This problem is worse on Cape Cod than opiate dependency
While the opioid crisis on Cape Cod is an epidemic in need of addressing, another type of substance use is more prevalent in the region.
“The burden of alcoholism on Cape Cod is much larger than the burden of opiate use,” said Daria Hanson, MD, chief of behavioral health at Cape Cod Healthcare.
The numbers back up the anecdotal evidence. In 2015, the Barnstable County Department of Human Services issued a report, “Analysis of Substance Abuse on Cape Cod.” The report estimated that 17,063 or 7.9 percent of the population on Cape Cod is dependent on alcohol. That is higher than all the other addictions combined.
Because of the serious nature of the problem, Cape Cod Healthcare instituted a policy last year at both Cape Cod Hospital and Falmouth Hospital whereby all patients who are admitted are screened by a trained nurse for alcohol dependence.
“We try to let people know that our questions about their alcohol use are not meant to accuse them of anything,” Dr. Hanson said. “We’re screening everyone because you never know who is going to go into alcohol withdrawal unless you ask the questions. Our goal is to provide a safety net underneath the patient.”
The protocol was developed because in the past so many patients would be admitted to the hospital for health conditions and the staff wouldn’t discover that the patient was in alcohol withdrawal until it was well underway. That meant that treatment for it wasn’t as accurate as it would be if the medical personnel had that information upfront.
“Alcohol withdrawal is a very serious condition,” Dr. Hanson said. “The patient will have changes in their heart rate, their blood pressure and their mental status. Oftentimes they become confused and agitated. They are at risk of progressing into a dangerous and potentially fatal condition called delirium tremens.”
How It’s Treated
The treatment of choice for alcohol withdrawal is a group of medications called benzodiazepines. In the past the hospital staff had to play “catch up” after the symptoms of alcohol withdrawal were detected. This led to over or under prescribing of the medicines that can help.
If a patient is overprescribed one of the medications, their gag reflex could be reduced and lead to aspiration and a stay in the intensive care unit for aspiration pneumonia. If a patient is under-medicated and the condition isn’t caught in time, no amount of benzodiazepines will be able to prevent the slide into serious alcohol withdrawal, seizures and delirium tremors. That patient would also end up in the ICU. Both problems dramatically increase the amount of time in the hospital.
“It’s a fine balance,” Dr. Hanson said. “You want to find the right dosing that matches up to their withdrawal symptoms.”
To do so, there are a series of screening tools. The first one is called an AUDIT-C Questionnaire (Alcohol Use Disorders Identification Test). The admitting nurse asks all patients three simple questions:
- How often do you have a drink containing alcohol?
- How many standard drinks containing alcohol do you have on a typical day?
- How often do you have six or more drinks on one occasion?