Addressing Unhealthy Alcohol Use in Primary Care PDF
Preview Addressing Unhealthy Alcohol Use in Primary Care
Addressing Unhealthy Alcohol Use in Primary Care Richard Saitz Editor Addressing Unhealthy Alcohol Use in Primary Care 2123 Editor RichardSaitz SectionofGeneralInternalMedicine BostonMedicalCenter Boston,Massachusetts USA ISBN978-1-4614-4778-8 ISBN978-1-4614-4779-5(eBook) DOI10.1007/978-1-4614-4779-5 SpringerNewYorkHeidelbergDordrechtLondon LibraryofCongressControlNumber:2012952149 © SpringerScience+BusinessMediaNewYork2013 Thisworkissubjecttocopyright.AllrightsarereservedbythePublisher,whetherthewholeorpartofthe materialisconcerned,specificallytherightsoftranslation,reprinting,reuseofillustrations,recitation, broadcasting,reproductiononmicrofilmsorinanyotherphysicalway,andtransmissionorinformation storageandretrieval,electronicadaptation,computersoftware,orbysimilarordissimilarmethodology nowknownorhereafterdeveloped.Exemptedfromthislegalreservationarebriefexcerptsinconnection withreviewsorscholarlyanalysisormaterialsuppliedspecificallyforthepurposeofbeingenteredand executed on a computer system, for exclusive use by the purchaser of the work. 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Printedonacid-freepaper SpringerispartofSpringerScience+BusinessMedia(www.springer.com) Preface AsaprimarycarephysicianIhaveseenthehealthandsocialconsequencesofex- cessivealcoholuseandIhavebeenfrustratedbymyinabilitytopreventthem.After afewyearsinpracticeitbecamecleartomethatmyassumptionthatsomeoneelse wastakingcareoftheproblemwasverywrong. Itturnsoutthatalthoughthereis aspecialtycaresystemthathelpspeoplewhoseekhelp,mostpeopledon’tenterit (anditcan’tdeliveralloftheproveneffectivetreatmentsanyway).Thesituationso impressedmethatIdecidedtodevotemycareertofiguringouthowtoaddressthe problemasageneralist.RecentlyIsawthattherewasnoresourceforpeoplelikeme tryingtodothesame,soIdecidedtodeliverthisbook. Thevastmajorityofpeoplewithhealthrisksandconsequencesrelatedtoalco- hol use receive no attention at all from healthcare, despite the fact that alcohol is a leading cause of early preventable death. Early in the last century excessive al- cohol use was addressed largely as a social and moral problem, and then people at the most severe end of the spectrum of unhealthy use—alcohol dependence or alcoholism—reaped the benefits of a social network, AlcoholicsAnonymous (the small proportion who made it there and stuck with it). But attention to this health problem—bothitspreventionandtreatment—hasbeennotablyabsentfromhealth care.Theendofthelastcenturybroughtrecognitionthathealthconsequencesfrom alcoholwerenotlimitedtoalcoholism—thattherewasaspectrumofunhealthyuse fromamountsthatriskconsequencesinpeoplewhohaveyettohaveone,todrinking withconsequencesbutnodiagnosabledisorder,tothealcoholusedisordersinclud- ingdependence(knownalsoasalcoholism).Recognitionofthespectrumcamewith theobviousunderstandingthatitshouldbeaddressed, inpartbecausemostofthe healthconsequencesofdrinkinginapopulationaccruetothosewithoutdependence. Publichealthmeasuresplayabigroleinaddressingunhealthyalcoholusebutthe lastfourdecadeshavebroughtresultsofclinicaltrialsthatdemonstratetheefficacy ofhealthcareinterventions. Becausethereareknownefficaciousmedicalinterventions—fromscreeningand briefcounseling,topharmacotherapy,toreferralforspecialtycareandcoordination ofcare—generalistphysicianshaveaverybigroletoplay, justastheydoforany other medical problem. Yet medical training and medical textbooks are generally weakinhowtheyaddressunhealthyalcoholuse.Thisbookaimstoprovideclinically v vi Preface actionableinformationsothatprimarycareclinicianscanaddressunhealthyalcohol useinpatients.Thisfirsteditiondoesnotaddresspregnantwomenorchildren—that remains for another time. But in these chapters, the generalist clinician will find information on how to identify, diagnose, and intervene in ways that help people withunhealthyuse. Whatisunhealthyalcoholuse?Usethatrisksconsequences(definedbyamounts ofconsumption),usewithconsequencesofthatuse,andthealcoholusedisorders— currently called abuse and dependence (likely to be combined by the American Psychiatric Association in the fifth Diagnostic and Statistical Manual for Mental Disorders(DSM5)underonealcoholusedisorder).Ithinkthisdefinitioniscritical— unhealthyuseistheonlytermthatcoverswhatdoctorsandotherclinicianscareand shouldcareabout—itiswhatwescreenfor,wecandosomethingaboutit,anditis somethingourpatientsneedustocareabout. In summary, this book is written for generalists and primary care clinicians in the hopes that it will provide clinically useful information for clinical practice— to identify and address unhealthy alcohol use as a medical condition that can be screenedforandmanaged.Ihopethatthiswillleadtomanypatientsbeinghelped. Ialsohopetoimproveonthiseditioninthefuture.Iwelcomereaderfeedback. RichardSaitzMD,MPH Contents 1 UnhealthyAlcoholUse:Whatisit?WhatCanandShouldWe beDoingAboutitinPrimaryCareSettings? ...................... 1 RichardSaitz 2 ScreeningforUnhealthyAlcoholUse ............................. 7 KatharineBradleyandDouglasBerger 3 AssessmentofUnhealthyAlcoholUseinPrimaryCare ............. 29 HillaryKuninsandChinazoCunningham 4 BriefInterventionforUnhealthyAlcoholUse...................... 41 RichardSaitz 5 AlcoholPharmacotherapies ..................................... 49 DylanBrock,BabakTofighi,JoshuaD.LeeandJuddFastenberg 6 MakingEffectiveReferralstoSpecialtyCare...................... 63 DariusA.Rastegar 7 MakingEffectiveReferralstoAlcoholicsAnonymousandOther 12-stepPrograms .............................................. 73 MaryannAmodeoandLuzMarilisLópez 8 ManagementofPatientswithAlcoholDependenceinRecovery: OptionsforMaintenanceandAnticipatingandManagingRelapse inPrimaryCare ............................................... 85 ThomasJ.Doyle,PeterD.FriedmannandWilliamH.Zywiak 9 ManagingPainintheContextofUnhealthyAlcoholUse............ 93 ErikW.GundersonandDanielP.Alford 10 MedicalConsequencesofUnhealthyAlcohol ...................... 107 AdamJ.Gordon,JoanneM.GordonandLaurenMatukaitisBroyles vii viii Contents 11 PsychiatricComorbidity ........................................ 119 AmyHarrington 12 OtherDrugUse................................................ 129 JenniferMcNeely,JoshuaD.LeeandEllieGrossman 13 To Drink or Not to Drink? “Moderate”Alcohol Consumption in a ClinicalContext ............................................... 147 TimothyS.Naimi 14 ElectronicandOtherSelf-HelpMaterialsforUnhealthyAlcohol UseinPrimaryCare ........................................... 157 StevenJ.OndersmaandGolfoK.Tzilos 15 ScreeningandBriefInterventionPracticeSystemsandImplementation 171 JohnMuench 16 Confidentiality................................................. 189 RichardSaitz 17 ChoicesforPatientsandClinicians:EthicsandLegalIssues ........ 195 MichaelWeaver 18 HospitalManagement .......................................... 207 RichardD.BlondellandMohammadrezaAzadfard 19 PerioperativeManagement...................................... 221 DanielP.Alford 20 PhysicianswithUnhealthyAlcoholUse ........................... 233 LuisT.Sanchez AppendixA:Instrumentsforsubstanceuseassessment ................ 241 AppendixB:Usefultoolsandonlinematerials ........................ 247 Index ............................................................ 251 Contributors Daniel P.Alford, MD, MPH, FACP, FASAM,Associate Professor of Medicine, Section of General Internal Medicine, ClinicalAddiction Research and Education Unit,BostonUniversitySchoolofMedicineandBostonMedicalCenter,Boston,MA MaryannAmodeo,PhD,MSW,ProfessorofClinicalPractice;Co-Director,Center forAddictions Research and Services, Boston University School of Social Work, Boston,MA MohammadrezaAzadfard, MD,Department of Family Medicine, University at Buffalo,Buffalo,NY Douglas Berger, MD,General Medicine Service, VA Puget Sound Health Care System;DepartmentofMedicine,UniversityofWashington,Seattle,WA Richard Blondell, MD,Department of Family Medicine, University at Buffalo, Buffalo,NY KatharineBradley,MD,MPH,GroupHealthResearchInstitute,HealthServices Research and Development Northwest Center of Excellence in Substance Abuse TreatmentandEducation;DepartmentsofMedicineandHealthServices,University ofWashington,Seattle,WA LaurenMatukaitisBroyles,PhD,RN,ResearchHealthScientist,CenterforHealth Equity Research and Promotion (CHERP),VA Pittsburgh Healthcare System;As- sistantProfessorofMedicine,DivisionofGeneralMedicine,UniversityatPittsburg MedicalCenterMontefioreHospital,Pittsburgh,PA DylanBrock,UniversityofLouisvilleSchoolofMedicine,Louisville,KY Chinazo Cunningham, MD, MS,Associate Professor of Medicine (Division of GeneralInternalMedicine)andFamilyandSocialMedicine,AlbertEinsteinCollege ofMedicineandMontefioreMedicalCenter,Bronx,NY10467,USA Thomas J. Doyle, MD,Staff Physician, Primary Care and Hospitalist Services, ProvidenceVA Medical Center; ClinicalAssistant Professor of Medicine, Warren AlpertMedicalSchoolofBrownUniversity,Providence,RI ix x Contributors JuddFastenberg,MD,AlbanyMedicalCollege,Albany,NY PeterD.Friedmann,MD,MPH,FASAM,FACP,ReapDirector,ResearchService, Providence,VAMedicalCenter;Director,ResearchSection,DivisionofGeneralIn- ternalMedicine,RhodeIslandHospital;ProfessorofMedicine,HealthServices,Pol- icyandPractice,WarrenAlpertMedicalSchoolofBrownUniversity,Providence,RI Adam J. Gordon, MD, MPH, FACP, FASAM,Associate Professor of Medicine, andAdvisoryDean,UniversityofPittsburghSchoolofMedicineandVAPittsburgh HealthcareSystem,Pittsburgh,PA,USA Joanne M. Gordon, PhD, RN,Emeritus Professor of Biomedical Sciences, MissouriStateUniversity,Springfield,MO,USA EllieGrossman,MD,MPH,AssistantProfessor,DeparmentofMedicine,Division ofGeneralInternalMedicine,NYUSchoolofMedicine,NewYork,NY ErikW.Gunderson,MD,FASAM,AssistantProfessor,DepartmentsofPsychiatry andNeurobehavioralSciencesandMedicine,UniversityofVirginia,Charlottesville, VA;AdjunctAssociate Research Scientist, Department of Psychiatry, Division of SubstanceAbuse, Columbia University College of Physicians and Surgeons, New York,NY AmyHarrington,MD,AssistantProfessor,DepartmentofPsychiatry,Divisionof AddictionPsychiatry,UniversityofMassachusettsMedicalSchool,Worcester,MA HilaryKunins,MD,MPH,MS,ProgramDirector,DepartmentsofMedicine(Di- visionofGeneralInternalMedicine)andPsychiatryandBehavioralSciences,Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10467, USA JoshuaD.Lee, MD,MSc,AssistantProfessor, DepartmentsofPopulationHealth and Medicine, Division of General Internal Medicine, NYU School of Medicine, NewYork,NY Luz Marilis López, PhD, MSW, MPH,Clinical Associate Professor, Boston UniversitySchoolofSocialWork,Boston,MA JenniferMcNeely,MD,MS,AssistantProfessor,DepartmentsofPopulationHealth and Medicine, Division of General Internal Medicine, NYU School of Medicine, NewYork,NY JohnMuench, MD,MPH,AssociateProfessor, DepartmentofFamilyMedicine, OregonHeath&ScienceUniversity,Portland,OR Timothy S. Naimi, MD, MPH,ClinicalAddiction Research and Education Unit, SectionofGeneralInternalMedicine,BostonMedicalCenter;AssociateProfessor, BostonUniversitySchoolsofMedicineandPublicHealth,Boston,MA
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