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Assessment of Alcohol Use Disorder

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Assessment of Alcohol Use Disorder

0.5 hr CE

Goal: To provide clinical skills to assess alcohol use problems, diagnose uncomplicated cases of alcohol use disorder, and evaluate co-morbid health problems.

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Activity Steps

1. Activity Content
2. Post-Assessments
3. Earn Certificate

Funding: Initial development of this activity was supported by funding from the National Institute on Alcohol Abuse and Alcoholism (Grant #1 R43 AA026474-01).

This activity is designed to change: Competence, Performance, Patient Outcome. 0.5 hr

Overview

Needs and Training Gaps

Educational Objectives:

After completing this activity, participants will be able to:

  • Confidently interviewing patients to assess alcohol use problems
  • Assessing patient’s for risk of alcohol use disorder
  • Diagnosing alcohol use disorder in patients

Training Activity References

Audience and Accreditation

Audience: Health professionals

TypeEst. TimeReleasedExpires
DCBN0.5 hr(s)4/9/214/8/23
FBN CNA0.5 hr(s)4/9/214/8/23

Accreditation Statement: Clinical Tools, Inc. is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

DCBN Credit Statement: Clinical Tools, Inc. designates this enduring material for a maximum of 0.5 hour(s) of DCBN credit. Clinical Tools, Inc. is an approved provider by the District of Columbia Board of Nursing and is registered with CE Broker, Provider #50-1942.

FAPA Credit Statement: Clinical Tools, Inc. designates this enduring material for a maximum of 0.5 hour(s) of Florida Physician Assistants credit. Providers and other health professionals should claim only the credit commensurate with the extent of their participation in the activity.

FBN CNA Credit Statement: Clinical Tools, Inc. designates this enduring material for a maximum of 0.5 hour(s) of Florida Board of Nursing – Certified Nursing Assistants credit. Providers and other health professionals should claim only the credit commensurate with the extent of their participation in the activity.

Arkansas State Board of Nursing Accreditation Statement: Clinical Tools, Inc. is recognized by the Arkansas State Board of Nursing as an accredited provider of continuing medical education for nurses.

Georgia Board of Nursing Accreditation Statement: Clinical Tools, Inc. is recognized by the Georgia Board of Nursing as an accredited provider of continuing medical education for nurses.

New Mexico State Board of Nursing Accreditation Statement: Clinical Tools, Inc. is recognized by the New Mexico State Board of Nursing as an accredited provider of continuing medical education for nurses.

South Carolina Board of Nursing Accreditation Statement: Clinical Tools, Inc. is recognized by the South Carolina Board of Nursing as an accredited provider of continuing medical education for nurses.

A letter of completion for 0.5 hours is available.

A score of 70% on the post-test is required to complete the activity.

Participation Requirements

Authors

Clinical Tools, Inc. requires everyone who is in a position to control the content of an educational activity to disclose all relevant financial relationships with any commercial interest to the provider, which are defined as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. Any conflicts of interest are resolved prior to the delivery of the educational activity to the learner. CTI does not permit individuals with financial conflicts of interest to participate in any stage of activity development.

T Bradley Tanner, MD (President, Clinical Tools, Inc.)
Disclosure: Has disclosed no relevant financial relationships. Dr. Tanner is the owner of Clinical Tools.

Read Bio
T. Bradley Tanner, MD is president of Clinical Tools and responsible for the vision of the company. He has received funding via grants and contracts from NIDA, NIAAA, NIMH, NCI, AHRQ, CDC, the Dept of Defense, and NASA to develop medical and health education projects. Dr. Tanner served as principal investigator on 2 NIDA grants to develop the DATA-2000 qualifying buprenorphine training program and clinical practice tools on BupPractice.com. He also has a strong background in technology and oversees the development and delivery of all Clinical Tools websites. Dr. Tanner is also a board-certified psychiatrist with experience in inpatient, outpatient, and emergency health settings. He currently treats patients and educates medical students and residents via his role as a Clinical Associate Professor of Psychiatry at the University of North Carolina at Chapel Hill.

Karen Rossie, DDS, PhD (Research Scientist, Clinical Tools, Inc. )
Disclosure: Has disclosed no relevant financial relationships.

Read Bio
Karen Rossie, DDS, PhD, directs projects at Clinical Tools. She majored in biology at Cleveland State University and studied dentistry at Case Western Reserve University followed by completing a Masters in pathology at Ohio State University, and later, a PhD in Psychology from the Institute of Transpersonal Psychology. She taught and practiced oral pathology and oral medicine for 15 years at the Ohio State University and the University of Pittsburgh, doing research in autoimmune disease, viral effects in bone marrow transplantation, oral cancer, salivary gland disease, candidiasis, and diabetes. She has used this diverse background to lead or contribute to CTI projects related to tobacco cessation, opioid abuse treatment, anxiety, dementia care, alcohol use disorder, screening and brief interventions for substance abuse, obesity, and pain and addiction.

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Funding Information Development of this website was funded by grant #2R44AA026474 from the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health. The website contents are solely the responsibility of the authors and do not necessarily represent the official views of NIH. No commercial support is received.
Clinical Tools is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

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Training Activity References

American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.. 2013.

Baker AL, Thornton LK, Hiles S, et al. Psychological interventions for alcohol misuse among people with co-occurring depression or anxity disorders: a systematic review. Journal of Affective Disorders. 2012; 139: 217-229. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21890213 Accessed on: 2015-06-17.

Boden JM, Fergusson DM. Alcohol and Depression. Addiction. 2011; 106(5): 906-914. Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2010.03351.x/full Accessed on: 2015-06-16.

CDC. Effects of Blood Alcohol Concentration (BAC). Injury Prevention & Control: Motor Vehicle Safety. 2015. Available at: http://www.cdc.gov/motorvehiclesafety/impaired_driving/bac.html Accessed on: 2015-03-13.

Clinical Tools, Inc.. Diagnosing Alcohol Use Disorder. Clinical Tools, Inc.. 2016. Available at: https://www.youtube.com/embed/zGuiEbaAk3gAccessed on: 2016-01-08.

Connor J. Alcohol consumption as a cause of cancer. Addiction. 2016; 112(2): 10.1111/add.13477. Available at: http://onlinelibrary.wiley.com.libproxy.lib.unc.edu/doi/10.1111/add.13477/full Accessed on: 2018-02-27.

eHowhealth. Alcohol & substance abuse: warning signs of an alcoholic. YouTube. 2009. Available at: https://www.youtube.com/watch?v=bx61NXzc3xY Accessed on: 2015-05-07.

Emmite D, Swierzewski SJ III. Alcohol Abuse Diagnosis. Remedy Health Medial, LLC. 2011. Available at: http://www.healthcommunities.com/alcohol-abuse/diagnosis.shtml Accessed on: 2015-03-13.

Goldberg IJ, Mosca L, Piano MR, et al.. AHA Science Advisory: Wine and your heart: a science advisory for healthcare professionals from the Nutrition Committee, Council on Epidemiology and Prevention, and Council on Cardiovascular Nursing of the American Heart Association.. Circulation. 2001; 103(3): 472-5. Available at: http://circ.ahajournals.org/content/103/3/472.long Accessed on: 2018-02-27.

Graham K, Bernards S, Knibbe R, et al.. Alcohol-related negative consequences among drinkers around the world. Addiction. 2011; 106(8): 1391-405. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3682406/ Accessed on: 2015-03-13.

Grover S, Mattoo S, Pendharkar S, et al.. Sexual Dysfunction in Patients with Alcohol and Opioid Dependence. Indian J Psychol Med. 2014; 36(4): 355-365. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4201785/ Accessed on: 2015-03-12.

Heumann D. Alcoholic hepatitis clinical presentation. Medscape Drugs and Diseases. 2014. Available at: http://emedicine.medscape.com/article/170539-clinical Accessed on: 2015-07-27.

Hillbom M, Saloheimo P, Juvela S. Alcohol Consumption, Blood Pressure, and the Risk of Stroke. Curr. Hypertension Rep.. 2011; 13(3): 208-213. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21327566 Accessed on: 2015-06-17.

Kilgour AR, Chudley AE. Fetal Alcohol Spectrum Disorder. Drug Abuse and Addiction in Medical Illness: Causes, Consequences and Treatment. 2012. Available at: http://link.springer.com/chapter/10.1007/978-1-4614-3375-0_36 Accessed on: 2015-06-12.

LoConte NK, Brewster AM, Kaur JS, et al.. Alcohol and cancer: A statement of the American Society of Clinical Oncology.. J Clin Oncol. 2018; 36(1): 83-93. Available at: https://www.ncbi.nlm.nih.gov/pubmed/29112463 Accessed on: 2018-02-27.

Marino EN, Fromme K. Alcohol-induced blackouts and maternal family history of problematic alcohol use. Addictive Behaviors. 2015; 45: 201-206. Available at: http://www.ncbi.nlm.nih.gov/pubmed/25705013 Accessed on: 2015-06-17.

Mehta MM, Moriarty KJ, Proctor D, Bird M, Darling W. Alcohol misuse in older people: heavy consumption and protean presentations. Journal of Epidemiology Community Health. 2006; 60: 1048-1052.

Merrick EL, Horgan CM, Hodgkins D, Garnick DW, Houghton SF, Panas L, Saitz R, Blow FC. Unhealthy drinking patterns in older adults: prevalence and associated characteristics. JAGS. 2008.

National Institute on Alcohol Abuse and Alcoholism. Alcohol Alert No. 56: Screening for Alcohol Use Problems — An Update. NIAAA Website. 2002a. Available at: http://pubs.niaaa.nih.gov/publications/aa56.htm Accessed on: 2008-10-10.

National Institute on Alcohol Abuse and Alcoholism. Helping Patients Who Drink Too Much: A Clinician’s Guide, Updated 2005 Edition. Bethesda, MD. 2007. Available at: http://pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/guide.pdf Accessed on: 2008-10-10.

NIAAA. Alcohol’s Effects on the Body. NIAAA. 2015. Available at: http://www.niaaa.nih.gov/alcohol-health/alcohols-effects-body Accessed on: 2015-04-29.

NIAAA. Beyond hangovers. NIAAA Publications. 2010b. Available at: http://pubs.niaaa.nih.gov/publications/Hangovers/beyondHangovers.htm#chapter03 Accessed on: 2015-07-27.

O’Conner PG. Drug Use and Dependence: Alcohol. Merick Manuals. 2008-2013. Available at: http://www.merckmanuals.com/professional/special_subjects/drug_use_and_dependence/alcohol.html Accessed on: 2015-03-11.

Rehm J, Samokhvalov AV, Shield KD. Global burden of alcoholic liver diseases. Journal of Hepatology. 2013; 59: 160-168. Available at: http://www.ncbi.nlm.nih.gov/pubmed/23511777 Accessed on: 2015-06-17.

Rogers J, Wiese BS. Geriatric drinkers: Evaluation and treatment for alcohol overuse. BCMJ. 2011; 53: 353-356. Available at: http://www.bcmj.org/articles/geriatric-drinkers-evaluation-and-treatment-alcohol-overuse Accessed on: 2015-03-13.

Rogers RG, Boardman JD, Pendergast PM, et al. Drinking problems and mortality risk in the United States. Drug and Alcohol Dependence. 2015; 151: 38-46. Available at: http://www.ncbi.nlm.nih.gov/pubmed/25858785 Accessed on: 2015-06-17.

Sheps S. Does drinking alcohol affect your blood pressure?. Mayo Clinic. 2012. Available at: http://www.mayoclinic.org/diseases-conditionsAccessed on: 2015-03-13.

Singh S, Sangam S, Joginapally VR, et al. Alcohol, glycine, and gastritis. International Journal of Nutrition, Pharmacology, Neurological Diseases. 2015; 5(1): 1-5. Available at: http://www.ijnpnd.com/article.asp?issn=2231-0738;year=2015;volume=5;issue=1;spage=1;epage=5;aulast=Singh Accessed on: 2015-06-17.

Sinha R. How Does Stress Lead to Risk of Alcohol Relapse?. Alcohol Research. 2012; 34: 432-440. Available at: http://pubs.niaaa.nih.gov/publications/arcr344/432-440.htm Accessed on: 2015-06-17.

Smyth A, Teo KK, Rangarajan S, O’Donnell M, Zhang X, Rana P, Leong DP, Dagenais G, Seron P, Rosengren A, Schutte AE, Lopez-Jaramillo P, Oguz A, Chifamba J, Diaz R, Lear S, Avezum A, Kumar R, Mohan V, Szuba A, Wei L, Yang W, Jian B, McKee M, Yusuf S. Alcohol Consumption and Cardiovascular Disease, Cancer, Injury, Admission to Hospital, and Mortality: A Prospective Cohort Study. The Lancet. 2015. Available at: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)00235-4/references Accessed on: 2015-09-28.

Stern TA, Gross AF, Stern TW, et al. Current approaches to the recognition and treatment of alcohol withdrawal and delirium tremens: “old wine in new bottles” or “new wine in old bottles”. Primary Care Companion to The Journal of Clinical Psychiatry. 2010; 12(3): . Available at: http://www.psychiatrist.com/PCC/article/Pages/2010/v12n03/10r00991ecr.aspx Accessed on: 2017-03-16.

Substance Abuse and Mental Health Services Administration. Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings. NSDUH Series H-48, HHS Publication No. (SMA) 14-4863. Rockville, MD: Substance Abuse and Mental Health Services Administration. 2014. Available at: http://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.pdf Accessed on: 2015-04-30.

Sullivan JT, Sykora K, Schneiderman J, et al. Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar). Br J Addict. 1989; 84(11): 1353-7. Available at: https://www.ncbi.nlm.nih.gov/pubmed/2597811 Accessed on: 2017-03-16.

Thakkar MM , Sharma , Sahota P . Alcohol disrupts sleep homeostasis . Alcohol . 2015; 49(4): 299-310. Available at: http://www.ncbi.nlm.nih.gov/pubmed/25499829 Accessed on: 2015-07-21.

Primary care physicians (PCPs) and other health care providers can have an overall positive effect on the patients they treat. Since about 70% of the population visits a PCP at least every other year, this puts the health care provider in a unique position to help (CASA 2000). Alcohol use continues to be a widespread public and social health problem. The health care provider needs to be able to screen for drinking in patients and assess, provide brief interventions, and/or make appropriate referrals when screening results are positive. Routine screening of all adults and adolescents for the continuum of alcohol use problems is currently recommended (NIAAA 2007) but does not always occur. The reality is that few physicians or other health care providers are routinely providing screening or intervention with their patients (D’Amico et al., 2005). Routine screening of all adults and adolescents for the continuum of alcohol use problems is currently recommended (NIAAA 2007).

At-risk drinkers can be effectively treated solely in primary care by using brief interventions (SAMHSA, 2014). Motivational interviewing skills can be used as a part of brief interventions for alcohol use problems. No two patients with alcohol use disorders will respond to treatment in the same manner. Alcohol abuse can affect anyone, regardless of age, gender, race, or specific lifestyle situations. As a health professional, it will be important for you to tailor your patient interviews about alcohol use to the patient’s age, gender, and race.

Alcohol addiction is a complex disease, and continued research provides insight into the biological basis of this disease. Patient education is key to increasing compliance and thus improving the success of treatment.

Training Gap References

CASA. National Survey of Primary Care Physicians and Patients on Substance Abuse. The National Center on Addiction and Substance Abuse at Columbia University. 2000.

D’Amico EJ, Paddock SM, Burnam A, Kung FY. Identification of and guidance for problem drinking by general medical providers: results from a national survey. Medical Care. 2005; 43(3): 229-236.

National Survey of Primary Care Physicians and Patients on Substance Abuse. The National Center on Addiction and Substance Abuse at Columbia University. 2000.

NIH. Alcohol-Related Traffic Deaths Fact Sheet. NIH. 2010. Available at: http://report.nih.gov/NIHfactsheets/Pdfs/AlcoholRelatedTrafficDeaths(NIAAA).pdf Accessed on: 2015-05-07.

SAMHSA. Screening, Brief Intervention, and Referral to Treatment (SBIRT). SAMHSA. 2014. Available at: http://www.samhsa.gov/sbirt Accessed on: 2015-03-20.

Participation Requirements

Activity Credit: Obtaining credit for participation in this activity requires that you complete the pre-assessments, work through the modules (including all in-module interactive activities), complete the post-assessments with a 70% score on the post-test, and then request credit. At the end of the activity, you will be instructed on how to print out a certificate for your records.

Time Requirement: Keep track of the amount of time it takes you to complete this activity. You will be required to spend a set amount of time in order to claim credit. You should claim credit only for the time actually spent in the activity.

Technical Requirement: To participate in this activity, you will need a computer, an Internet connection, and a Web browser. This activity requires Chrome, Firefox, and IE7 or higher.