Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
24 Cards in this Set
- Front
- Back
|
SBIRT
|
Screening, Brief Interventions, Referral, Treatment
|
|
|
Brief Intervention
|
"A Brief Conversation" 5 counseling sessions, 3-5 minutes, Minimum of 15 minutes for payment under CPT and HCPC rules, Should take place in primary healthcare settings
SIMPLY ASKING reduces use and subsequent problems at follow-up Brief Intervention results in further reduction of use, often to "safe" levels Failure of brief intervention suggests diagnosis of dependence |
|
|
Physical Signs of Substance Abuse
|
Skin Changes - rosacea, rhinophima, bruises, spider angiomata
HEENT - conjunctival injection Lungs - associated COPD changes Heart - arrhythmias, tachycardia, cardiomegaly Abdomen - liver enlargement, tenderness, ascites Extremities - vascular changes, nicotine stains |
|
|
CAGE-AID
|
Do with or without physical signs
Have you ever felt that you ought to cut down on your drinking or drug use? Have people annoyed you by criticizing your drinking or drug use? Have you ever felt bad or guilty about your drinking or drug use? Have you ever had a drink or used drugs first thing in the morning to steady your nerves or to get rid of a hangover? |
|
|
How Much is "Too Much"?
|
Drinking becomes too much when it..
-Causes or elevates the risk for alcohol related problems, or -Complicates management of other health problems Men who drink more than 4 standard drinks in a day Women who drink more than 3 standard drinks in a day |
|
|
Why Screen for Heavy Drinking?
|
At Risk drinking and alcohol problems are common - 30% of people have a problem
Heavy drinking often goes undetected - only 10% are getting what they need Patients are likely to be more receptive, open, and ready to change than you expect You are in a prime position to make a difference - brief interventions can promote significant, lasting reductions in drinking levels in at-risk drinkers who are not alcohol dependent Some drinkers who are dependent will accept referral to addiction treatment programs. Even for patients who don't accept referral, repeated alcohol-focused visits with health providers can lead to significant improvement |
|
|
Decide on a Screening Method
|
- A single question about heavy drinking days to use during a clinical interview
- the AUDIT, a written self-report instrument; it takes less than five minutes to complete |
|
|
What are some clinical indications for screening?
|
As part of a routine examination
Before prescribing a medication that interacts with alcohol In the emergency department or urgent care center When seeing patients who: are pregnant or trying to conceive, are likely to drink heavily, have health problems that might be alcohol induced, have a chronic illness not responding to treatment |
|
|
Step 1 - Ask About Alcohol Use
|
Prescreen: Do you sometimes drink beer, wine, or other alcoholic beverages
If no... the screening is complete. If yes... Ask How many times in the past year have you had 5 (for men) or 4 (for women) or more drinks in a day? If negative - advise staying within these limits If positive (1 or more heavy drinking days or an AUDIT score of >8 (men) or >4 (women) ) your patient is an at-risk drinker. Ask - on average, how many days a week do you drink? and how many drinks do you have on those day? weekly average. |
|
|
Maximum Drinking Limits
|
For healthy men up to age 65 - no more than 4 drinks in a day AND no more than 14 drinks in a week
For health women and healthy men over 65 - no more than 3 drinks in a day AND no more than 7 drinks in a week |
|
|
Step 2 - Assess for Alcohol Use Disorders (AUDs)
|
Determine if there is - a maladaptive pattern of alcohol use or causing clinically significant impairment or distress
1. Determine if the patient's drinking has repeatedly caused or contributed to... -risk of bodily harm -relationship trouble -role failure -run-ins with the law If yes to one or more = Alcohol Abuse Assess for Dependence Determine whether the patient has ... -not been able to stick to drinking limits -not been able to cut down or stop -shown tolerance -shown signs of withdrawal -kept drinking despite problems -spent a lot of time drinking -spent less time on other matters If yes to 3 or more = alcohol dependence |
|
|
Step 3- Advise and Assist for a Patient with At-Risk Drinking
|
1. State your conclusion and recommendation clearly "You are drinking more than is medically safe. I strongly recommend that you cut down (or quit) and I'm willing to help."
2. Gauge readiness to change drinking habits - "Are you willing to consider making changes in your drinking?" |
|
|
Step 3- Advise and Assist for a Patient with At-Risk Drinking and the Patient is NOT ready to commit to change at this time
|
Don't be discouraged - ambivalence is common. Your advice has likely prompted change in your patient's thinking, a positive change in itself.
Restate your concern about his or her health. Encourage reflection- ask patient to weigh what they like about drinking versus their reasons for cutting down. What are the major barriers to change? Reaffirm your willingness to help when he or she is ready. |
|
|
Step 3- Advise and Assist for a Patient with At-Risk Drinking and the Patient IS ready to commit to change at this time
|
Help set a goal to cut down to within maximum limits or abstain for a period of time.
Agree on a plan, including - what specific steps the patient will take, how drinking will be tracked - diary, how to manage high risk situations, who might be willing to help, such as a spouse or non-drinking friends Provide educational materials Document alcohol use and review goals |
|
|
Step 3- Advise and Assist for a Patient with At-Risk Drinking and the patient was NOT able to meet and sustain the drinking goal?
|
Acknowledge change is difficult
Support any positive change and address barriers to reaching the goal Renegotiate the goal and plan; consider a trial of abstinence Consider engaging significant others Reassess the diagnosis if the patient is unable to either cut down or abstain |
|
|
Step 3- Advise and Assist for a Patient with At-Risk Drinking and the patient WAS able to meet and sustain the drinking goal?
|
-Reinforce and support continued adherence to recommendations
-Renegotiate drinking goals as indicated -Encourage patient to return if unable to maintain adherence -Rescreen at least annually |
|
|
Step 3 - Advise and Assist for a Patient with Alcohol Use Disorders (abuse or dependence)
|
1. State your conclusion and recommendation clearly - "I believe that you have an alcohol use disorder. I strongly recommend that you quit drinking and I'm willing to help."
2. Consider referring for additional evaluation by an addiction specialist, especially for dependence 3. Consider recommending a mutual help group 4. Arrange followup appointments - including medication management support if needed |
|
|
Step 3 - Advise and Assist for a Patient with Alcohol Use Disorders - DEPENDENCE
|
Consider :
- the need for medically managed withdrawal (detoxification) and treat accordingly - prescribing a medication for patients who endorse abstinence as a goal |
|
|
Step 4: At Follow-Up - Was the patient able to meet and sustain the drinking goal? NO
|
Acknowledge that change is difficult
Support efforts to cut down or abstain, while making it clear that your recommendation is to abstain Relate drinking to problems (medical, psychological, and social) as appropriate If the following measures are not already being taken, consider -referring to an addiction specialist or consulting with one -recommending a mutual help group -engaging significant others -prescribing a medication for alcohol dependent patients who endorse abstinence as a goal |
|
|
Step 4: At Follow-Up - Was the patient able to meet and sustain the drinking goal? YES
|
Reinforce and support continued adherence to recommendations
Coordinate care with a specialist if the patient has accepted referral |
|
|
Quick Screen for Drugs
|
How many times in the past year have you used a recreational drug or prescription medication for nonmedical reasons
Use other language to relate to patient |
|
|
Assessment - DRAFT BEER
|
Drug
Route Amount Frequency Timing/Treatment Sample questions: When did you first use and why? Last use? Dependency indicators: Using more than intended, use impacts work/school/family, tolerance/withdrawal |
|
|
If screening is positive for drug use
|
1. Advise and Assist (brief intervention) - state your conclusion and recommendation
2. Gauge willingness to change - encourage reflection, reaffirm your willingness to help, set a goal, agree on a plan and provide educational materials 3. Helping patients who drink too much 4. How to refer for addiction: call insurer for coverage, # of days, detox, rehab, after-care, SAMSHA facility locator, private detox/rehab facilities ($$$$) but some have sliding scales, medicaid pays for 1 detox per month, psychotherapy after detox |
|
|
Alternative assessment tool for drug screen - ASSIST
For a positive ASSIST... |
-focus the intervention on one substance only
-more often than not, the substance of most concern will be the one that is being injected or has attracted the highest ASSIST score - takes 3-15 minutes and targets clients who are in the pre-contemplation or contemplation stages of change, which are likely to comprise the majority of primary care clients screened Intervention 1. ask client if interested in questionnaire score 2. provide personalized feedback 3. give advice on how to reduce risk |
