Chronic Alcohol Abuse – Don’t Miss the Signs

April might be the month for Alcohol Awareness, but it is important to watch for the signs and symptoms of chronic alcohol abuse during your patient’s visit.

CAGE test for alcohol abuseIf indicated, you can easily incorporate the screening CAGE questionnaire in your history taking process.  The CAGE test can identify alcohol problems over the patient’s lifetime. Two positive responses are considered a positive test and indicate further assessment is warranted:

  • Have you ever felt the need to cut down on your drinking?
  • Have people annoyed you by criticizing your drinking?
  • Have you ever felt bad or guilty about your drinking?
  • Eye-opener: Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?

 

T-ACE test for alcohol abuseThe T-ACE is a test is similar to the CAGE but was developed to ascertain drinking in pregnant women.  A score of 2 or more is considered positive. Affirmative answers to questions A, C, or E = 1 point each. Reporting tolerance to more than two drinks (the T question) = 2 points:

  • Tolerance: How many drinks does it take to make you feel high?
  • Have people annoyed you by criticizing your drinking?
  • Have you ever felt you ought to cut down on your drinking?
  • Eye-opener: Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?

 

AUDIT test for alcohol abuse  Additionally there is the AUDIT (alcohol use disorders identification test) consists of 10 questions that can be done during the visit or given as a paper-and-pencil test. It can detect alcohol problems experienced in the last year. A score of 8+ on the AUDIT generally indicates harmful or hazardous drinking. Questions 1–8 = 0, 1, 2, 3, or 4 points. Questions 9 and 10 are scored 0, 2, or 4 only.

Thanks to the Affordable Care Act (ACA), mandatory coverage for preventive services such as alcohol misuse counseling and screening can be provided to patients with Marketplace health plans, Medicare and Medicaid.  The coinsurance, copayment and deductibles are waived for these services.

$To bill for these services, use the following codes:

HCPCS Code       Code Descriptor

G0442                   Annual alcohol misuse screening, 15 minutes

NOTE: This code should be billed first for initial alcohol misuse annual screening

G0443                   Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes

NOTE: Use the following HCPCS code to report counseling to reduce alcohol misuse once the annual screening (G0442) has occurred.

i For the recent publication from the Department of Health and Human Services “Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse”  go to www.cms.gov and search for: ICN 907798. 

The ACA also ensures patients can receive treatment for a diagnosed substance abuse disorder.

signs of alcohol abuseBelow are common physical complications that can indicate the patient may be abusing alcohol:

Alcohol abuse is the second most common cause of cirrhosis in the United States after hepatitis C.

Roughly 30% of Hepatocellular carcinoma (HCC) cases are due to excessive alcohol use.

Alcohol use is one of the leading causes of esophageal cancer in the United States.

Heavy alcohol use significantly increases the risk for both ischemic and hemorrhagic stroke.

Alcohol abuse is the second most common cause of acute pancreatitis and is associated with 70% of cases of chronic pancreatitis.

Patients with chronic pancreatitis from alcohol abuse have a higher incidence and earlier age of onset of pancreatic cancer.

Alcohol induces a number of pathologic changes to the heart with heart failure from dilated cardiomyopathy being very common.

Chronic alcohol abuse suppresses the immune system, impairing neutrophils, leading to poor response to injury and infection.

Dr Ernie supports alcohol awareness month Dr. Ernie says, by being aware of the signs of chronic alcohol abuse, you can effect great health changes in your patients.