Alcohol screening and intervention in medical and surgical settings

This chapter discusses alcohol screening and intervention in medical and surgical settings. Heavy alcohol consumption and alcohol use disorders cause or exacerbate a number of medical conditions and surgical complications. Valid and reliable self-report and alcohol biomarker measures are available to detect hazardous drinking in medical and surgical settings. Several alcohol biomarkers have potential clinical utility in medical and surgical settings. The optimal biomarker depends on the nature of the clinical question. The tests for recent ingestion include fatty acid ethyl esters, methanol, and urinary ratio of 5-HTOL/5-HIAA. As these markers in blood or urine are only useful for very recent ingestion, hours to perhaps one or two days postdrinking cessation, they have less potential clinical utility in medical and surgical settings than EtG. In addition to their use in screening, biomarkers are also clinically useful for monitoring drinking behavior after brief intervention and treatment. Advances in pharmacotherapy suggest a potentially greater role for health care providers in the treatment of alcohol use disorders. Detoxification needs must be considered in managing alcohol-dependent patients. It is suggested that evidence-based research on the efficacy of alcohol biomarkers, and pharmacotherapy, and brief intervention strategies in medical settings, will need to be followed by applied research designed to evaluate and overcome patient, physician, healthcare system, and insurer barriers to use.