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Case 2 Ms. B Assess and Advise A 32 year old single mother and assembly line worker presents for routine follow-up with a chief complaint of insomnia and forgetfulness She reports drinking: 4-6 drinks,  2-3 times a week CAGE score =1: Guilty Family history of alcohol dependence Sleep disorder Problems with work (late, injury)  and kid’s school (forgetful) Guilty about son No symptoms of alcohol dependence 3, but willing to consider cutting down Readiness to Change Red Flags Results of ASSESSMENT ADVISE Abstinence Alcohol dependence Pregnancy Trying to conceive Medication that contraindicates alcohol use (e.g. warfarin) Medical condition that contraindicates alcohol use (e.g. hepatitis) Blackouts Failed attempts to cut down ADVISE: Cutting Down or Abstinence Family history of alcohol problems Injuries related to drinking Medical history indicators Behavioral indicators ADVISE Cutting Down Risky drinking amounts without Red Flags Advising Ms. B… What should be advised? No Red Flags indicating abstinence is the best or only option Cutting down or abstinence should be recommended N=774 men and women drinking risky amounts, from 17 US primary care practices; 93% follow-up Randomized to receive A general health booklet (control) A general health booklet plus two 15-minute physician alcohol discussions and a nurse telephone call Efficacy of Advice: Project TrEAT Fleming MF et al., 1997. Efficacy of Advice *p0.001. Numbers in table are means. Cost of intervention: $166 per patient (includes patient costs) Net benefit: $546 in medical costs, $7780 if societal costs included (mainly motor vehicle) *36 months. 20 drinks (men), 13 drinks (women) per week Fleming MF et al., 2002. At 4 years… Control Intervention Hospital Days (p0.05) 663 420 ED Visits (p0.08) 376 302 Risky Drinking* (p0.001) 35% 23% Efficacy and Cost of Advice TrEAT Long-term Follow-up Case 2 Ms. B  Advise and Assist How to ADVISE State your concern Give feedback based on the drinki