction in alcohol consumption and improvement in alcohol-related problems among patients with drinking problems Can a person’s genes affect their risk of alcohol-related cancers?
Can drinking red wine help prevent cancer? The Million Women Study in the United Kingdom (which included more than 28, women with breast cancer) provided a more recent, and slightly higher.