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NR 503 Week 6 Assignment: Epidemiological Analysis: Chronic Health Problem (Alcoholism) NR 503 Week 6 Assignment: Epidemiological Analysis: Chronic Health Problem NR 503 Week 6 Assignment: NR 503 NR 503 Week 6 NR 503 Week 6 Assignment: Epidemiological Analysis: Chronic Health Problem (Alcoholism). Epidemiological Analysis Chronic Health Problem: Alcohol Addiction Chamberlain College of Nursing NR503-62711: Population Health Epidemiology and Statistical Principles   Between 1943 and 2014, life expectancy in the US increased almost every year. Among the years of 2014 and 2017, the country faced the lengthiest unceasing decline in deaths since 1915 (Glei and Weinstein, 2019). Majority of the decline has been attributed to the drug epidemic, but alcohol related suicide and mortality has also been a factor increasing the death rates since the 1990s. Alcohol consumption in excess, is responsible for greater than 93,000 deaths annually, or about 225 deaths a day (CDC, 2020). According to Ma, Huo and Meng (2015), alcohol consumption has been identified as a major contributor to the global burden of economic cost, chronic disease, and injury. The World Health Organization (WHO) reports the harmful use of alcohol is accountable for 7.1% (males) and 2.2% (females) of the disease’s global burden, and is the leading risk factor for disability and premature mortality among those aged 15 to 49 years (2020). With that being said, alcoholism is a chronic health problem that needs to be addressed. This paper with explore alcoholism’s background and significance, surveillance and reporting among healthcare providers, analyze the epidemiology of this disease process, diagnosing and current national standards for alcoholism, and implement plans to counter this chronic health issue within health care settings. Background and Significance Alcoholism is a serious chronic disease that endangers many populations, and the effects are seen worldwide. It is the third leading preventable cause of death in the United States, subsequent to tobacco and poor diet/physical inactivity One of Merriam-Webster’s definition of alcohol abuse (alcoholism) states it is “a chronic, progressive, potentially fatal disorder marked by excessive and usually compulsive drinking of alcohol leading to psychological and physical dependence or addiction,” (Alcoholism, n.d.). That definition alone explains the importance of how this is a chronic health issue, because the excessive drinking can lead to death, thus becoming an important aspect of social epidemics. Abusing alcohol impairs a person’s motor functions and judgement, which can become a lethal combination. Excessive drinking incorporates heavy drinking, binge drinking, and any drinking by pregnant women or persons younger than 21 years of age. The CDC (2020) reports excessive drinking being responsible for one-tenth of deaths amongst working-age adults (20-64 years), and economic costs averaged at $249 billion due to excessive alcohol consumption. Many harmful heath conditions result from disproportionate alcohol consumption. Short-term health risks include: injuries (falls, burns, motor vehicle accidents, drownings); violence (suicide, sexual assault, homicide); alcohol poisoning; risky sexual behaviors (unprotected sex, multiple partners, STDs, HIV, unintended pregnancies); and miscarriage and stillbirth among pregnant women (CDC, 2020). Overtime, long term health risks can lead to the development of chronic diseases and additional serious problems: cardiovascular effects (hypertension, heart disease, stroke); liver disease; digestive problems; cancer (mouth, throat, esophagus, breast, colon, liver); weakened immune system; learning and memory problems; mental health problems; social problems (familial problems, productivity loss, unemployment); or alcohol dependence (CDC, 2020). Antisocial individualized behavior from alcohol consumption, promotes negative community effects of criminal endeavors and violence (Ma et al., 2015). Alcohol is the primary drug of abuse in Texas. Incidence refers to the occurrence of individuals developing a specific disease or experience related event during a particular time frame (i.g. a month or year). Prevalence, usually described as a percentage of a population, relates to the number of all cases for the specific disease or experience for the population at risk (Curley and Vitale, 2016). As for comparison of incidence and prevalence in relation to alcoholism between Texas and the Nation, there were not many articles for both epidemiological methods. Statistical analysis of prevalence between binge drinking and excessive drinking was reported. WHO (2020) reports both the volume of lifetime alcohol used and amount consumed per occasion, increases the wide range risks of health and social harms. Table 1.1 shows the prevalence percentages for male and female excessive drinking rates nationally and statewide [Texas], and also binge drinking among youth and adults, 18 and older. Surveillance and Reporting The Behavioral Risk Factor Surveillance system is the nation’s principal system using telephone surveys to collect data about residents concerning their chronic health conditions, health-related risk behaviors and preventive service uses (CDC, 2020). This tool allows the user to view and download prevalence estimates through maps, charts, and graphs. The tool is continuously updated as new data and functions become available. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) is a repository of data that is collected for the surveillance of current state and national diseases. The disadvantage since reporting is not mandatory, the results are limited only what is reported. The Centers for Disease and Prevention (2020) states out of every 6 adults, only 1 have discussed their drinking habits with their primary care physician. Advantages for the survey allows minority groups to be included, and analyzes drinking patterns, underage drinking, and tracking of alcohol use disorders (NIAAA, 2020). The Youth Risk Behavior Surveillance System (YRBSS) conducts biennial surveys among high school youth at the national, state, and local levels. The survey monitors six priority health risk behavior categories contributing to the amount of death and disability among youth. Collected data includes information about age of first drink, frequency of drinking, frequency of binge drinking, alcohol consumption on school property, and drinking associated with driving and sexual activities (CDC, 2020). The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) assess alcohol use disabilities and disorders in the general population (i.e. 18 years and older U.S residents, non-institutionalized household adults) and information related to treatment is also provided (CDC, 2020). In recent years, alcoholism has been masked by the opioid crisis and other health concerns that require urgent attention. However, with these surveillance and reporting methods, providers can incorporate these surveys into clinical practice to help aid in treating their patients holistically. Epidemiological Analysis Epidemiology is a method of quantitative method casual reasoning, based on probability, statistics and research. Since illnesses does not occur within a population randomly, epidemiologists search for determinants using the 5 W’s: what (diagnosis or heath event), who (person), where (place), when (time), and why/how (causes, risk factors, and mode of transmission)(Divisions of Scientific Education and Professional Development, 2019). Alcohol (what) as an intoxicant, can affect a ride range of structures and processes in the central nervous system, while simultaneously increasing the risk of intentional/unintentional injuries and adverse social consequences (WHO, 2020). Not one particular age group or population (who) is effected by alcohol abuse. The prevalence of excessive drinking is highest among men compared to women, adults aged 18-24 compared with adults 45+, and Hawaiian/Pacific Islander and multiracial adults compared with Black and Asian adults (Maxwell, 2014). The occurrence of the disease changes over time. Some occur regularly, while others are unpredictable. WHO created a chart depicting alcohol consumption per capita (15+ years) during the time (when) of 1961-2016, for the United States (where). Table 1.2 and Table 1.3 details some of the alcohol consumption patterns, and health consequences (mortality and morbidity) from WHO research. Risk factors (how) for alcoholism includes familial history of alcohol use, depression, anxiety, PTSD (post-traumatic stress disorder), personality disorders, tobacco use, history of other substance abuse, low socioeconomic status, criminal involvement, poor coping skills, long work week hours (>48 hours/week), eating disorders, and high-stress lifestyles (Schub and Karaashian, 2018). Screening and Guidelines Alcohol use disorder (AUD) is a substantial public health constrain, accounting for approximately 2.5 million deaths annually in the United States. As mentioned earlier, alcohol consumption is the 3rd leading preventable cause of death in the U.S. Symptoms of this disorder include increased tolerance, consumption of long time periods, withdrawal symptoms or drinking to prevent withdrawal, foregoing other important interest to consume and continued drinking despite known current harm (Pasha et al., 2020). Excessive drinking incorporates binge drinking, heavy drinking, and any drinking by people younger than 21 years or pregnant women. Binge drinking is during a single occasion, men consume more than 5 drinks and women consume more than 4 drinks (CDC, 2020). Heavy drinking is defined as women intaking more than 8 drinks per week, and men intaking more than 15 drinks per week (CDC, 2020). Unhealthy alcohol use is relatively common in the United States. In 2016, 26% of adults and 4.9% of adolescents reported heavy use episodes (Curry et al., 2018). Screening and counseling to reduce alcoholism has the possibility to prevent adverse health effects and help prevent progression of severe forms of unhealthy use. Beginning in 2013, the US Preventive Task Force (USPSTF) recommend clinicians adults 18+ years, including pregnant women, for alcohol abuse. The screening also was a method to provide brief behavioral counseling interventions for individuals engaged in risky or hazardous drinking behaviors (Curry et al., 2018). The USPSTF determined the abbreviated Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and the NIAAA-recommended Single Alcohol Screening Question (SASQ). The AUDIT-C test had good sensitivity and specificity for detecting alcohol abuse across multiple populations. It comprises of 3 questions about typical alcohol use amount, heavy use occasions, alcohol use frequencies, that takes less than 2 minutes to administer. The SASQ has adequate sensitivity and specificity across the spectrum of unhealthy alcohol use, and takes less than 1 minute to complete. The primary question, “How many times in the past year have you had 4 [women and adults > 65 years] or 5 [men] or more drinks in a day?” Once patients screen positive using one of these brief screening tools, a follow-up with a more in-depth risk assessment is warranted to confirm alcohol abuse and determine the next steps for care (USPSTF, 2018). The USPSTF (2018) evidence supports conducting initial screenings using brief instruments with higher sensitivity and lower specificity, followed by a longer instrument with greater specificity (i.e. AUDIT). Plan of Action After graduation, Nurse Practitioners (NP) can aim to increase patient awareness and outcomes and to overcome this global chronic health condition of alcohol misuse, by incorporating alcohol screening into their regular clinical setting . NPs can collaborate with their interdisciplinary team to create methods of engaging at-risk populations and promote healthcare policy reform by efforts made to report alcohol misuse. Primary intervention involves helping at-risk individuals avoid the development of alcoholism. Written and electronic materials can be supplied to explain the risk factors, short-term and long-term effects of excessive drinking. The USPSTF reports currently lacking in data, due to screening barriers such as, lack of knowledge of best practices, time constraints, and lack of services for adolescents who screens positive (2018). As an NP, providing a judgmental-free environment for adolescents, allows for building rapport to where the adolescents will be honest about alcohol consumption. Data is continuously being updated, therefore, NPs need to stay current on alcohol trends and patterns. Screening is a secondary intervention, and even mild-moderate risk patients can quickly be screened. The AUDIT screening tool, screens for unhealthy alcohol use in adults 18 years or older, including pregnant women. Electronic screening can be used since adolescents use technology more, therefore, they do not have feel shamed during face-to-face contact. For those who have been diagnosed with having alcoholism, behavioral counseling can be implanted in the clinical setting. Explain to the individuals that overcoming an alcohol disorder is an ongoing process, that can include setbacks. Persistence is the key. Continued follow-up with a treatment provider is critical in overcoming a drinking problem (NIAAA, 2020). For those who have occurred the long-term effects, such as, liver disease, cardiovascular effects, implementation will be aimed at managing the disease and conducting routine follow-ups. Nurse practitioners can employ the CDC’s Unhealthy Alcohol Use Screening Follow-up tool to measure and quantify high-risk individuals or those living with alcoholism (CDC, 2020). Summary People drink to socialize, celebrate, and relax. That itself is not the problem, its drinking too much that can cause harmful outcomes and a variety of consequences (NIAAA, 2020). Alcohol effects differ between each individual depending on a variety of factors, such as, amount, frequency, age, current health status, and familial history. Since any alcohol use is associated with both short-term and long-term health risks, defining universally applicable population-based thresholds for low-risk drinking is difficult (WHO, 2020). Excessive alcohol use can increase the risk of health problems, such as cancer violence, injuries, and liver diseases. This paper aimed to research the global burden alcohol abuse brings to the society, and what health professionals can do to help screen those affected by this disease [alcoholism], how to implement treatments, and follow-up care for those experiencing the long-term effects of consuming alcohol. Binge drinking and excessive drinking has cost the United States approximately $250 billion dollars, and 93,000 deaths annually (CDC, 2020). NPs can be at the forefront of helping at-risk populations combat the effects of alcohol abuse by bringing awareness, implementing a safe environment for divulging drinking habits, and following up as necessary for those adversely impacted. NPs can advocate for policy change within their clinical setting if screening methods and actions after the fact are not fully defined. The first step is acknowledgment of the drinking problem, allowing the patient to mutually participate in their plan of care, and subsequent improved adherence to that plan (USPSTF, 2018).   References Alcoholism. (n.d.). In Merriam-Webster.com dictionary. https://www.merriam-webster.com/dictionary/alcoholism Centers for Disease Control and Prevention. (2020). Deaths from Excessive Alcohol Use in the U.S. https://www.cdc.gov/alcohol/features/excessive-alcohol-deaths.html Curley, L. A. & Vitale, A. P. (2016). Population-Based Nursing, Concepts and Competencies for Advanced Practice (2nd ed.). New York; NY, Springer Publishing Company Curry, S. J., Krist, A. H., Owens, D. K., Barry, M. J., Caughey, A. B., Davidson, K. W., . . . O'Connor, E. (2018). Screening and Behavioral Counseling Interventions to Reduce Unhealthy Alcohol Use in Adolescents and Adults. Jama, 320(18), 1910-1915. doi:10.1001/jama.2018.16789 Division of Scientific Education and Professional Development. DSEPD. (2019). Lesson 1: Introduction to Epidemiology. Principles of epidemiology in public health practice. https://www.cdc.gov/csels/dsepd/index.html Glei, D. A. & Weinstein, M. (2019). Drug and alcohol abuse: The role of economic insecurity. American Journal of Health Behavior, 43(4), 838-857. http://dx.doi.org.chamberlainuniversity.idm.oclc.org/10.5993/AJHB.43.4.16 Ma, S.H., Huo, H. F., & Meng, X.Y. (2015). Modeling alcoholism as a contagious disease: A mathematical model with awareness program and time delay. Discrete Dynamics in Nature and Society, 1(1), 1-13. DOI:10.1155/2015/260195 Maxwell, J. (2014). Substance abuse trends in Texas: June 2014. Community Epidemiology Work Group. CEWG, 15(4), 1-42. National Institute on Alcohol Abuse and Alcoholism. (2020). Alcohol facts and statistics. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics Pasha, A. K., Chowdhury, A., Sadiq, S., Fairbanks, J., & Sinha, S. (2020). Substance use disorders: Diagnosis and management for hospitalists. Journal of Community Hospital Internal Medicine Perspectives, 10(2), 117-126. doi:10.1080/20009666.2020.1742495 Schub, T. and Karakashian, A. (2018). Alcohol use disorder: and overview. CINAHL Nursing Guide U.S. Preventive Services Task Force. (2018). Unhealthy alcohol use in adolescents and adults: Screening and behavioral counseling interventions. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/unhealthy-alcohol-use-in-adolescents-and-adults-screening-and-behavioral-counseling-interventions#bootstrap-panel--5 World Health Organization. (2020). Health topics, alcohol. https://www.who.int/health-topics/alcohol#tab=tab_1 Table 1.1 Prevalence Tables about excessive drinking and binge drinking in Texas 2019 National Texas Excessive drinking Women 13.4% 13.6% Male 22.9% 24.1% 2018 Among youth Adults > 18 years Binge drinking 11.8% 18.0% Heavy drinking 28.0% 26.1% Information cited from: 2019 and 2018, CDC (2020) Chronic disease indicators: Alcohol comsumption. https://nccd.cdc.gov/cdi/rdPage.aspx?rdReport=DPH_CDI.ExploreByLocation&rdRequestForwarding=Form Table 1.2 Alcohol Consumption Patterns (2016) Total alcohol per capita (15+) consumption, drinkers (liters) Men 19.0 Women 6.7 Abstainers (lifetime) 4.4% 13.8 Former drinkers 12.6% 22.5% Table 1.3 Health Consequences: Mortality and Morbidity (2016) (per 100,000 pop. (15+)) Males Females Liver cirrhosis 19.7 10.0 Road traffic injuries 20.3 7.9 Cancer 178.3 133.9 Alcohol use disorders 17.6 10.4 Alcohol dependence 9.9 5.5 Information cited from World Health Organization. (2018). Management of Substance abuse: United States of America. https://www.who.int/substance_abuse/publications/global_alcohol_report/profiles/usa.pdf?ua=1