Health Assessment Theory Chapter 6- Substance Use Assessment

CAGE questionnaire

-Have you ever felt you should Cut down on your drinking? -Have people Annoyed you by criticizing your drinking? -Have you ever felt bad or Guilty about your drinking? -Have you ever had a drink first thing in the morning to steady your nerves (Eye-opener)? les than 1 minute to complete yes/no questions works well in busy primary care settings 2+ yes questions=possible abuse/further assessment

Affects of alcohol

-increase risk of cardiomyopathy, w/increase left ventricle mass - wall thinning and dilation of ventricles -arrythmogenic: muscle tissue in right ventricle dies -increase ICU admission -sepsis - chemicals in blood stream -septic shock -hospital morality

Alcohol effects on the Aging Adult

-increasing -decrease of metabolic functions -muscle mass decline -polypharmacy interaction w/ alc -cogn. decline -risk for falls, depression, GI problems

rate of death In od compare to motor vehicle accidents

INCREASE

intoxication

Maladaptive behavioral or psychological changes caused by excessive use of a drug or alcohol effects on CNS

under-diagnosed in primary and hospital setting

alcohol abuse

AST (serum aspartate aminotransferase)

aspartate aminotransferaseI,enzyme found in high conc. in heart and liver chronic drinking for months increases this

one or more heavy drinking days means a person is a _____ drinker

at risk

If patient is currently intoxicated or going through substance withdrawal, collecting data is

UNRELIABLE AND DIFFICULT

alcohol dependence (alcoholism)

chronic progression diagnosis, not curable, but highly treatable

41%

current alc drinkers aged 20+ that also take prescribed medicine

Abuse

daily or recurrent use such that impairment and decreased functioning are ongoing issues

Breath Alcohol

detects any amount of alcohol in end of exhaled air following a deep inhale until all ingested alc is metabolized - BAC -basic for legal interpretation of drinking

how much alcohol had been determined to be safe for women?

no amount of alcohol

What drugs interact with alcohol?

opioid pain relievers heroin benzodiazepines antidepressants antihistamines cough syrups 10% alc blood pressure meds antibiotics anti-eleptics BLOOD THINNERS

3 most frequently abused prescription opioid pain relievers

oxycodone hydrocodone methadone

Fetal of Alcohol Spectrum

physical deformities as well as learning behavioral problems -some consequences are unknown

dependence

physiological reliance

AUDIT questionnaire

quantitative form with 10 questions that cover alcohol consumption, drinking behavior or dependence, and adverse consequences of alcohol max score= 40 primary care setting free of any type of bias

tolerance

requires more to get desired effect

GGT (gamma glutamyl transferase)

serum protein, gamma glutamyl transferase is the most commonly used biochemical marker of alcohol drinking. *only increased by chronic drinking *Liver disease can also increase GGT (unrelated to alcohol drinking)

CDT (carbohydrate-deficient transferrin)

used together with got and may increase detection of alcohol abuse -healthy women have higher levels than men, so the

Clinical Lab findings Data

less sensitive and specific than questionnaires GGT CDT AST MCV PEth Breath Alc CIWA

Men=____, women=___ is heavy or at risk drinking

men= 15+ week, women = 8+ week

alcohol usage

moderate- less than 2 per day for men, less than 1 per day for men heavy- more than 15 a week for men, more than 8 a week for women binge- more than 5 per occasion for men, more than 4 per occasion for women

phosphatideylethanol (PEth)

more sensitive indicator used to measure abstinence and sober living, only biomarker than can detect moderate alcohol intake phospholipid produced only in present of alcohol

CIWA (Clinical Institute Withdrawal Assessment)

most sensiitve for objective measurement for withdrawal - quantified to measure the progress of it -10 measured criteria -vitals and oxygen saturation scores 0-9 absent or minimal withdrawal 10-19 mild 20+ severe if score 8+ take vitals every hour for 8 hr straight 15+ tiggers scheduled meds

Alcohol Affects on Adolescence

- sexual high-risk -academic problems -injuries from trauma -continuation of disease later in life

Abuse of prescription drugs

-fastest growing issue in US -obtained from friend/relative, only 34% prescribed from dr

alcohol abuse

-many patients will have significant history of drinking that has impact on health -morbidity and mortality reflect adverse consequence of excessive abuse -many medications are classified as alcohol interactive -binge related to increasing health risks

7 categories of illicit drug use

1.marijuana 2. cocaine 3. heroin 4. hallucinogens 5. inhalants 6.methaphetamines 7.nonmedical use of psychotherapeutics (pain pills, sedatives, stimulants etc)

Alcohol standard drink

12 oz Beer(5%), 8-90z malt liquor(7%), 5oz Wine (17% bottle=5 servings), 1.5 oz spirits(40%, mixed drink=1-3 servings), 3 oz martini (40%,=2 standard drinks)

Effects on women

2 standars drinks/day - cirrhosis- liver scarring - breast cancers -hypertension

Effects on Men

4 standars drinks a day - cirrhosis- liver scarring -cancers -injury - high blood pressure- hypertension

Screening tools

AUDIT: Alcohol Use disorders Identification Test CAGE: 4-items asked TWEAK SMAST-G

how to diagnose in gold standard for alcohol abuse

DMV- 5 Diagnostic and Statistical Manual of Mental Disorders- 5th edition

AUDIT-C

Shorter version of AUDIT for acute and critical care units - screening test for heavy drinking and/or active abuse Score: 3 or above = heavy or at-risk drinking

SMAST-G questionnaire

for older adults who report social or regular drinking of any amount of alcohol. -low risk response is 0 or 1 point. (10 questions)- yes/no responses -2 or more yes indicate problem

TWEAK questions

for women w/ alcohol problems Tolerance: how many drinks can you hold? 3 + = tolerance Worry: anyone complain about ur drinking? Eye-opener: do u drink in am when first waking up? Amnesia: has someone told you something you can remember ? Kut down: feel the need to cut down?

MCV (mean corpuscular volume)

index of RBC'S not sensitive enough to use as only biomarker for problems

withdrawal

the discomfort and distress that follow discontinuing the use of an addictive drug physiological effects