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Wednesday May 14, 2014

Ask the Question: Screening for Alcohol Misuse Can Save Lives

I recently returned home from an incredibly inspiring weekend at the AAFP's Annual Leadership Forum and National Conference of Special Constituencies in Kansas City, Mo., but my good mood quickly faded when I found the local Chicago news filled with stories of yet another accident caused by drinking and driving.

A man driving an SUV entered the northbound lanes of Lake Shore Drive headed south and struck a taxi head-on. According to police reports, the man’s blood-alcohol content was more than twice the legal limit.

A young law student who was riding in the taxi died in the crash. She was reported to be an accomplished and big-hearted leader among students, was on schedule to graduate next month and had already received and accepted a job offer.

Sadly, she won't be graduating with her classmates or celebrating her accomplishments with her family. And her story, tragically, is just one of many.

In fact, the World Health Organization (WHO) said in a report released this week(www.who.int) that alcohol contributed to 3.3 million deaths -- or 6 percent of all deaths -- worldwide in 2012. That staggering total means that roughly every 10 seconds, someone dies an alcohol-related death. Accidents, including car crashes, accounted for 17 percent of all alcohol-related deaths.

Here in the United States, excessive alcohol use is the third-leading preventable cause of death(www.cdc.gov),  claiming roughly 80,000 lives annually. Alcoholic liver disease is the second-leading indication(www.ncbi.nlm.nih.gov) for transplantation in the United States.

So what are we doing about it in our practices?

"Do you drink?" is a question we are trained to ask in medical school, but are enough of us actually asking it? According to the CDC(www.cdc.gov), only one in six U.S. adults have ever talked to a health care professional about alcohol use. That's unfortunate because, according to the agency, alcohol screening and brief counseling can reduce the amount excessive drinkers consume by as much as 25 percent.

Of course, there are reasons why a primary care physician might hesitate to ask the question. Some physicians tend to shy away from questions about substance abuse. Not only can it be an uncomfortable topic, but some practices and communities lack adequate resources for treatment. It's also likely that some patients are less than forthcoming about their struggles.

Health care payers require us, and offer incentives, to ask every patient at every visit about certain other clinical issues, such as tobacco use, pain and asthma. In a health care environment where an office visit may be limited to 15 minutes or less, there are many issues to cover in a limited amount of time.

But considering that excessive alcohol use costs our country roughly $185 billion a year in health care costs, criminal justice expenses and lost productivity, wouldn't it make sense for alcohol use to be just as important a question as tobacco use when taking a patient's health history?

According to the WHO report, 7 percent of U.S. men and 2.6 percent of U.S. women are alcohol-dependent. More than 10 percent of men and more than 4 percent of women have an alcohol disorder, meaning either dependence or harmful use of alcohol. However, only 15 percent of people with such a disorder seek treatment, according to the National Institute on Alcohol Abuse and Alcoholism(www.niaaa.nih.gov).

If none of those statistics grabbed your attention, consider that 10 percent of U.S. children live with an adult who has an alcohol problem. So what can we do to help patients and their families?

It's really very simple: We need to ask the question. The AAFP recommends that physicians screen adults for alcohol misuse and provide patients engaged in risky or hazardous drinking with brief behavioral counseling interventions.

American Family Physician has compiled an extensive collection of articles and other resources that cover screening, diagnosis, treatment and more. Patient information(familydoctor.org) also is available online.

Although time certainly can be a barrier during an office visit, there are many simple screening tools that are easy and quick to use. For example, the CAGE questionnaire(www.integration.samhsa.gov) consists of just four questions. The WHO's Alcohol Use Disorders Identification Test(whqlibdoc.who.int) can be completed in as little as two minutes.

Once we've asked that difficult first question, these tools can help us determine whether a patient needs counseling. If your practice isn't equipped to offer counseling, take the time to inform yourself about the resources that are available in your community.

The third-leading cause of preventable death in our country is an issue we can't continue to be silent about.

Javette Orgain, M.D., M.P.H., is vice speaker of the AAFP Congress of Delegates.

Posted at 03:49PM May 14, 2014 by Javette Orgain, M.D.

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