Here are steps to take if you suspect alcoholism

Here is a list of the interventions that occur in the ED at Harborview Medical Center in Seattle if alcohol or substance abuse is identified:

1. A social worker or a chemical dependency counselor does "motivational interviewing" to assess the patient’s substance use issues while increasing his or her awareness of the extent of the problem.

2. The patient is provided with information on options for obtaining detox and treatment as appropriate. From the ED, patients may receive the following interventions:

• The patient goes to "sobering." This is generally for patients who are not amenable to treatment, says Bonnie Conley, MSW, the hospital’s ED social work supervisor. "Patients must be drunk and not in withdrawal," she says.

• The patient goes to detox. Patients should be in active withdrawal, requiring medications and monitoring by a nurse, says Conley. "There are two levels of care at detox: acute and subacute. Acute is medical for alcohol detox, and subacute is for substances like heroin and cocaine," she explains. Sometimes patients with a history of difficulties during withdrawal are sent to detox when it looks like they’re getting close to going into withdrawal, adds Conley. Patients may be accepted into detox because they have a treatment bed date approaching and need to detox before going, she says. "Unfortunately, many of our patients do not have private insurance that would cover going directly into treatment," notes Conley. "So even if we have a patient who is agreeable, they generally have to go through a monthlong process to actually get into treatment."

• The patient is admitted. If withdrawal symptoms are such that acute-care criteria are met, or if the patient is in active withdrawal and there are no beds at detox, the patient is admitted, says Conley.

• The patient leaves with information on how to obtain detox, treatment, and support. The following forms of support may be provided, says Conley: Alcoholics Anonymous, a chemical dependency appointment at the facility’s mental health center for the following day, or case management. "There is a limited number of case managers, so there is a waiting list for obtaining one," she notes. The process for getting funding and into treatment is reviewed with the patient, and support and encouragement is available through the pre-treatment group at the facility’s mental health center, she adds. "This is similar to the chemical dependency next-day appointments, but is a group with a staff person as a facilitator," Conley explains. Patients cannot go directly from the ED to treatment unless they have a way to pay for it on their own and there is an open bed, she adds.

• The patient is referred to county personnel for involuntary treatment. This option is for patients that appear to be gravely disabled due to their substance use. "This process does take some time, but we are becoming increasingly successful at getting people into treatment via this process," says Conley.