February 2013 · Vol. 62, No. 02: 63-69Patient abusing alcohol or drugs? Help starts with a single question
Although binge drinking and drug use are rarely discussed during office visits, they’re common, costly, and potentially fatal. Help patients stop with these easy-to-use screening tools and effective intervention strategies.
Daniel
C.
Vinson,
MD, MSPHFamily and Community Medicine, University of Missouri, Columbia
VinsonD@health.missouri.edu The author reported no potential conflict of interest relevant to this article.
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PRACTICE RECOMMENDATIONS
• Screen patients for substance use disorders, with a single (validated) question for alcohol and another for drugs. A
• Follow a positive screen for alcohol with an assessment to distinguish between hazardous drinking and drinking that is indicative of alcohol dependence. C
• Approach a substance use disorder as you would any chronic medical condition, seeking to engage the patient to encourage behavior change. Motivational interviewing is a useful tool. C
• Consider pharmacotherapeutic options for patients with alcohol or drug dependence. A
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
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Episodic heavy drinking, like alcoholism and drug addiction, is increasingly recognized as a medical problem that primary care physicians can, and should, address.1 But it is rarely the chief reason for an office visit. Nor is it a subject patients are likely to bring up.
However, patients are generally willing to talk to a trusted doctor who asks about their use (or misuse) of alcohol or other substances. And primary care physicians can do much to help—with brief interventions, a growing armamentarium of pharmacotherapy, and referrals as needed. In the pages that follow, you’ll find easy-to-use screening tools and effective intervention strategies.
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