As EMS providers, we know that ethanol overuse contributes to a lot of our calls. From drunk driving crashes, falls and assaults, and liver disease and addiction, alcohol keeps us in business. However, this disturbing trend in the increase of heavy- and binge- drinking behavior may provide the opportunity for us to provide assistance beyond basic airway and transport protocols.
To begin, heavy- or binge drinking are not necessarily considered to be in the same realm of alcoholism. An isolated episode or two of binge drinking may be simply compulsive activity, and not repeated. However, an increasing frequency of repeat episodes may point to a greater issue and a developing potential for addictive behavior.
Studies have shown that screening routinely for excessive alcohol use is a very effective tool for reducing the behavior, through motivational interviewing techniques. For example, the CAGE interview is a series of four questions that, when asked in the context of a routine history, can identify the potential for destructive drinking behavior. The questions are:
- Have you ever felt you should cut down on your drinking?
- Have people annoyed you by criticizing your drinking?
- Have you ever felt bad or guilty about your drinking?
- Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (eye-opener)?
Answering “yes” to two or more of the CAGE interview questions is clinically significant for potential alcohol abuse issues.
Ask these questions in a nonjudgmental manner, just as you might ask questions about a history of high blood pressure. If the patient seems to be open to suggestions, a brief intervention of suggesting follow up with a primary care provider has been shown to be effective in getting patients to seek further treatment.
As EMS providers, we often see the result of binge- or heavy drinking, such as a fall or motor vehicle collision. In the minutes that follow, there is a window of opportunity where the EMS provider can help the patient make the “connection” between the drinking and the incident, rather than being critical or disapproving of the behavior. A nonjudgmental approach reduces the ability of the patient to throw up a defense and instead consider the consequences of the behavior.
Taking a nonjudgmental approach might be tough to consider, but that change in our mindset will be more effective for the patient, and perhaps encourage them to seek help.
