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![Page 1: Research Group](https://reader036.fdocuments.net/reader036/viewer/2022062422/56812c70550346895d91076d/html5/thumbnails/1.jpg)
Identifying and characterizing alcohol at-
risk individuals in a
university emergency department utilizing AUDIT-
C within a short general health screen:
A pilot study
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Presenter: Arshadul Haque MBBS, MPH
J Helmkamp PhD, S Swisher McClure BS, J Williams MD, P Ehrlich MD, W Manley RN
Research Group
Research Funded by grant from CDC/NCIPC
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• Alcohol use is pervasive in our society. About 50% of all Americans ages 12 and olderare current drinkers which translates to 120 million people.1
• A wide range of physical, social and psychological problems are associated with excessive drinking
• Annual economic cost to the nation is approximately $148 billion2
Introduction1
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Introduction2
• Why early detection and treatment?
• Where can early detection occur?
• How is early detection facilitated?
• How can detection improve?
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Difficulties and Problems
• What are the barriers in early detection?
• Are providers increasing their scope of screening in their regular practice?
• “Missed opportunities” and various “teachable moments”.3
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Additional Problem
• There is a growing size of the population who are accessing the ED as the only source of care and do not have primary care physicians4
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Alcohol Screening Instruments
• To name a few: TWEAK, CAGE, AUDIT, MAST, etc.
• Alcohol Use Disorders Identification Test (AUDIT), a 10-item questionnaire
• However, the AUDIT still remains to be routinely incorporated in routine health screening
• Likely limitation is the 10 items itself and the required training for its interpretation
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Current Research
• AUDIT-C has been found to be equally specific compared to the full instrument5
• However, three screening questions related to alcohol use will not cover the full scope of detecting alcohol problems
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Research study objectives
• To explore the feasibility of inclusion of a short alcohol screening tool within a general health screen
• To identify patients with alcohol problems with AUDIT-C. Subsequently, characterize the full range of alcohol problems; intake, dependence and harm conditions
• Finally, to study the associations of screened positive individuals with other items of a general health screen
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Methods• Study Period : August 2001 to July 2002
• Patients coming to the ED were approached to participate in the study
• Eligibility was determined based on age criteria (18-39 years)
• Consent to participate in the study and to receive information was
obtained
• A short general health screen was provided with AUDIT-C questions
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Methods
• Using AUDIT-C cut off score of 4, patients were further evaluated with the full AUDIT questionnaire
• Other co-morbidity information was also collected
• Patients were provided with feedback and a brief intervention based on the methods described by Miller and Rollnick
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AUDIT-C; Intake section
1. In the past year, how many drinks containing alcohol do you have on a typical day, when you are drinking?
1 or 2 3 or 4 5 or 6 7 or 9 10 or more 0 1 2 3 4
2. How often do you drink that amount?
Never <Monthly Monthly Weekly Daily/almost daily 0 1 2 3 4
3. How often in the past year you had 5 (male)/4 (female) or more drinks on one occasion?
Never <Monthly Monthly Weekly Daily/almost daily 0 1 2 3 4
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AUDIT- Dependence section1. How often during the past year have you found that you were not able to
stop drinking once you had started?Never <Monthly Monthly Weekly Daily/almost daily
0 1 2 3 42. How often during the past year have you needed a first drink in the
morning to get yourself going after a heavy drinking session?
Never <Monthly Monthly Weekly Daily/almost daily 0 1 2 3 4 3. How often during the past year have you had a feeling of guilt or
remorse after drinking?Never <Monthly Monthly Weekly Daily/almost daily
0 1 2 3 4 4. How often during the past year have you been unable to remember what
happened the night before because you had been drinking?Never <Monthly Monthly Weekly Daily/almost daily
0 1 2 3 4
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AUDIT- Harm section1. How often during the past year have you not done what
was normally expected from you because of drinking? For example, have you ever missed work or class?Never <Monthly Monthly Weekly Daily/almost daily
0 1 2 3 42. Has your drinking contributed to an injury to yourself
or anyone else?Never Yes, but not in the last year Yes, during the last year
0 2 4 3. Has a relative, friend, doctor, or other health worker
been concerned about your drinking or suggested that you should cut down?Never Yes, but not in the last year Yes, during the last year
0 2 4
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Results of Patient process1
• 1991 patients were approached in the Emergency Department
• 96% (1910) met age and drinking eligible criteria
• 48% (925) patients consented to participate in the study
• Median time for the process to obtain consent was 3 minutes
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Results of Patient process2
• 925 patients were administered the general health screen inclusive of AUDIT-C questions
• 26% (241) were found to be screen positive for alcohol problems (at AUDIT-C cut off score of 4)
• Median time to complete the screening process was 4 minutes
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Patient Characteristics1
Consenting patient group (N=925) consisted of:
• Females 53% (484)
• Ages:
•18-20 yrs 21% (193)
•21-24 yrs 27% (246)
•25-39 yrs 52% (482)
• Race:
•White 95% (858)
•Black 4% (32)
•Asian/PI 1% (8)
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Patient Characteristics2Other select characteristics of Consenting patient group:
• Students 30% (275)
• Completed Education level:
•Less than high school 16% (1145)
•High School/GED 35% (322)
•Some College 40% (368)
• Smokes Tobacco 51% (467)
• Not married 66% (607)
• Source of regular Medical Care:
•Private physician 41% (372)
•Emergency Department 27% (251)
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Screen Positive and Screen Negative Patient Characteristics1
Screen-Pos Screen-Neg
•Gender (N=921)
Female 34% 59%
Male 66% 41%
• Ages:
18-20 yrs 31% 17%
21-39 yrs 69% 83%
• Student:
Currently a student 48% 23%
Not a current student 52% 77%
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Screen Positive and Screen Negative Patient Characteristics2
Screen Pos Screen Neg
•Education Completed (N=917)
High School or Less 45% 53%
Some College or above 55% 47%
• Marital Status
Single 85% 59%
Married 15% 41%
•Tobacco Use (N=924)
Smoked 64% 46%
Did not Smoke 36% 54%
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Screen Positive and Screen Negative Patient Characteristics3
Screen-Pos Screen-Neg
•Exercise (N=924)
Regular in activity 64% 55%
Do not Exercise 36% 45%
•Seatbelt Use
Always 55% 68%
Seldom/Never 45% 32%
• Source of Regular Health Care
ED 37% 24%
Other than ED 63% 76%
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Drinking characteristics of Screen Positive Patients
Alcohol Intake* (N=241) • 3 or more drinks
per typical drinking day97%• 7 or more drinks
per typical drinking day53%
•Usually drank
•1 or fewer times per week50%
•2 to 3 times per week39%
•4 or more times per week11%
•Binged** 3 or more times in past two weeks
58%
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Drinking characteristics of Screen Positive Patients
Dependence Symptoms Related to Drinking* (N=238)
• Not able to stop drinking once started§ 23%
• Needs drink in morning to get going§ 7%
• Feels guilt or remorse after drinking§ 27%
• Amnesia of events due to drinking§ 44%
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Drinking characteristics of Screen Positive Patients
Harm Symptoms Related to Drinking* (N=238)
• Failed to fulfill normal expectations§
23%
• Injury to self or others§ 7%
• Relatives, friends, or health care providers express concern about drinking§
27%
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Multiple Logistic Regression Analysis for AUDIT-C screen positive
patients OR 95%CI p-value
• Student (currently being a student) 3.4 1.9-6.3
<0.0001
• Not married/Single 3.1 1.7-5.8 0.0002
• Smokes Tobacco 2.8 1.6-4.7 0.0002
• Place for regular medical care (ED based) 2.1 1.2-3.6
0.0068
• Seatbelt use (Never/seldom uses seatbelts) 2.0 1.2-3.2 0.0092
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Conclusions
• A short alcohol screening tool can be conveniently utilized within a general health screen
• Initial screen with this tool can facilitate further evaluation of alcohol problems
• Besides intake factors other risk factors are associated with alcohol problems
• Patients with certain profiles should arouse the curiosity of health care professionals to discuss alcohol related problems
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References
1. Results from 2002 National Survey on Drug Use and Health (NSDUH) at www.samhsa.gov/oas/NHSDA/ 2K2NSDUH.Results/2h2results.htm
2. Harwood H, Fountain D et al. The economic costs of alcohol and drug abuse in the United Sates, 1992. NIH publication No. 98-4327, printed September 1998
3. Maio RF. Alcohol and injury in the emergency department: opportunities for intervention. Ann Emerg Med. 1995; 26: 221-223.
4. Cross LA.: Pressure on the emergency department:The expanding right to medical care. Ann Emerg Med. 1992; 21: 1266-1272.
5. Gordon A, Maisto S, et al. Three questions can detect hazardous drinkers. J of Fam Pract 2001;50(4):313-320