Chapter 6: Substance Use Assessment

Alcohol Use and Abuse* In 2008, slightly more than half of Americans ages 12 and older reported being alcohol drinkers. * Alcohol is the more used and abused psychoactive drug.* Alcohol is involved in 40% of the 41,000 annual traffic deaths.*  Alcohol consumption of at least 4 standard drinks per day is associated with increased rates of death from cirrhosis and alcoholism; certain cancers; injuries.

Effects of Alcohol* alcoholic cardiomyopathy, with increase in left ventricular mass, dilation of ventricles, and wall thinning. * hypertension, with about 3 to 5 drinks*alcohol and illicit drugs are arrhythmogenic and are associated with the rapid heart rate of atrial fibrillation.

Defining Illicit Drug Use* In 2008, about 8% of Americans ages 12 years and older reported current illicit drug use in the past month.* Include marijuana/hashish, cocaine, heroin, hallucinogens, inhalants, and prescription-type drugs used non medically. * Marijuana was the most commonly used illicit drug, with 6.1% usage in past month.* Abuse of prescription drugs is the fastest growing drug problem in the US.     -The 3 most frequently abused: oxycodone, hydrocodone, and methadone.

What is a Standard Drink?*any drink that contains about 14 grams of pure alcohol, 0.6 fl oz or 1.2 tablespoons.

Diagnosing Substance Abuse* 9.2% of the population ages 12 years and older are classified with substance abuse or dependence.    -68% were dependent on or abused alcohol, and 14% used both alcohol and illicit drugs.

Older Adults* prevalence of current alcohol use decreases with increasing age.* liver metabolism and kidney function are decreased which increases the bioavailabity of alcohol on the blood for longer time periods. * aging people lose muscle mass; less tissue for the alcohol to be distributed to means an increased alcohol concentration in the blood.* medications can interact adversely with alcohol.* increase risk for fall, depression, GI problems.

AUDIT Questionnaire (Alcohol Use Disorders Identification Test)* a quantitive form used, not open to individual interpretation.* covers 3 domains: alcohol consumption, drinking behavior or dependence, and adverse consequences of alcohol.*help detect less severe alcohol problems as well as alcohol abuse and dependence disorders.**cutpoint of more than 8 points out of 40 for men and 4 points or more for women, kids, and those older than 60  indicates hazardous alcohol consumption. *Audit-C is a shorter form helpful in acute and CC units.    -valid screening test for heavy drinking and or active alcohol abuse....uses the first 3 questions.    - points greater than 3    -A 'yes' to drinking  6 or more drinks on 1 occasion ever in the past year warrants further assessment.    

CAGE Questionnaire (Cutdown, Annoyed, Guilty, Eye-opener)* works well in primary care settings bc it takes less than 1 minute.*4 questions *tests for lifetime alcohol abuse and or dependence but does not distinguish past problem drinking from active present drinking.* less effective with women and minority groups*Yes to more than 2 questions signals possible alcohol abuse and needs further assessment.

TWEAK Questions (Tolerance-2pt, Worry-2pt, Eye-opener- 1 pt, Amnesia-1pt, Kut down-1pt. * a combination of items or two other questionnaires that help identify at-risk drinking in women, especially pregnant. Includes a question that measures tolerance.* greater than 2 points, a drinking problem.

SMAST-G *for older adults who report social or regular drinking of any amount of alcohol.*10 questions, yes or no*greater than 2 points, alcohol problem,* yes is 1 point, no is 0

Advise and assist, brief intervention  If your assessment has determined the patient to have at-risk drinking or illicit substance use, state your conclusion and recommendation clearly 

OBJECTIVE DATA* GGT, gamma glutamyl transferase, is the most commonly used biochemical marker of alcohol drinking. Chronic drinking will show, not occasional. Nonalcoholic liver disease can also increase GGT levels.* AST, serum aspartate aminotransferase, is an enzyme found in high concentrations in the heart and liver. Increases with chronic drinking.* MCV, mean corpuscular volume, from CBC, is an index of red blood cell size. Increases with heavy drinking.

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