April 23, 2018
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It’s time for physicians to ask patients about their drinking

Curtis Compton | TNS
Curtis Compton | TNS
In Maine, alcohol is the most misused substance. The primary care office is an ideal place to talk about alcohol use and prevent it from becoming unsafe.
By Labrini Nelligan, Mark Publicker, and Noah Nesin, Special to the Bangor Daily News
Updated:

“I have some concerns about your drinking that I’d like to discuss with you. Is that OK?” Not enough people are saying these words to the people who need to hear them. We are part of a new project that aims to change that.

In Maine, alcohol is the most misused substance. It also has the highest need for treatment. In 2010 alone, excessive alcohol use cost our state an estimated $938.7 million. This includes the costs of health care, reduced workplace productivity, law enforcement and more.

Our culture in Maine supports unhealthy alcohol use. Societal norms create a perception that alcohol use is OK, even in excess. Social media furthers this perception. It often portrays heavy drinking as not only acceptable, but something to celebrate.

These trends play out beyond Maine as well. Excessive alcohol use is the leading cause of preventable death among working-age adults ages 20 to 64, according to the U.S. Centers for Disease Control and Prevention. And here’s why. Roughly 16 million Americans meet criteria for alcohol use disorders, yet only 1 in 10 receive the treatment they require.

There have been large efforts to expand screening and counseling for alcohol use. Despite that, across the nation only 1 in 5 people who drink alcohol say they have ever discussed it with a clinician.

Screening remains notably low among the folks that patients often see the most: primary care providers. The primary care office is an ideal place to talk about alcohol use and prevent it from becoming unsafe. In fact, it is very cost effective as a prevention strategy. Data show that brief interventions with patients in primary care can reduce weekly alcohol use and binge drinking. This also helps patients adhere to the lowest risk levels of alcohol use.

So, why the low level of screening? Well, many health care professionals get little education and training on substance use disorders. As a result, they may lack the comfort level, confidence and communication skills to start sometimes difficult yet much-needed conversations with patients about alcohol use. Plus, it can be hard to fit in these regular conversations. There may be other important medical issues that create the need for an office visit, for example. Seeing patients is only one of the many duties we have in a health care practice.

In short, there is a gap in our health care system. We all need to understand the health impacts of unhealthy alcohol use, better identify who is at risk, and provide the help they need.

Our project is called Time to Ask. It is being developed by the Lunder-Dineen Health Education Alliance of Maine. A group of advisers from across the state has met every month since 2014 to help create the program. They represent practice, policy and academia. We are proud to be part of that group.

Our mission is to educate primary care health professionals on how to talk with patients about alcohol use. You might think this sounds simple. Yet, it is actually complex.

This education has to include clinical training for individuals, of course. Yet, it means new processes for the practice as well: updating workflows, defining staff roles and duties, standardizing data collection, and more.

In other words, Time to Ask transforms the practice model. It improves quality of care. It encourages health professionals to treat patients holistically. It also focuses on enhanced communication skills. This is crucial in helping people become motivated to examine and change their alcohol use.

Take a minute to learn more about Time to Ask at lunderdineen.org. There are short videos and resources on the risks of alcohol use. Alcohol Awareness Month is a perfect time to improve your knowledge about this issue. If you are informed, you can make healthy decisions. And help others do the same.

It all comes back to conversations. “I have some concerns about your drinking that I’d like to discuss with you. Is that OK?” That is what we want to hear more people asking.

Labrini Nelligan is the executive director of Lunder-Dineen Health Education Alliance of Maine. Mark Publicker is past president of the Northern New England Society of Addiction Medicine. Noah Nesin is vice president of medical affairs at Penobscot Community Health Care. Denise O’Connell, senior program manager at Lunder-Dineen Health Education Alliance of Maine; Peter P. Michaud, associate general counsel at Maine Medical Association; Malory Otteson Shaughnessy, executive director of the Alliance for Addiction and Mental Health Services; Mary Lindsey Smith, research associate at the Cutler Institute for Health and Social Policy in the Muskie School of Public Service at the University of Southern Maine in Portland; and Shawn Yardley, CEO of Community Concepts in Lewiston, also contributed to this piece.

 


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