Chapter 6: Substance Use Assessment

Page 1

Alcohol Use and Abuse

* In 2008, slightly more than half of Americans ages 12 and older reported being alcohol drinkers.

* Alcohol is the more used and abused psychoactive drug.

* Alcohol is involved in 40% of the 41,000 annual traffic deaths.

* Alcohol consumption of at least 4 standard drinks per day is associated with increased rates of death from cirrhosis and alcoholism; certain cancers; injuries.

Effects of Alcohol

* alcoholic cardiomyopathy, with increase in left ventricular mass, dilation of ventricles, and wall thinning.

* hypertension, with about 3 to 5 drinks

*alcohol and illicit drugs are arrhythmogenic and are associated with the rapid heart rate of atrial fibrillation.

Defining Illicit Drug Use

* In 2008, about 8% of Americans ages 12 years and older reported current illicit drug use in the past month.

* Include marijuana/hashish, cocaine, heroin, hallucinogens, inhalants, and prescription-type drugs used non medically.

* Marijuana was the most commonly used illicit drug, with 6.1% usage in past month.

* Abuse of prescription drugs is the fastest growing drug problem in the US.

-The 3 most frequently abused: oxycodone, hydrocodone, and methadone.

What is a Standard Drink?

*any drink that contains about 14 grams of pure alcohol, 0.6 fl oz or 1.2 tablespoons.

Diagnosing Substance Abuse

* 9.2% of the population ages 12 years and older are classified with substance abuse or dependence.

-68% were dependent on or abused alcohol, and

14% used both alcohol and illicit drugs.

Older Adults

* prevalence of current alcohol use decreases with increasing age.

* liver metabolism and kidney function are decreased which increases the bioavailabity of alcohol on the blood for longer time periods.

* aging people lose muscle mass; less tissue for the alcohol to be distributed to means an increased alcohol concentration in the blood.

* medications can interact adversely with alcohol.

* increase risk for fall, depression, GI problems.

AUDIT Questionnaire (Alcohol Use Disorders Identification Test)

* a quantitive form used, not open to individual interpretation.

* covers 3 domains: alcohol consumption, drinking behavior or dependence, and adverse consequences of alcohol.

*help detect less severe alcohol problems as well as alcohol abuse and dependence disorders.

**cutpoint of more than 8 points out of 40 for men and 4 points or more for women, kids, and those older than 60 indicates hazardous alcohol consumption.

*Audit-C is a shorter form helpful in acute and CC units.

-valid screening test for heavy drinking and or active alcohol abuse....uses the first 3 questions.

- points greater than 3

-A 'yes' to drinking 6 or more drinks on 1 occasion ever in the past year warrants further assessment.

CAGE Questionnaire (Cutdown, Annoyed, Guilty, Eye-opener)

* works well in primary care settings bc it takes less than 1 minute.

*4 questions

*tests for lifetime alcohol abuse and or dependence but does not distinguish past problem drinking from active present drinking.

* less effective with women and minority groups

*Yes to more than 2 questions signals possible alcohol abuse and needs further assessment.

TWEAK Questions (Tolerance-2pt, Worry-2pt, Eye-opener- 1 pt, Amnesia-1pt, Kut down-1pt.

* a combination of items or two other questionnaires that help identify at-risk drinking in women, especially pregnant. Includes a question that measures tolerance.

* greater than 2 points, a drinking problem.

SMAST-G

*for older adults who report social or regular drinking of any amount of alcohol.

*10 questions, yes or no

*greater than 2 points, alcohol problem,

* yes is 1 point, no is 0

Advise and assist, brief intervention

If your assessment has determined the patient to have at-risk drinking or illicit substance use, state your conclusion and recommendation clearly

OBJECTIVE DATA

* GGT, gamma glutamyl transferase, is the most commonly used biochemical marker of alcohol drinking. Chronic drinking will show, not occasional. Nonalcoholic liver disease can also increase GGT levels.

* AST, serum aspartate aminotransferase, is an enzyme found in high concentrations in the heart and liver. Increases with chronic drinking.

* MCV, mean corpuscular volume, from CBC, is an index of red blood cell size. Increases with heavy drinking.

New Page