While cultural views surrounding addiction and substance abuse have shifted over recent decades, there are still many stigmas. As substance use disorders have increased dramatically since the pandemic, healthcare providers must re-evaluate their approach to treating patients facing addiction.
Changing the narrative around alcoholism will take time and effort, but it ties into the Hippocratic oath. Here are some helpful guidelines to improve care for patients with alcoholism in your medical practice.
Build a Response Network
Creating a referral network for specialized health issues isn’t a new concept. Doctors refer out to specialists all the time. However, there’s often a gap in resources for addictions and substance abuse disorders.
Building a catalog of resources for those struggling with substance abuse will ensure you’re prepared and informed when a patient needs help. Using sites like findrecovery.com can help you find AA meetings in your area both for general support and specific communities (i.e., LGBTQ+, women-only, and Jewish faith-based meetings).
Creating this network also presents an opportunity to learn from addiction treatment professionals. They can provide additional guidelines on communication and compassionate care.
Reflect Upon Biases
One should always look inward before assessing the flaws in their environment. Before you look at opportunities for improvement in your practice and continued education, consider reflecting upon your biases as a medical professional and an individual. Practice self-awareness and consider how your preconceived notions might impact your quality of care.
Biased and outdated thinking is a natural side effect of working in the medical field for some time. However, medical professionals must challenge their thought patterns to take a neutral approach when assisting patients with alcoholism. Trust and compassion are essential for high-quality treatment; anything else could derail a patient’s chances of achieving sobriety.
Avoid Harmful Language
Language changes and evolves over the years. Medical professionals must stop and reflect upon their language to determine if newer terminology is preferred. Stigmatizing language can create shame around alcoholism, leading a patient to keep information hidden or delay treatment.
Medical care providers should prioritize person-first language. For example, rather than referring to someone as an alcoholic or drunk, saying, “someone with an alcohol use disorder” or “someone with alcoholism.” This shift in language seems minor, but it preserves the person’s identity and humanity.
Many professionals struggle with this shift as they hear patients use stigmatized language when referring to themselves. Using the introduction, “Hi, my name is X, and I’m an alcoholic,” is still customary in many 12-step meetings and programs. A frustrated patient may angrily say, “I can’t do this because I’m just a drunk.” Using these terms is a form of self-stigmatization (or, in meetings, a form of first-person acceptance and accountability); they’re not appropriate for medical professionals to use in modern practice.
Ask the Right Questions
It’s common for patients to under-report their alcohol consumption. Some patients are unaware of their consumption habits, while others are fearful of judgment and stigma. As such, asking someone how much they drink in a week is no longer considered best practice.
Instead, consider using a more immediate line of questioning. Ask, “How many times in the past year have you had five (four for women) or more drinks in a day?” According to the National Institute on Alcohol Abuse and Alcoholism, this type of question has a sensitivity of 73-88% and specificity of 74-100% when used to detect substance misuse.
It can also be helpful to ask qualitative questions related to consumption, such as:
- Have you ever thought about cutting back on your alcohol consumption?
- Have you tried to cut back on alcohol but were unable to?
- Has your spouse/ family shared concerns about your consumption?
- Have you been experiencing any changes in stress, finances, sleep, etc.?
Asking these questions can encourage the person to reflect and share additional insights. Maintaining a neutral tone and judgment-free expression when asking these sensitive questions is crucial.
Implement Self-screening Methods
The NIAAA’s question about annual alcohol consumption is an effective starting point for determining if additional screening or assessments are required. Some studies have shown that administering self-assessment screenings rather than interviews can elicit more honest and open responses. The theory is that patients feel more comfortable sharing information with an inanimate object than answering direct questions.
The Alcohol Use Disorders Identification Test (AUDIT) is considered one of the most effective screening tools for identifying excessive alcohol consumption and misuse. The World Health Organization developed this two-minute questionnaire for all ages and genders. It’s considered the gold standard in alcohol misuse identification.
Invest in Trauma-informed Training
Trauma-informed training is founded on the concept that likely every patient you treat has experienced trauma. As alcoholism is closely intertwined with trauma, offering trauma-informed care is paramount for providing high-quality treatment.
Using person-first and destigmatized language is one component of trauma-informed care. Learning how to communicate in a manner that empowers people facing alcoholism to share their experiences is also integral. It’s equally important for practitioners and patient touchpoints (such as receptionists) to receive this training. Advocate for your practice to include this training as a part of its hiring and onboarding process.
Learn Motivational Interviewing Skills
Motivational interviewing (MI) is a communication method implemented in counseling and coaching. The goal is to create an environment that facilitates change management by prioritizing active listening and exploratory questions.
Many practitioners who uncover alcohol misuse face resistance from their patients. The natural inclination when facing resistance is to take an authoritative approach, reiterating the health concerns and ignoring the complexities of change psychology and the intention-behavior gap.
Motivational interviewing is an effective technique used in addiction treatment. It relies on building trust and empathy with the patient and empowering them to uncover their motivations and barriers to overcome ambivalence and improve self-efficacy. The irony is that many practitioners are resistant to MI due to the same ambivalence and resistance to change that could be processed through MI work.
Final Thoughts
Improving the quality of care for patients with alcoholism comes down to recognizing it as a medical disease. Treating patients with the same compassion and care as you would if they have a broken leg or heart condition is a must.
Implement these techniques and reflect upon your biases and beliefs as a practitioner.
