If we are looking and trying to understand a person's behavior, we need to assess, right?
We need to evaluate this person. And so, we have to ask questions.
Most people with an alcohol use disorder
are not forthcoming to tell the nurse on admission that they have an alcohol use disorder
unless in fact they are being admitted for detox.
So, let's ask them questions that might establish their patterns of drinking.
Ask them, "How often do you drink? Is it usually only on weekends?
When you drink, how many drinks on an individual time do you actually consume?
Do you have a drink every single day?
And it's important as you're asking these questions to check yourself.
Are you only drinking on weekends? So, are you binge drinking?
I mean, are you having four or five drinks every time you go out?
How about every day? Are you drinking every day?
Oh my God, you're drinking every day?" We don't want to do that to somebody.
We want to make sure that this is an assessment like any other assessment
we would do on the heart, on the lungs, on food patterns.
So, you want to be able to say, "So, how often do you drink alcohol?
Oh, okay, once or twice a week, is that usually on weekends?
When you do drink, how many drinks do you have in a given event?
What about on a daily basis, are you consuming alcohol on a daily basis?
Oh, you are drinking on a daily basis,
so, is that all-day or is it usually in the evening, is it usually at nighttime?"
And be able to say to the person,
"I'm about to ask you some questions about your alcohol use.
These are questions that I ask every single patient who comes in to the hospital."
Let the person know that they are not being singled out.
Stigma is a terrible thing and the most important thing that we want is honesty
and if a person feels as though they're being singled out,
they will not trust you and they will not give you honest answers.
Why are we asking this? Because we want to make sure
that we know if there is any alcohol use disorder in this person's life.
If they are a person who is struggling with alcohol use disorder and why do we care?
Because we need to know if we are in the event of possible having withdrawal symptoms.
So, one of the most important questions we want to ask is,
so, when was the last time you had a drink?
And that's important because we know that those symptoms
are going to begin to show-up six to eight hours after that last drink.
You want to make sure that alcohol is the only substance that's being used.
Usually not. Usually, the person has - you've been using at the same time other things.
Perhaps, they're using a sleeping pill. Maybe they'll say to you,
"Oh, I have a couple of drinks at night. Lately, I've been really anxious, so, I'm taking Valium."
Or, "I haven't been able to sleep at night, so, I take an Ambien."
The fact that they have a prescription to take a barbiturate or take a Benzodiazepine
doesn't mean that if they do that, it won't cause respiratory depression and they could die.
You just want to know. You want to have all the information about this patient that you can possibly have.
A person who is fighting terminal cancer can also have an alcohol use disorder.
So, they might be on Oxycodone for pain.
It might be prescriptive. They're coming in, they say, "Here are my prescriptions."
And you see that that's there but they can also have a concomitant alcohol use disorder.
So, we want to look, are they taking any narcotics? Are they taking any benzos?
Are there any street drugs that they're taking, drugs that are not legal?
Are they smoking? Are they smoking marijuana?
So, cannabis now is legal in so many states
but it's important to understand whether or not cannabis
is being used along with alcohol because one potentiates or increases the other.
The idea that a person is drinking. Remember, drinking is also legal and now, cannabis is also legal.
You want to know if they are using heroin and if they are using cocaine.
Quite often, we'll see somebody who has an alcohol use disorder
who has learned how over a period of time how to wake themselves up
with the use of cocaine or with the use of Ritalin.
They may go to a general practitioner
and then, say, "I have ADHD. I need something to calm my ADHD."
And they are placed on Ritalin.
And so, they wake up in the morning and they'll take their Ritalin.
And then, in the evening, they will smoke pot and have a couple of drinks
and go to sleep to allow them to function.
We need to know this because we need to help them.
Early intervention is their best, best outcome.