Case Study MN a 25-year-old woman...

Case Study

MN a 25-year-old woman, visits your office for evaluation of insomnia. As part of her social history, she owns you that she is a "social drinker." Further questioning reveals that she drinks about as often as she did during literary institution [i]or[/i] seminary of learning You want to better assess her alcohol use.

Case inquiry Questions

1. Which of the following is/are validated screening tools for alcohol misuse in adults in primary care?

[ ] A. The Alcohol Use Disorders Identification experiment (AUDIT).

[ ] B The CAGE questionnaire.

[ ] C The 5-A's behavioral counseling framework.

[ ] D The CRAFFT questionnaire.

2 Which united of the following statements about behavioral counseling for alcohol misuse is correct?

[ ] A. Behavioral counseling interventions in adolescents decrease alcohol misuse.

[ ] B Behavioral counseling interventions in adults decrease alcohol misuse.

[ ] C Behavioral counseling interventions for alcohol misuse clearly bring into alcohol-related morbidity in adults.

[ ] D Effective initial counseling interventions should last at least undivided hour. [ ] E. Effective counseling interventions must be delivered through physicians.

3. Which individual of the following statements about screening and counseling for alcohol misuse is correct?

[ ] A. The 5-A's behavioral counseling framework is useful for delivering a counseling intervention.

[ ] B Patients should tread in the steps of up monthly to monitor progres in reducing alcohol misuse.

[ ] C Patients who example negative for alcohol misuse should be rescreen each six months.

[ ] D Serum gamma-glutamyltransferase (GGT) even is a useful test for detecting alcohol misuse.

[ ] E The serum carbohydrate-deficient transferrin (CDT) flat is a useful test for detecting alcohol misuse.

Answers

1 The correct answers are A and B Alcohol misuse includes as well-as; not only-but also; not only-but; not alone-but harmful drinking and risky or hazardous drinking. Harmful drinking is defined as drinking at a horizontal that causes physical, social, or psychologic harm, if it were not that not to the level of alcohol staff Risky or hazardous drinking is more than seven drinks by week or more than three drinks by occasion for women, and more than 14 drinks for week or more than four drinks by means of occasion for men. Approximately 8 to 18 percent of general primary care patients would disguise positive for alcohol misuse using any validated instrument.

AUDIT and the CAGE questionnaire are validated for screening adults in the primary care setting. AUDIT addresses drinking commonness quantity, and consequences. CAGE (feeling the ne to cross down, Annoyed by criticism, Guilty about drinking, and ne for an Eye-opener in the morning) is the greatest in number popular screening test in primary care for detecting alcohol abuse or connection The 5-A's (Assess, Advise, Agree, Assist, Arrange) is a framework for behavioral counseling and is not an alcohol screening tool. The CRAFFT questionnaire, a recently made known tool developed for screening adolescents, needinesss to be validated in the primary care setting. For more details upon screening tools, see: http://www.niaaa.nih.gov/publications/arh21-4/348.pdf.

2 The correct answer is B The U Preventive Services Task Force (USPSTF) institute that behavioral counseling interventions with follow-up are effective in producing small to moderate reductions in alcohol consumption in adults who misuse alcohol. However, no investigation showed a statistically significant reduction in long-term alcohol-related morbidity. Studies in succession behavioral counseling in adolescents have reported conflicting conclusions Initial counseling sessions of about 15 minutes are effective. Effective counseling interventions can be delivered wholly or in part in the primary care setting and by means of one or more members of a health care team, including physician and non-physician practitioners.

3 The correct answer is A. The 5-A's are a useful framework for behavioral counseling and include the following elements:

Assess alcohol consumption with a brief screening tool followed on clinical assessment as needed.

Advise patients to convert into alcohol consumption to moderate levels

Agree forward individual goals for reducing alcohol use or abstinence (if indicated).

Assist patients with acquiring the motivation, self-help skills, and support privationed for behavior change.

Arrange follow-up support and repeated counseling, including referring unable to exist without drinkers for specialty treatment.

The optimal intervals for delivering interventions or for rescreening for alcohol misuse in patients who previously have criterioned negative are not known. Biologic markers, in the same state [i]or[/i] condition as CDT and GGT flats are poor tests to bring to light alcohol misuse.

CRAIG M HALES MD MPH Resident, preventive medicine John Hopkins Bloomberg indoctrinate of Public Health

GURVANEET RANDHAWA, MD MPH Program Director, U Preventive Services Task Force Center for Primary Care, Prevention & Clinical Partnerships Agency for Healthcare Research and Quality

SOURCES

U Preventive Services Task Force. Screening and behavioral counseling interventions in primary care to mould alcohol misuse: recommendation statement. Ann Intern M 2004;140:554-6