You should ask patients these 3 questions

At Harborview Medical Center in Seattle, ED nurses routinely ask patients about alcohol use, says Bonnie Conley, MSW, the ED’s social work supervisor. Conley recommends asking patients the following questions during a two-minute screening:

1. How much alcohol do you use and how often?

Conley notes that people frequently underreport alcohol use, so there is really no absolute in terms of answers. "Of course, if a patient states that she gets shaky when she doesn’t drink for several hours, that’s clearly a problem whether or not negative consequences are identified," she says. Conley sometimes uses results of urine toxicology and blood alcohol levels as a reality check. "So we can say, You tell me you only drink a couple of beers a day, but your blood alcohol level is 350.’"

2. Has your use of alcohol negatively impacted your life?

You should consider the responses to these two questions together, says Conley. She gives this example: If a patient reports drinking four beers a day and has not been able to stop, and it has resulted in negative consequences in his life, such as his wife leaving him, then the patient most likely will benefit by speaking to someone about his drinking.

3. Would you like to talk to someone about your alcohol use?

If a patient says "no" to this question, Conley first explains why a problem with alcohol is suspected. For example, she may say, "I’m concerned that you were assaulted because you were in a state where you weren’t able to protect yourself, and I don’t want to see you hurt again, perhaps worse," or "I’m hearing from the doctor that you have very serious health issues related to your alcohol use."

She offers patients written information in case they change their minds. "Quite a few people refuse a complete assessment, but very few refuse to listen briefly while we state our concern and offer the written resources," she says. If a patient adamantly refuses, Conley says, "If you change your mind while you’re here, you can let your nurse know, and I’ll come back."

If a patient reports moderate use of alcohol, but also acknowledges other problems or issues that could be linked to alcohol use, Conley recommends asking if they’d like to talk to a social worker or chemical dependency counselor. However, if you feel certain that a patient has an alcohol abuse problem, it’s best to simply refer them to social work, instead of leaving the decision up to the patient, advises Conley. "The patient can always refuse social work services after we arrive."