BEHS 380 Experiential Paper

BEHS 380 Experiential Paper

BEHS 380 Experiential Paper

Early diagnosis of alcohol use disorder (AUD) and timely treatment are recommended to reduce the burden of the mental disorder and promote desirable care outcomes. However, in most cases, patients continue to suffer from the disorder for several years before seeking help. As such, routine screening of AUD is recommended to avoid associated complications, such as liver cirrhosis (Higgins-Biddle & Babor, 2018). Other than the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria for AUD, several other evidence-based screening tools have been proven beneficial for the timely diagnosis and grading of AUD. Such screening tools include Alcohol Use Disorder Identification Test and T-ACE (Moehring et al., 2019). The purpose of this paper is to illustrate a personal experience of administering the above AUD screening tools with consideration of both their strengths and weakness, in addition to the opportunities for improvement.

Alcohol Use Disorder Identification Test (AUDIT)

AUDIT is recommended by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) for routine screening of alcoholism among all patients at risk (Moreta-Herrera et al., 2020). The administration of the screening tool follows four main steps. The first step involves asking the patient about their alcohol use (Nadkarni et al., 2019). This is where the patient gives his symptoms and duration of use, among other factors crucial in promoting the diagnosis of the disorder. The second step involves an assessment of the patient for alcohol use disorder. The third step is associated with advising the patient on the course of action and developing a care plan to manage the AUD (Källmén et al., 2019). Patients who record a score of 8 or higher among males, and 4 or higher among females, with the use of this tool, require further evaluation (Moehring et al., 2019). The final step involves offering the patient continued support to promote care outcomes and prevent instances of relapse.

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Administering AUDIT was quite simple and beneficial in promoting a brief assessment of the patient. The tool can help in identifying excessive alcohol use in addition to the cause of the patients presenting illness. It also provides a framework for the necessary interventions needed to help the patient reduce or stop consuming alcohol hence avoiding the potential harm to their body (Higgins-Biddle & Babor, 2018). AUDIT can also help in identifying drug dependence and harmful effects caused by the time of administration. However, AUDIT has also been reported to be less significant in identifying AUD among women, unlike in men (Moreta-Herrera et al., 2020). Consequently, high possibilities of false positives have been reported in countries with a low prevalence of AUD. However, to optimize the use of AUDIT, the tool should use a total score of 7 among men, and 5 among females, hence avoiding the above-mentioned limitations (Nadkarni et al., 2019). The tests should also be administered more than once, and an average of outcomes taken to reduce the risks of false positives.

T-ACE

The T-ACE screening tool on the other hand is mainly composed of four questions utilized in identifying the

BEHS 380 Experiential Paper
BEHS 380 Experiential Paper

risks of alcohol use during pregnancy (Moise, 2019). It is considered a type of Cut-down, Annoy, Guilt, and Eye-opener (CAGE) but for the specific patient population of pregnant women. Administering the tool is simple. The first question assesses the tolerance of the pregnant women, with the other three questions assessing annoyance, cut down, and eye opener. Studies show that T-ACE has an accuracy level of approximately 90% hence most effective in identifying AUD  during pregnancy (Ferraguti et al., 2019). The tool has also been reported as beneficial in identifying AUD among other populations beyond pregnant women. T-ACE scores less than two are considered negative  (Dozet et al., 2021). Women who score positive results are usually evaluated to help them stop drinking and avoid potential harm.

Nevertheless, administering T-ACE was associated with several limitations or challenges ranging from limited item coverage, and lack of psychometric assessment to collapsing of assessment items and response options (Moise, 2019). To optimize the effectiveness of the T-ACE assessment tool, studies recommend an increase in the total T-ACE scoring criterion  (Dozet et al., 2021). Consequently, more items should be included in the scale to reduce the risks of false positives or false negatives and promote the accuracy and validity of the careening tool (Ferraguti et al., 2019).

Conclusion

            Early detection of alcohol use disorder is crucial to promote timely intervention hence reducing the significance of the associated risks of alcoholism. Several screening tools are available to promote the timely detection and treatment of AUD. However, clinicians must pay close attention to the patient’s characteristics such as age, gender, and pregnancy among other factors, before deciding on which tool to utilize. For instance, from the experience of administering both T-ACE and AUDIT, it is evident that the former is effective in identifying AUD among pregnant women, while the latter is effective among male adult individuals. However, both screening tools present limitations that need to be addressed to optimize their effectiveness in the future.

 

 

References

‌Dozet, D., Burd, L., & Popova, S. (2021). Screening for Alcohol Use in Pregnancy: a Review of Current Practices and Perspectives. International Journal of Mental Health and Addiction, 1–20. https://doi.org/10.1007/s11469-021-00655-3

Ferraguti, G., Merlino, L., Battagliese, G., Piccioni, M. G., Barbaro, G., Carito, V., Messina, M. P., Scalese, B., Coriale, G., Fiore, M., & Ceccanti, M. (2019). Fetus morphology changes by second‐trimester ultrasound in pregnant women drinking alcohol. Addiction Biology25(3). https://doi.org/10.1111/adb.12724

Higgins-Biddle, J. C., & Babor, T. F. (2018). A review of the Alcohol Use Disorders Identification Test (AUDIT), AUDIT-C, and USAUDIT for screening in the United States: Past issues and future directions. The American Journal of Drug and Alcohol Abuse44(6), 578–586. https://doi.org/10.1080/00952990.2018.1456545

Källmén, H., Elgán, T. H., Wennberg, P., & Berman, A. H. (2019). Concurrent validity of the Alcohol Use Disorders Identification Test (AUDIT) in relation to Alcohol Use Disorder (AUD) severity levels according to the brief DSM-5 AUD diagnostic assessment screener. Nordic Journal of Psychiatry73(7), 397–400. https://doi.org/10.1080/08039488.2019.1642382

Moehring, A., Rumpf, H.-J., Hapke, U., Bischof, G., John, U., & Meyer, C. (2019). Diagnostic performance of the Alcohol Use Disorders Identification Test (AUDIT) in detecting DSM-5 alcohol use disorders in the General population. Drug and Alcohol Dependence204, 107530. https://doi.org/10.1016/j.drugalcdep.2019.06.032

Moise, I. K. (2019). Alcohol use, pregnancy and associated risk factors: a pilot cross-sectional study of pregnant women attending prenatal care in an urban city. BMC Pregnancy and Childbirth19(1). https://doi.org/10.1186/s12884-019-2652-5

Moreta-Herrera, R., Rodas, J. A., & Lara-Salazar, M. (2020). Factor Validity of Alcohol Use Disorders Identification Test (AUDIT) Using Robust Estimations in Ecuadorian Adolescents. Alcohol and Alcoholism. https://doi.org/10.1093/alcalc/agaa126

Nadkarni, A., Garber, A., Costa, S., Wood, S., Kumar, S., MacKinnon, N., Ibrahim, M., Velleman, R., Bhatia, U., Fernandes, G., Weobong, B., & Rane, A. (2019). Auditing the AUDIT: A systematic review of cut-off scores for the Alcohol Use Disorders Identification Test (AUDIT) in low- and middle-income countries. Drug and Alcohol Dependence202, 123–133. https://doi.org/10.1016/j.drugalcdep.2019.04.031