Module 4 Screening

Screening for Alcohol Problems in Social Work Settings : Screening for Alcohol Problems in Social Work Settings NIAAA Social Work Education Module 4 (3/04)


Outline : Outline Screening Basics Screening Tools Screening in Social Work Practice


Screening Issues : Screening Issues Importance to practice Various approaches: structured interview self-report instruments/questionnaires, clinical laboratory tests Screening versus diagnosis


Screening Accuracy : Screening Accuracy Specificity Ability of a screening tool to avoid false positives; accuracy in not including non-affected persons. False Positive— Subject does not have problem; incorrectly identified as having the problem. Sensitivity Ability of a screening tool to avoid false negatives; accuracy in including all who have the problem. False Negative—Subject has problem; incorrectly identified as not having the problem.


Screening : Screening First Rule… ASK


Ask : Ask “Do you drink alcohol?”


Ask : Ask “On average, how many days a week do you drink?”


Ask : Ask “On a day when you drink alcohol, how many drinks do you have?” “What is the maximum number of drinks you consumed on any given occasion during the past month?”


Why Ask? : Why Ask? We ask questions about the quantity and frequency of alcohol consumption because it is: Common Sensitive Based on epidemiological research Related to a continuum of risk


Slide11 : Standard Drink Measure


Defining “At-Risk” Drinking : Defining “At-Risk” Drinking Differs by age Differs by gender Differs by pregnancy status Differs by health/medication status Differs by family history of alcoholism


Screening Tools : Screening Tools Self-administered screening tests asking about quantity/frequency and binge use of alcohol: CAGE S-MAST (Short Michigan Alcohol Screening Test) AUDIT (Alcohol Use Disorders Identification Test HSS (Health Screening Survey) Computerized lifestyle questionnaires


CAGE : CAGE Asks client about the past year: C = Cutting down on drinking considered? A =Annoyed you by criticizing drinking? G = Guilt about your drinking? E = Eye openers necessary? Designed to detect alcohol dependence Will miss up to 50% of at-risk drinkers


NIAAA Physicians Guide : NIAAA Physicians Guide Physicians Guide recommends: 1. using the CAGE plus 2. questions about quantity and frequency of consumption


AUDIT : AUDIT Alcohol Use Disorders Identification Test Structured interview Introduction: Tell client that you will be asking questions about his/her use of alcoholic beverages during the past year. Circle the number that comes closest to client’s answer.


AUDIT (continued) : AUDIT (continued) 1. How often do you have a drink containing alcohol? (0) never (1) monthly or less (2) 2-4 times/month (3) 2-3 times/week (4) 4 or more times/week 2. How many drinks containing alcohol do you have on a typical day when you are drinking? [number of standard drinks] (0) 1-2 (1) 3-4 (2) 5-6 (3) 7-9 (4) 10 or more 17


AUDIT (continued) : AUDIT (continued) 3. How often do you have six or more drinks on one occasion? (0) never (1) less than monthly (2) monthly (3) weekly (4) daily or almost daily 4. How often during the last year have you found that you were not able to stop drinking once you had started? (0) never (1) less than monthly (2) monthly (3) weekly (4) daily or almost daily 18


AUDIT (continued) : AUDIT (continued) 5. How often during the last year have you failed to do what was normally expected from you because of drinking? (0) never (1) less than monthly (2) monthly (3) weekly (4) daily or almost daily 6. How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session? (0) never (1) less than monthly (2) monthly (3) weekly (4) daily or almost daily 19


AUDIT (continued) : AUDIT (continued) 7. How often during the last year have you had a feeling of guilt or remorse after drinking? (0) never (1) less than monthly (2) monthly (3) weekly (4) daily or almost daily 8. How often during the last year have you been unable to remember what happened the night before because you had been drinking? (0) never (1) less than monthly (2) monthly (3) weekly (4) daily or almost daily 20


AUDIT (continued) : AUDIT (continued) 9. Have you or someone else been injured as a result of your drinking? (0) No (2) Yes, but not in the last year (4) Yes, during the last year 10. Has a relative or friend or doctor or other health worker been concerned about your drinking or suggested you cut down? (0) No (2) Yes, but not in the last year (4) Yes, during the last year 21


AUDIT (continued) : AUDIT (continued) In determining the response categories, it has been assumed that one “drink” contains 10g of alcohol. In countries where the alcohol content of a standard drink differs by more than 25% from 10g, the response category should be modified accordingly. Record sum of individual item scores:___ A score of 8 or greater may indicate the need for a more in-depth assessment 22


T-ACE and TWEAK : T-ACE and TWEAK T-ACE Tolerance = How many drinks does it take to make you feel high? Annoyed = Have people annoyed you by criticizing your drinking? TWEAK Tolerance = How many drinks can you hold? Worried = Have close friends or relatives worried or complained about your drinking in the past year? 23


T-ACE & TWEAK (cont.) : T-ACE & TWEAK (cont.) T-ACE Cut down =Have you ever felt you ought to cut down on your drinking? Eye opener = Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover? TWEAK Kut down = Do you some-times feel the need to cut down on your drinking? Eye opener = Do you some-times take a drink in the morning when you get up? Amnesia = Has a friend or family member ever told you about things you said or did while you were drinking that you couldn’t remember? 24


CHARM : CHARM C = Cutting down; heaviest drinking period in your history? H = Habits and personal rules about drinking A = Annoyed by others’ reactions R = Reasons for drinking, including sleep M = More than you intended to drink


RAFT/CRAFT : RAFT/CRAFT Specific adolescent screening tools: Ask about peer group/friends Ask about problematic consequences Ask about related high-risk behavior (CRAFT) Ask about drinking alone


Screening Adolescents : Screening Adolescents ADI (Adolescent Drinking Index) AAIS (Adolescent Alcohol Involvement Scale) DAP (Drug & Alcohol Problem Quick Screen) SSI-AOD (Simple Screening Instrument for Alcohol and Other Drug Use) PESQ (Personal Experience Screening Questionnaire) DUSI (Drug Use Screening Inventory) POSIT (Problem Oriented Screening Instrument for Teenagers


Clinical Laboratory Testing : Clinical Laboratory Testing Poor sensitivity and specificity in screening; only 10-30% problem drinkers identified Confirming lab tests might include: GGT MCV CDT


Screening in Practice : Screening in Practice Screening Opportunities Intake interviews Home visits Office visits Telephone contacts Family member visits Increasing Accuracy Consider the context Use a sensitive approach Be alert to nonverbal cues


Assessing Health Problems : Assessing Health Problems Liver dysfunction Hypertension Chronic abdominal pain Depression Sexually transmitted disease Ask about alcohol-related health problems: Is there a history of… Headaches Suicide ideation Trauma Anxiety or panic attacks Sleeping problems Pancreatitis


Assessing Health (continued) : Assessing Health (continued) Blood/Urine Alcohol Levels (breath, urine, blood, skin sampling) GGT  MCV SGOT  HDL CDT Consider requesting clinical laboratory tests. Understand their indications, methodology, collection issues, interpretations, and legal issues in their use.


Assessing Family, Social, and Employment Problems : Assessing Family, Social, and Employment Problems Have you ever been arrested for driving while under the influence of alcohol? Have any family members, friends, or people at work ever asked you to change your drinking habits? Has your drinking caused problems in your life? Have you ever participated in a work-related alcohol treatment program? Have you ever had a problem with your job because of drinking?


Assessing for Evidence of Physical Dependence : Assessing for Evidence of Physical Dependence Do you ever drink in the morning to get over a bad hangover? Do you develop shakes when you stop drinking for more than a day? Have you ever been in DTs, been detoxed, or had an alcohol withdrawal seizure? Have you ever been treated for alcohol or drug withdrawal? How many days a week do you drink in the morning?


Slide34 : Steps for Alcohol Screening & Brief Intervention


Slide35 : Steps for Alcohol Screening & Brief Intervention Alcohol-related problems or at Alcohol dependence risk for developing problems wAdvise to abstain wAdvise to cut down wRefer to a specialist wSet a drinking goal wConsider pharmacotherapy wConsider pharmacotherapy Step III- Advise Appropriate Action Step IV- Monitor and Assist