Interviewing

AUDIT

• A: alcohol

• U: use

• D: disorders

• I: identification

• T: test

Importance of Family Hx

• Genetic disorders

• Increased susceptibility for disease

• Longevity

Michigan Alcoholism Screening Test (MAST)

24 question test with points for each question

• Have a score

  • 0-3: no problem

  • 4-5: possible problem

  • >5: problem

• Good follow up test to CAGE

Red Flags

• Closely related individuals with similar disease

• Common disorder that occurs earlier then expected

• Sudden death in otherwise healthy person

• Individual or couple with >3 pregnancy losses

• Specific

  • Seizures

  • Developmental delay

  • Movement disorders

  • Congenital or early deaf/blind/cataracts

SBIRT

• Screening quickly assesses the severity of substance use and identifies the appropriate level of treatment

• Brief intervention focuses on increasing insight and awareness regarding substance use and motivation toward behavioral change

• Referral to treatment provides those identified as needing more extensive treatment with access to specialty care

• Interventions are a great follow up to CAGE

Collecting Family Hx

• First degree relatives

• Sometimes second degree relatives, maybe third degree

• Collect

  • Current age or death at death

  • Relevant medical conditions, onset, management

  • Ethnicity

Documenting Family Hx

Tabular

• List

Pedigree diagram

• Family tree

Components of Social History

• Smoking

• Alcohol

• Recreational drugs

• Stressors

• Diet

• Lifestyle

• Caffeine

• Occupation

• Hobbies

• Upbringing

• Education

• Residence

• Financial

• Military service and close quarters

  • Important for asking about vaccines

Smoking/Tobacco Use

• Number of packs per day X number of years = pack years

• Clarify forms of smoking

Alcohol

• Questions to ask

  • Number of drinks a day/week/month

  • The type of alcohol

• Very important to screen: many people have never discussed alcohol use with their PCP

CAGE

• Do they feel the need to cut down/have been told to cut down

• Do they feel annoyed when told to cut down

• Do they feel guilt about how much they are drinking

• Do they ever need an eye opener in the morning

Types of Alcohol Disorders

• Alcohol abuse: use that interferes with activities of daily living

• Alcoholism

  • Dependence

  • Craving

  • Loss of control

  • Tolerance

Barriers to discussing alcohol

• Shame and guilt

• Denial

• Risk of being labelled

• Societal stigma

• Clinician’s attitude

Question development

• Quantity

• Frequency

• What type of alcohol

• When did you start

• Who do you drink with

• Where do you drink

• How much do you drink

• Have you ever tried to stop

• How do you pay for it

• Why do you drink

• How does it make you feel

• Any changes in your drinking patterns

Do’s and Don’ts for alcohol questions

Do

• Open ended questions

• Clarify what a drink means

• Quantify the use

• Be empathetic

• Be alert, suspicious, and circumspect

• Be willing to be inquisitive

Don’t

• Ask leading questions

• Ask in a judgemental way

• Judge a patient based on their response

• Assume they are answering truthfully

• Settle for vague answers

Depression screening: SIG E CAPS

• S: sleeping issues

• I: anhedonia (lack of joy or pleasure)

• G: guilt about the feelings

• E: lack of energy

• C: problems with concentration

• A: appetite issues

• P: psychomotor changes (moving too fast or moving too slow)

• S: suicidal ideation

  • How long has it been going on for

  • Do they have a specific plan in place to kill yourself