Dear friends, [*see note below]
Now, I would like to comment about a number of evidence-based practices that can improve the care of patients with alcohol problems, including alcohol use disorder (AUD), that should be taught to all health professionals, especially those at the Primary Care Level:
1. Strategies to manage stigma. Both that of the patient themselves (self-stigma) and that of the health professional towards the person with AUD. Of course, if this stigma exists, the HCP must first identify and become aware of it.
The second step would be to change the “language” used in interacting with these people, avoiding the words alcoholic, alcoholism and replacing them with alcohol use disorders. This can already facilitate interaction and encourage patient openness.
2. Using simple tools to detect people with alcohol consumption problems, such as:
- The Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) that consists of three questions related to drinking frequency and quantity
- The NIAAA Single Alcohol Screening Question (SASQ) , where you have to ask “How many times in the past year have you had (4 for women, or 5 for men) or more drinks in a day?” A response of one or more warrants follow-up. Before asking the SASQ, you can ask for a prescreen along the lines of “How often did you have a drink containing alcohol in the past year?” https://assets.publishing.service.gov.uk/media/6357a857e90e0777aa2cfe98/...
- Routinely integrating an Alcohol Symptom Checklist [PDF – 147.8 KB] into primary care may make it easier for healthcare professionals to hold comfortable, patient-centered, non-judgmental conversations about alcohol that help destigmatize AUD and its treatment
Who should conduct screening?. Any healthcare professional in medical or mental health fields can easily screen for heavy drinking as part of a comprehensive assessment or health history. In primary care, teams that include nurses and other non-physician providers are increasingly used for alcohol screening.
3. After assessing for AUD, your next steps could be :
- For patients who drink heavily and do not have AUD: Offer brief advice. You can find some examples on how to provide Brief Advice in this links:
https://www.youtube.com/watch?v=PaSKcfTmFEk
https://www.youtube.com/watch?v=b-ilxvHZJDc
- For patients who have AUD: Advise abstinence and emphasize that it’s important to cut down gradually because suddenly stopping can result in alcohol withdrawal, which can be risky. Be cautious and consider the need for medically managed withdrawal. Again, if the patient is hesitant to abstain, then negotiate individualized drinking goals. If you don't feel secure to manage the patient and he/she accepts, refer to a specialized program.
4. Knowing and managing FDA-approved medications for AUD—naltrexone, acamprosate, or disulfiram—can help many patients reduce or quit drinking. Healthcare professionals at Primary Care Level can prescribe these non-addicting medications in primary care without specialized training, or can refer to a specialty prescriber
Reference
https://www.niaaa.nih.gov/health-professionals-communities/core-resource...
What do you think?
What else will you add to these basic steps?
Kind regards,
Eduardo
Dr. Eduardo Bianco
Director, Addiction Training Program for Health Professionals (ATHP)
Email: ebianco@nextgenu.org
Web: NextGenU.org
HIFA profile: Eduardo Bianco is a medical doctor and Cardiologist, Certified Tobacco Cessation Expert with a Masters in Prevention and Treatment of Addictive Disorders. Currently, he is Chair of the World Heart Federation Tobacco Expert Group. Dr. Biancos research examines tobacco control and cessation, and he is a prominent member of several organizations that address tobacco control in Latin America. Dr. Bianco has worked for 25 years in Uruguay and Latin America to promote and train in smoking cessation treatment and tobacco control policies. He is also the former Regional Coordinator for the Americas of the Framework Convention Alliance and former Technical Director of the MOH Center for International Cooperation for Tobacco. ebianco AT nextgenu.org
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