Alcohol Use Disorder A Patient-Centered, Evidence-Based Diagnostic and Treatment Process 1,2,3 A Presentation for SOMC Medical Education Kendall L. Stewart, MD, MBA, DLFAPA October 18, 2012 1 This presentation is designed as a problem-based learning module. 2 You will be surprised by many of your patients throughout your career. 3 Some of you and your colleagues will abuse alcohol.
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Alcohol UseDisorder
A Patient-Centered, Evidence-Based Diagnostic and Treatment Process1,2,3
A Presentation for SOMC Medical Education
Kendall L. Stewart, MD, MBA, DLFAPAOctober 18, 2012
1This presentation is designed as a problem-based learning module.2You will be surprised by many of your patients throughout your career.3Some of you and your colleagues will abuse alcohol.
• Alcohol misuse is a leading cause of morbidity and mortality.
• Alcohol problems are often comorbid with other physical and mental disorders.
• Alcohol-related healthcare costs are already north of $250 billion per year.
• Alcohol-related problems are under-diagnosed and under-treated.
• Treatment outcomes for alcohol use disorders are as good or better than those for other chronic illnesses.
• After listening to this presentation, you will be able to answer the following questions:
– Why is this important?– What are the diagnostic criteria?– What are some of the
demographics of alcohol use disorder?
– What are some clues to alcohol abuse?
– What is the CAGE screening tool?– What counseling techniques are
helpful?– What medications are helpful?– What should you do?1
1 Not surprisingly, these people are often untruthful; their families will call you with the real scoop.
What diagnoses will likely be included in this category in DSM-5?
• Alcohol-Related Disorders– Alcohol Use Disorder– Alcohol Intoxication– Alcohol Withdrawal– Alcohol Use Disorder Not Elsewhere
Classified (NEC)
What are the diagnostic criteria?1
• Problematic pattern of alcohol use causing significant impairment or distress– Alcohol used in greater amounts and longer than intended– Unsuccessful efforts to cut down usage– A great deal of time consumed by alcohol-related
activities and complications– An alcohol-related failure to fulfill obligations at school,
work or home– Continued alcohol use in spite of the problems it causes– Alcohol use negatively impacts social, occupational or
recreational activities– Recurrent use when physically hazardous– Continued use in spite of alcohol-related complications– Tolerance– Withdrawal– Craving
1 These are the proposed DSM-5 criteria.
How many people does drinking kill each year?1
Disease 34,000
Accidents 41,000
1 NBCNews.com.
What are some of the key demographics of alcohol use?1
• About 61% of Americans drink alcohol.• About 15% of those abuse it.• About 14% binge drink (5 or more drinks
during one episode)• Heavy use is more frequent in men (10%)
than in women (3%).2
• Maximum moderate alcohol use is 2 drinks per day for men and 1 drink per day for women.
• Alcohol use disorders are as common as hypertension and much more common than diabetes.
1Rakel and Rakel, Textbook of Family Medicine2Family physicians and anesthesiologists are over-represented among physician alcoholics.
• You must be the change you want to see in the world. Mahatma Gandhi
• Become a wellness champion and continue that lifestyle as long as you live.
• If you abuse alcohol, stop now; if you cannot, seek treatment and stick with it.
• Support prevention efforts for kids.• Ask every new patient about alcohol use.• If a patient drinks alcohol, screen them for
misuse.• Inquire whether patients who are abusing
alcohol are ready to stop—at every visit.1Rakel and Rakel, Textbook of Family Medicine
What else should you do?1
• Seize every teachable moment to urge quitting.
• View this as a chronic disease.• Remember that relapse is the rule rather
than the exception.• Focus on what you can do instead of fretting
about what you can’t do.• Bear in mind that the prognosis is not
hopeless.• Never, never, ever give up.
1Rakel and Rakel, Textbook of Family Medicine
The Psychiatric InterviewA Patient-Centered, Evidence-Based Diagnostic and Therapeutic Process
• Introduce yourself using AIDET1.• Sit down.• Make me comfortable by asking some
routine demographic questions.• Ask me to list all of problems and concerns.• Using my problem list as a guide, ask me
clarifying questions about my current illness(es).
• Using evidence-based diagnostic criteria, make accurate preliminary diagnoses.
• Ask about my past psychiatric history.• Ask about my family and social histories.• Clarify my pertinent medical history.• Perform an appropriate mental status
examination.
• Review my laboratory data and other available records.
• Tell me what diagnoses you have made.• Reassure me.• Outline your recommended treatment
plan while making sure that I understand.
• Repeatedly invite my clarifying questions.
• Be patient with me.• Provide me with the appropriate
educational resources.• Invite me to call you with any
additional questions I may have.• Make a follow up appointment.• Communicate with my other
physicians.1Acknowledge the patient. Introduce yourself. Inform the patient about the Duration of tests or treatment. Explain what is going to happen next. Thank your patients for the opportunity to serve them.
Psychiatry Pre Test Self-Assessment and Review, Twelfth Edition, March 20093
• Oransky, I, and Blitzstein, S, Lange Q&A: Psychiatry, March 2007• Ratey, JJ, Spark: The Revolutionary New Science of Exercise and the Brain, January
2008• Medina, John,
Brain Rules: 12 Principles for Surviving and Thriving at Home, Work and School, February 2008
• Stewart KL, “Dealing With Anxiety: A Practical Approach to Nervous Patients,” 2000• Order the Kindle version of the Rakel and Rakel Textbook of Family Medicine here.
Where can you find evidence-based information about mental disorders?
• Explore the site maintained by the organization where evidence-based medicine began at McMaster University here.
• Sign up for the Medscape Best Evidence Newsletters in the specialties of your choice here.
• Subscribe to Evidence-Based Mental Health and search a database at the National Registry of Evidence-Based Programs and Practices maintained by the Substance Abuse and Mental Health Services Administration here.
• Explore a limited but useful database of mental health practices that have been "blessed" as evidence-based by various academic, administrative and advocacy groups collected by the Iowa Consortium for Mental Health here.
• Download this presentation and related presentations and white papers at www.KendallLStewartMD.com.
• Learn more about Southern Ohio Medical Center and the job opportunities there at www.SOMC.org.
• Review the exceptional medical education training opportunities at Southern Ohio Medical Center here.