Objective Three

To describe one well researched method of screening patients for tobacco, alcohol and other drug use.

The Physician's' Guide To Helping Patients With Alcohol Problems is an excellent resource for understanding the whole process of interviewing patients relative to their use of alcohol. The major limitation of this guide is that it addresses only alcohol use. The basic approach, however, is solid, incredibly well researched, and, with a little creativity can be used for other substances as well. It is just a matter of adding some questions to include the other drugs.

Drugs that you should consider screening for include:

In high-risk populations, clinicians may want to screen for other drugs, such as inhalants, anabolic steroids, PCP, and hallucinogens.

If you haven't already done so, go to the Physicians' Guide and explore the introductory materials and read through the end of STEP I. Then Click on the "back" button and continue here.
In addition to the questions suggested for alcohol use, you should ask the following questions related to other drug use:

Have you smoked any cigarettes in the past year?
Have you used chewing tobacco in the past year?
Have you used any tranquilizers or pain pills in the past 5 years?
If yes, please tell me about the circumstances?
Have you used marijuana, cocaine, heroin, or amphetamines or any other drugs in the last five years?
If yes, which drugs?
When was your last use of these drugs?

Once you have the answers to all these questions you can make a judgment about the need to go into the next step - assessing the extent and level of their substance abuse problem.
As you read in the Physicians Guide the rules for alcohol are
 

A patient would need further assessment if the following are true:

The patient reports more than the following alcohol use:

Men: 14 drinks per week or 4 drinks per occasion

Women: 7 drinks per week or 3 drinks per occasion

and/or

The patient gives at least one "yes" response to the CAGE questions.

 

In addition, the following situations would indicate the need for further assessment:

The patient reports any use of tobacco products in the past year.

The patient reports using sedatives or pain killers under unusual circumstances.

The patient reports using any illicit drug during the past year.

We will cover the questions you could ask in order to make a thorough assessment under Objective Four. If none of these conditions are met, you should just thank the patient for cooperating with these questions. You then go on with the rest of your overall health assessment or interview.

Screening for alcohol, tobacco and other drug problems is appropriate:

Presenting problems that may be alcohol or drug related include: hypertension; cardiac arrhythmia; abdominal pain; bronchitis; depression.

Pediatric patients should be screened for substance use beginning at age 12. This is the average age of first use of mood altering substances.

Study Questions: Screening

  1. How does the U.S. Government define moderate drinking?
  2. List four conditions under which you should advise patients to abstain from alcohol.
  3. Why are the governments recommendations for moderate drinking limits different for men, woman and the elderly?
  4. What are the CAGE questions?
  5. What are the other drugs that you should screen for in a typical patient population?
  6. When is screening for alcohol or other drug use appropriate?
  7. What are the conditions under which you should go ahead with more questions to more thoroughly assess your patients potential substance abuse problems?
  8. Name three presenting physical conditions that are indicative of possible substance abuse problems?
  9. What is the average age of onset for the use of mood altering substances?

Essay Question: What is the significance of the "standard drink" concept in a screening interview?

The answers to the these questions are found either above (under Objective Three) or in The Physician's' Guide To Helping Patients With Alcohol Problems.