Alcohol and Alcohol Use Disorder _ _____________________________________________________________
9. Have you ever gone to anyone for help about your drinking? No = 0 Yes = 1 10. Have you ever been in a hospital because of drinking? No = 0 Yes = 1 11. Have you ever been arrested for drunken driving, driving while intoxicated, or driving under the influence of alcoholic beverages? No = 0 Yes = 1 12. Have you ever been arrested, even for a few hours, because of drunken behavior? No = 0 Yes = 1 Key: There are two definitions for this test. 1. Seltzer Definition:
When interpreters are enlisted and treated as part of the interdisciplinary clinical team, they serve as cultural brokers, who ultimately enhance the clinical encounter. When providing care for patients for whom English is a second language, the consideration of the use of an interpreter and/or patient education materials in their native language may improve patient understanding and outcomes. In addition, several organizations provide information and toolkits in languages other than English. The National Hispanic Medical Association offers an alcohol screening kit in Spanish, including patient education sheets [278]. The National Institute on Alcohol Abuse and Alcoholism also provides patient education brochures and pamphlets in English and Spanish [279]. LABORATORY TESTS The FDA has approved a test to detect alcohol use disorder and alcohol-related diseases. The test detects the level of carbohydrate-deficient transferrin (CDT) in the body, which is elevated in persons with alcohol use disorder and remains elevated even several weeks after drinking is stopped [280]. The advantages of the CDT test are reliability and the availability of automated test results within four hours [281; 282]. The CDT is often used in combination with other screening tests, such as the gamma-glutamyl transferase (GGT) test. While both CDT and GGT are independently associated with alcohol abuse, combining tests may dramatically increase sensitivity [267; 283]. CDT is less sensitive/specific in women than in men [267]. Tests for Recent Alcohol Use (Hours) The relationship between alcohol and the liver serves as the basis for many of the tests that identify possible alcohol abusers. Alcohol markers for recent alcohol ingestion include urine/breath/blood, AlcoPatch, methanol, urinary ethyl glucuronide (EtG) and ethyl sulfate(ES), whole blood phosphatidylethanol, and the ratio of 5-hydroxytryptophol (5-HTOL) to 5-hydroxyindole-3-acetic acid (5-HIAA) [267; 284]. Tests for Less Recent Alcohol Use (Weeks) The CDT test is often used to assess prolonged ingestion of high amounts of alcohol (more than 50–80 g/day for two to three weeks) [267]. Another test examines hemoglobin or whole blood acetaldehyde adducts. In a study of almost 3,000 women and 4,000 men, the combination of CDT and GGT compared with either alone shows a higher diagnostic sensitivity and specificity and is correlated more strongly with alcohol consumption than either test alone (Table 1) [285; 286; 287]. Tests for Chronic Alcohol Use (Years) Tests in this category look at the classic toxic markers that use of alcohol leaves on the body. They include [267]:
a. 0-1 points = Nonalcoholic b. 2 points = Possibly alcoholic c. 3 or “yes” to 6, 10, or 11 = Alcoholic
2. Ross Definition:
5 points = Alcohol abuse Comorbidity-Alcohol Risk Evaluation Tool (CARET) There are certain risks and comorbidities (e.g., psychiatric and medical conditions requiring pharmacologic treatment) that may modify the criteria of at-risk drinking, especially within the geriatric population [275]. It is important for healthcare providers to assess each patient’s threshold for alcohol use, taking into account their level of risk and comorbidities. The Comorbidity-Alcohol Risk Evaluation Tool (CARET) may be helpful in this task, with comorbidity-specific measures to place patients in “at-risk” or “not-at-risk” groups [276]. SCREENING FOR ALCOHOL ABUSE IN NON- ENGLISH-PROFICIENT PATIENTS Communication with patients regarding history and current alcohol use patterns is a necessary step in determining if alcohol use has become a problem. When there is an obvious disconnect in the communication process between the practitioner and patient due to the patient’s lack of proficiency in the English language, an interpreter is required. Frequently, this may be easier said than done, as there may be institutional and/or patient barriers. If an interpreter is required, the practitioner should acknowledge that an interpreter is more than a body serving as a vehicle to transmit information verbatim from one party to another. Instead, the interpreter should be regarded as part of a collaborative team, bringing to the table a specific set of skills and expertise [277]. Several important guidelines should be adhered to in order to foster a beneficial working relationship and a positive atmosphere.
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MDMI1826
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