Clinical Assessment of Alcohol Use

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Clinical Assessment of Alcohol Use
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Clinical Assessment

• Standardized Screening Tools
• Clinical Interview
• Physical Exam Lab Tests

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Standardized Screening Tools

• AUDIT
• AUDIT-C
• CAGE
• DSM Screener
• MAST
• UNCOPE
• Refer to Alcohol Screening Tools Chart for
  comparison of various tools

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Clinical InterviewBasics

• Pattern of use
• Frequency, duration, quantity, etc.
• Negative consequences of use, if any
• Physical, Medical, Psychological, Emotional,
  Legal, Social, Familial, Relational,
  Occupational, Financial
  
• Substance Abuse criteria
• Substance Dependence criteria

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Alcohol Abuse CriteriaDiagnosis met by meeting
one or more of these four criteria

• Recurrent inability to meet role obligations at
  work, school, or home
  
• Recurrent use in situations where it was
  physically dangerous to do so
  
• Recurrent alcohol-related legal problems
• Recurrent social or interpersonal problems caused
  or exacerbated use

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Dependence Criteria Diagnosis met by meeting
three or more of these seven criteria

• Presence of tolerance
• Presence of withdrawal symptoms
• Often consume more than intended
• Persistent desire/unsuccessful efforts to reduce
  use
  
• Much time spent obtaining, using, or recovering
• Important activities given up or reduced due to
  use
  
• Continued use despite knowledge use is causing or
  aggravating physical or psychological problem

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Clinical Interview

• What follows is a series of questions offered as
  examples of potential clinical interview
  questions
  
• Providers are free to use some, all, or none of
  these questions, and can choose to add questions
  of their own
  

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Clinical Interview

• Do you drink?
• How often do you drink?
• How many days per week do you drink on average?
• How much do you drink per occasion? or When you
  drink, how many drinks do you consume on
  average?
  
• Do you ever drink more than 4 drinks for women
  or 5 drinks for men in one setting?
  
• If yes, how often do you drink that much or
  more?
  
• Describe a typical drink (i.e., type of alcohol
  and quantity of serving)

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Clinical Interview

• How often do you drink to the point of
  intoxication?
  
• How many drinks does it take for you to feel
  intoxicated?
  
• Does it take more alcohol for you to become
  intoxicated now than in the past?
  
• Do you ever feel sick when you stop drinking?
• Do you need to continue drinking to avoid feeling
  sick?
  
• What is the longest period youve gone without
  drinking in the past year?

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Clinical Interview

• Has drinking ever caused you problems of any
  kind?
  
• Have you ever had legal problems due to alcohol?
• Have you ever had financial problems due to
  alcohol?
  
• Have you ever had any relationship problems due
  to alcohol?

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Clinical Interview

• Have you ever had problems at work because of
  alcohol?
  
• Have you ever been late to work because of your
  drinking?
  
• Have you ever missed a day of work due to
  drinking?
  
• Have you ever received disciplinary action
  because of your drinking?
  
• Has your work ever suffered because you were
  intoxicated or had a hangover at work?

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Clinical Interview

• Have you ever felt the need to cut down on your
  drinking?
  
• Has anyone ever complained to you about your
  drinking?
  
• Has anyone ever criticized you because of your
  drinking?
  
• Have you ever been angry or irritated by comments
  or questions about your drinking?
  
• Have you ever felt guilty about your drinking or
  about something you did while drinking?
  
• Have you ever felt the need for a morning drink
  to get you going?

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Clinical Interview

• Have you ever suffered an injury while drinking?
• Have you ever driven a vehicle after drinking?
• Have you ever been arrested for driving under the
  influence of alcohol?
  
• Have you ever been arrested for any other reason
  because of your drinking?

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Physical Exam Lab Tests

• Physical findings are often nonexistent or
  minimal in the early stages of alcoholism or
  alcohol abuse
  
• Lab tests are also often normal until later
  stages of illness

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Physical Exam Findings

• Jaundice
• Spider angiomas
• Palmar erythema
• Gynecomastia
• Testicular atrophy
• Splenomegaly
• Multiple recent bruises
• Multiple healed injuries

• Enlarged liver
• Hardened liver
• Ascites
• Tremor
• Peripheral neuropathy
• Hypo/hyperreflexia
• Decreased motor strength

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Medical Complications

• Hepatitis
• Cirrhosis
• Pancreatitis
• Gastritis
• Ulcers GI bleeding
• Anemia
• Cardiomyopathy
• Hypertension
• Wernicke-Korsakoffs Syndrome

• Dementia
• Peripheral neuropathy
• Cerebellar degeneration
• Trauma
• Depression other psychiatric disorders
• Fetal Alcohol Syndrome
• Testicular atrophy
• Myopathy

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Labs to Consider

• GGT often an early indicator of heavy alcohol
  use
  
• Sensitivity 40-60
• Specificity 90
• Returns to normal within a few weeks of sobriety

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Labs to Consider

• CBC
• Chem 7
• LFTs
• Bilirubin
• BUN
• Creatinine
• Blood alcohol
• PT

• Cholesterol
• Triglycerides
• Ca, Mg
• Albumin, total protein
• B12, Folate
• Stool guaiac
• Urine drug screen
• Hep B C

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Potential Lab Findings

• ? GGT
• ? AST, ALT, LDH
• ? Alk Phos
• ? PT
• ? Amylase
• ? Triglycerides
• ? Bilirubin

• ? Uric Acid
• ? MCV
• ? Hct Hg
• ? B12 Folate
• ? Albumin
• ? Total protein
• ? WBC platelets

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Questions?