Alcohol and Alcohol Use Disorder _ _____________________________________________________________
ADDITIONAL STANDARDIZED QUESTIONS OR TESTS Michigan Alcohol Screening Test (MAST) The Michigan Alcohol Screening Test (MAST) continues to be a good screening test for alcohol abuse and dependence, but for optimal results it should be used with a questionnaire that asks about the amount and frequency of alcohol consumption. The following questions are from the 13-item Short MAST (SMAST) regarding the respondent’s involvement with alcohol during the past 12 months [274]: 1. Do you think you are a normal drinker? (By normal we mean you drink less than or as much as most other people.) No = 1 Yes = 0 2. Does your wife, husband, a parent, or other near relative ever worry or complain about your drinking? No = 0 Yes = 1 3. Do you feel guilty about your drinking? No = 0 Yes = 1 4. Do friends or relatives think you are a normal drinker? No = 1 Yes = 0 5. Are you able to stop drinking when you want to? No = 1 Yes = 0 6. Have you ever attended a meeting of Alcoholics Anonymous? No = 0 Yes = 1 7. Has drinking ever created problems between you and your wife, husband, a parent, or other near relative? No = 0 Yes = 1 8. Have you ever gotten into trouble at work because of your drinking? No = 0 Yes = 1 9. Have you ever neglected your obligations, your family, or your work for two or more days in a row because you were drinking? No = 0 Yes = 1 10. Have you ever gone to anyone for help about your drinking? No = 0 Yes = 1 11. Have you ever been in a hospital because of drinking? No = 0 Yes = 1 12. Have you ever been arrested for drunken driving, driving while intoxicated, or driving under the influence of alcoholic beverages? No = 0 Yes = 1
13. 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:
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. 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].
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