Uncovering the Hidden Alcoholic And Offering Help

More and more people are drinking in very large amounts and it’s a problem, said Mark Aronson, MD, MACP, during his presentation “The Early Detection and Management of Patients With Problem Drinking,” at Pri-Med NY 2010, June 18.

Aronson is a professor at Harvard Medical School and a general internist.

The main focus of the talk was to consider the impact on society, with an emphasis on young adults and adolescents; review screening and diagnosis in a primary care setting, and to review the role of the primary care physician.

Aronson presented research on the definitions of moderate to severe drinking to begin his talk. Moderate drinking was considered two or fewer drinks a day for men and one or less for women, while binge drinking was considered to be five or more drinks a day for men and four or more for women. Men in the at-risk group drink 14 or more drinks a day and women drink seven or more drinks.

The cost of alcohol injuries and illnesses “are staggering,” he said. It is estimated that $15 billion in health costs is associated with alcohol. Alcohol related injuries and illness is the third leading cause of death in the US as well, he said. The rise of binge drinking in adolescents and young adults is also alarming, he said.

Some of the Red Flags related to alcohol use that physicians should be looking out for when dealing with patients are: alcohol-related job less, multiple ER visits, or multiple somatic complaints.

It is important to “ask everyone about it,” he said. Despite whatever common stereotypes exist, Aronson said a physician should ask each and every patient about his or her alcohol use and keep it in mind.

To make it easy, a physician can simply use questions from the CAGE model or Audit-C model, he said. Physical exams that check for comorbid conditions such as hypertension, or lab testing may also be useful, he said.

As primary care physicians, “our job is to identify these patients,” he said. One of the most important things a primary care physician can do for their alcoholic patient is to appropriately present the diagnosis, he said.

Providing different intervention methods such as initiating referrals to hospitals, outpatient clinics, or self help groups (AA, etc.), teaching about the consequences of continued abuse on the patient’s health, prescribing usage limits, and participating in ongoing care can all have an impact on their care, he said.