Patient Perceptions and Behavior Regarding Risky Drinking

Patient Perceptions and Behavior Regarding Risky Drinking Debra J. Sprague, M.A.Daniel C. Vinson, M.D.Bruce Horwitz, Ph.D. University of Missouri, Columbia, Missouri AMERSA

Background SBIRT Training via MU-ADEPT (Alcohol and Drug Education for Prevention and Treatment) Motivational Interviewing: • Partnering with patients to develop and enhance motivation towards behavior change • Helping risky drinkers to identify and consider pros and cons of changing their substance use behaviors AMERSA

Some feedback from our SBIRT trainees: • Low-risk, “safe” drinking limits seem unrealistic to some learners(med, nursing, and social work students as well as resident and attending physicians) • Initiating the conversation can be challenging(from virtually all types of trainees) • Any tools and strategies that help the conversation flow more comfortablyare welcome! AMERSA

To adequately address risky drinking, we and our patients/clients need to understand what “safe drinking” is. The Safe Drinking equation involves: Per Day and Per Week safedrink limits + what counts as “a Drink” AMERSA

…Daily and Weekly Drink Limits… AND… what counts as “a Drink”. 1.5 oz. of liquor (gin, vodka, whiskey, etc.) 12 oz. of beer 5 oz. of wine AMERSA

Objective We wanted to learn: • What do patients think daily and weekly safe-drinking limits are? • How accurately do they define “a standard drink”? • Among risky drinkers, does their drinking match what they think is safe? AMERSA

Methods Patient Exit Questionnaire (PEQ) in 11 outpatient clinics: 3 in Internal Medicine 8 in Family Medicine Voluntary and Anonymous 2-Month Data CollectionN = 1,331 AMERSA

Key Measures(subset of larger PEQ) AUDIT-C: The 3 Consumption questions from the Alcohol Use Disorders Identification Test • 98.3% (1309 of 1331) answered the AUDIT-C • 21.0% (279 of 1331) screened Positive “How many drinks can you safely have in one day?” • 69.2% (921 of 1331) answered. “How many drinks can you safely have in one week?” • 68.6% (913 of 1331) answered. AMERSA

Results AMERSA

Patients with Positive AUDIT-C:Stated Per-day Limits # of Respondents 86.3% of women (n=117) and 85.8% of men (n=106) answered at or below the accepted limits. N = 279 Number of drinks stated as “safe” in one day AMERSA

Patients with Positive AUDIT-C Screen:Stated Per-week Limits # of Respondents 71.8% of women (n=103) and 73% of men (n=100) answered at or below the accepted limits. Number of drinks stated as “safe” in one week AMERSA

What proportion of patients state the safe limit as 0? % AMERSA

To all: Do you know what a “standard drink” is? N = 1331 Next slide … AMERSA

Of 34% who said they knew what a Standard Drink is… 34% of total sample of 1331 Accurate = Stated amount within 1 oz. for wine and beer and within .5 oz. for liquor AMERSA

Patients with a positive AUDIT-C were twice as likely to say they know what “a standard drink” is. AMERSA

What is “a drink” of wine? AMERSA

What’s “a drink” of beer? AMERSA

What’s “a drink” of liquor? AMERSA

Risky drinkers thinking about change(in the next month)? N = 279 AMERSA

Conclusions • 61.3% of the total sample of patients did not know what a “standard drink” is. • That includes 38.4% of those who screened positive for risky drinking. AMERSA

Most who screened positive stated safe limits that were at or below the accepted thresholds even though they reported drinking more than that. Asking “How many drinks do you think are safe for you to have in a day, and in a week?” may be an easy and efficient way to introduce discrepancy and begin developing motivation to change. AMERSA

For those with a positive screen who are not aware of what it means to “drink safely”: Education by the clinician, on drink sizes and daily & weekly limits, can be a key step in a successful intervention. AMERSA

Thanks for attending! Please contact us with question or comments: Deb Sprague:spraguedj@health.missouri.edu Dan Vinson: vinsond@health.missouri.edu Visit our SBIRT training website at: https://adept.missouri.edu AMERSA

Patient Perceptions and Behavior Regarding Risky Drinking