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Substance Abuse:  Alcohol

Page 6 of  8    

 

As a physician, what do you need to do for your patients?

 

 

Educate

 

There is no amount of alcohol that is safe for use during pregnancy. Since many women are pregnant for weeks before they are aware, it is recommended that reproductive age women be informed of the benefits of abstaining from alcohol during their reproductive years if contraception is not being used. Teach women about the organ systems that develop during the first month of pregnancy and put that in the context of average time of detection of pregnancy. 1

 

Access reference 1 below to read more about fetal growth and development.  

 

 

Screen for Alcohol Abuse

 

Universal screening for alcohol abuse, which must include questions about tolerance must be a part of every patient encounter. One such test is called the TWEAK Test. The distinguishing factor about the TWEAK test is that it assesses tolerance, which has been shown as critical in increasing the sensitivity of alcohol screening tools for detecting alcohol abuse in women.

Brief intervention at the time of this discussion is also recommended. If you detect alcohol abuse, referral to treatment is the clinically appropriate response. “No physician would withhold HTN therapy because the medication adherence rate is only 60%. Physicians who detect serious medical condition of addiction are equally obligated to intervene.”2

In addition, brush up on terms like binge drinking as well as the recommended allowances for your patients based on gender, etc. Physicians are frequently inaccurate about estimating ‘healthy’ intake levels of alcohol for women; don’t let your own inaccuracy on this matter prevent you from taking the best care of your patients.

 

From the National Institute on Alcohol Abuse and Alcoholism (NIAAA):

  • For most adults, moderate alcohol use--up to two drinks per day for men and one drink per day for women and older people--causes few if any problems.”

  • One drink equals one 12-ounce bottle of beer or wine cooler, one 5-ounce glass of wine, or 1.5 ounces of 80-proof distilled spirits.3

  • A “binge” is a pattern of drinking alcohol that brings blood alcohol concentration (BAC) to 0.08 gram percent or above. For the typical adult, this pattern corresponds to consuming 5 or more drinks (male), or 4 or more drinks (female), in about 2 hours. Binge drinking is clearly dangerous for the drinker and for society.

  • Binge drinking is distinct from “risky”drinking (reaching a peak BAC between .05 gram percent and .08 gram percent) and a “bender” (2 or more days of sustained heavy drinking).4

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    1. Consult Cunningham FG, Leveno KL, Bloom SL, Hauth JC, Gilstrap LC III, Wenstrom KD, "Chapter 4. Fetal Growth and Development" (Chapter). Cunningham FG, Leveno KL, Bloom SL, Hauth JC, Gilstrap LC III, Wenstrom KD: Williams Obstetrics, 22e: http://www.accessmedicine.com (Available with membership; Search for William's Obstetrics, Chapter 4: "Fetal Growth and Development")

     

    1. American College of Obstetricians and Gynecologists. ACOG committee opinion: at risk drinking and illicit drug use: ethical issues in obstetric and gynecologic practice, number 422. Obstet Gynecol [Internet]. 2008 Dec [cited 2009 Jul 20];112(6): 1449-60. Available from http://www.acog.org (Search for Committee Opinion: 422)

    1. NIAAA: National Institute on Alcoholism and Alcohol Abuse of the National Institutes of Health [Internet]. Bethesda (MD): National Institute on Alcoholism and Alcohol Abuse; c2009. FAQs; 2007 Feb [cited 2009 Jul 20]; [less than 1 screen]. Available from http://www.niaaa.nih.gov/FAQs/General-English/default.htm.

    2. National Institute on Alcohol Abuse and Alcoholism. NIAAA council approves definition of binge drinking. NIAAA newsletter [Internet]. 2004 Winter [cited 2009 Jul 20];(3): [4 p.]. Available from http://pubs.niaaa.nih.gov/publications/Newsletter/winter2004/Newsletter_Number3.pdf.