______________________________________________________________ Alcohol and Alcohol Use Disorder
COMMON ELEMENTS OF BRIEF INTERVENTION Miller and Sanchez proposed six elements, summarized by the acronym FRAMES, to describe the key elements of brief intervention: feedback, responsibility, advice, menu of strategies, empathy, and self-efficacy [289]. How these elements enhance effectiveness has been supported in other reviews [290; 291]. Goal setting, follow-up, and timing are also important in brief intervention [292; 293]. • Feedback of Personal Risk: Health professionals use current drinking behaviors, lab test results, and actual or potential consequences of drinking to provide patients with feedback on the risk of developing a problem. • Responsibility of the Patient: Brief intervention often includes encouraging the patient to recognize that it is his or her responsibility and choice to change the behavior. This gives patients a sense of personal control in the process of change. • Advice to Change: Brief intervention may also include recommendations about moderate- or low-risk drinking and advice on cutting down or eliminating alcohol consumption. • Menu of Ways to Reduce Drinking: Patients are advised about how to cut back or avoid alcohol consumption. Health professionals can help patients set limits, recognize reasons for drinking, and acquire skills to avoid high risk drinking. Often, self-help materials such as drinking diaries are given to patients to help monitor their progress. • Empathetic Counseling Style: Confrontational methods of brief intervention are not as effective as when health professionals use a more empathetic counseling approach.
• Liver function tests • GGT
• Aspartate aminotransferase (AST) • Alanine aminotransferase (ALT) • Red blood cell index • Mean corpuscular volume (MCV)
BRIEF INTERVENTION Despite the fact that alcohol abuse complications have caused grave illness and many deaths, physicians are not always good at detecting alcohol and other drug abuse in their patients. Even when physicians and other health professionals identify an individual with alcohol use disorder, they are sometimes unsure of how to proceed. At times, the physician will offer help but the patient refuses. Nevertheless, the addiction specialist or the primary care physician with a continuous, comprehensive, patient-centered approach to the medical, psychosocial, and family issues is the ideal person to offer intervention, treatment, and recovery support. Almost 20% of patients treated in a primary care setting drink at levels that may place them at risk for developing alcohol-related problems [267; 288]. Brief intervention, as part of primary healthcare, can help reduce this risk. Brief intervention is generally conducted over one to a few visits with each session lasting from just a few minutes up to one hour. The type of brief intervention varies depending on how severe the problem. Brief intervention is often used with patients who have not yet developed alcohol use disorder and the goal may be to reduce drinking rather than abstinence. For persons with alcohol use disorder, the goal of brief intervention is abstinence, and for these individuals, referral to a more comprehensive treatment may be necessary. The USPSTF recommends that clinicians provide patients who are engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce alcohol misuse [263].
LABORATORY MARKERS FOR ALCOHOL USE
Markers
Sensitivity
Specificity
Men CDT GGT
73% 65% 90%
96% 89% 84%
CDT with GGT
Women CDT
52% 54%
94% 97% 91%
GGT
CDT with GGT
76%
Source: [285]
Table 1
69
MDMI1826
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