Can the Medical Community Reduce Underage Drinking?

WHAT PHYSICIANS SHOULD BE LOOKING FOR AND WHAT THEY SHOULD BE DOING ABOUT THE PROBLEM OF UNDERAGE DRINKING

So just how can the medical community prevent and reduce this huge and growing problem of underage drinking, is it even the doctor's responsibility.

Welcome to the Clinician's Roundtable on ReachMD XM 157, The Channel for Medical Professionals.

I am Bruce Japsen, the healthcare reporter for the Chicago Tribune and with me today is Dr. Raymond Scalettar. Dr. Scalettar is the former chairman of the American Medical Association and an advisor to the Distilled Spirits Council. Dr. Scalettar is a specialist in arthritis and rheumatology and for nearly two decades with a clinical professor of medicine at George Washington University Medical Center. Today, he comes to us as a medical advisor to the Distilled Spirits Council, which represents some of the biggest names in the liquor industry from Bicardi USA, Future Brands, and Moet Hennessy. Dr. Scalettar joins us today from his offices in Washington D.C.

MR. JAPSEN:

Dr. Ray Scalettar, welcome to ReachMD XM 157, The Channel for Medical Professionals.

DR. SCALETTAR:

Thank you, Bruce; it's a pleasure to be with you on ReachMD which I listen to all the time.

MR. JAPSEN:

That's great. Well, so there have been some recent studies showing that this problem of underage drinking is huge and growing and I want you to talk a little bit about that and also a lot of physicians may not really thing about this as something that they should address in their office and you're going to tell us a little bit about that today as well.

DR. SCALETTAR:

Yes, well, there was this recent SAMHSA study from the Substance Abuse and Mental Health Services Administration which was a detailed study that gave information on the fact that surprisingly to many that the majority of teens get their alcohol from their parents and other adults and they do not obtain it from commercial or retail sources, they are drinking in their home and they are binging in their homes and that's why it's so important for physicians to, if they are pediatricians or family practitioners or even the internal medicine, they have got to talk to their patients and talk to the parents to let them know and enquire a little bit more about the family dynamics and what the children are doing and what the parents responsibility may be and it goes beyond other issues. The physicians have to start, I know we are very sensitive, and many ask about tobacco, but I don’t think enough physicians ask about alcohol and alcohol consumption and it was brought home to me just recently with a patient who I saw last week who for six months have been going to physicians, the physician with multiplicity of very vague symptoms and more and more diagnostic tests being done and then I asked how much alcohol and she said well, you know I've had some trauma six months ago and I probably take a bottle of wine every night, and well bingo! This is the kind of thing that physicians have got to ask and got to be on the ball and know what's going on and this is the way you're going to reduce underage drinking. For example, kids coming here sometimes an adolescent; what did you do on the weekend? Well, I had a couple of 6-packs at Georgetown and without any concept of how much alcohol that is, so this is where physicians have to get the message of, first of all, underage drinking is illegal and its tremendous health effects, but parents and young people do not understand the equivalence of alcohol in alcoholic beverages that there is an equivalence of the same amount of alcohol in 5 ounces of wine or 12 ounces of beer or 1.5 ounces of distilled spirits an 80-proof that has 0.6 cc of alcohol, the same amount; and that's when somebody says having a 6-pack they have no concept of how much alcohol they are really consuming and it can be very dangerous. So this message of equivalence has to be given and this is all part of the dietary guidelines for America that acknowledge and get the message out for the equivalence and this is sponsored by, SAMHSA by the national institutes of NIAAA. These are all part of their website and in promoting and stating the equivalence of alcoholic beverages so is that any surprise that this is an important aspect that message that physicians have to get across.

MR. JAPSEN:

Well, can you talk also about your work as a medical advisor to the spirits industry and the fact that, you know, some people might be surprised that they are working with health professional organizations and they might be developing some things that doctors could use. If you could, if that is going and if you could tell us about it because perhaps there would be physicians listening in or even consumers that might want to look at something and, you know, and may be perhaps, you know, show the patients, say "hey, you know what, these 15 beers you are drinking on a given weekend even though you are 25 is not so great."

DR. SCALETTAR:

I am very glad, yes, <_____> I agreed to become the medical advisor when I realized that we were in confidence with our viewpoints that we are all against underage drinking and that once you drink moderately and responsibly and that means no more than 2 "units" or equivalents of alcoholic beverages per day for males or more than 1 for women and that message the distilled spirits industry has promoted over and over again, but what we've also done is we've been working on toolkits, adult toolkit and the family toolkit, which have useful information for the adults and for families and we send them out to physician's offices and there is a very convenient CD that we send out as well and it's received a great deal of praise from organizations and we've been working with a fair number of organizations, for example, American Medical Women's Association. We work for the American Academy of Nurse Practitioners, the American Academy of Physicians Assistants. We've worked with ACOG and various state medical societies, so we've been in the forefront in promoting these toolkits and the CD is very, very helpful and I know in the offices when the physicians get busy, some of the PAs or nurses in the office have been using them and showing them to the patients and the adults and their adolescent kids, so this is part of the stuff that we've been doing.

MR. JAPSEN:

And this would have been in the toolkit as a DVD or the CD?

DR. SCALETTAR:

It's a CD and we can obtain it and we'd be happy to send it. If you go to the website at www.discus.org we'd be happy to get you a toolkit. One of the other addresses would be www.familytoolkit.discus.org and we can certainly get the CDs out because they are really very, very useful. DISCUS also sponsors and has contributed tremendous sums of money to The Century Council, which is an independent organization with rather distinguished public servants who run that with having no relationship to the industry itself and they try to get the message out against underage drinking or alcohol abuse on campus and they sponsor various programs such as Girl Talk; Ask, Listen, Learn: Kids and Alcohol Don't Mix; Alcohol 101 Plus. So there are a lot of things that I believe the Distilled Spirits Council is doing very, very appropriately and I am pleased that their leadership understands the responsibility.

MR. JAPSEN

Well, if you are just joining us or even if you are new to our channel you are listening to The Clinician's Roundtable on ReachMD XM 157, The Channel for Medical Professionals. I am Bruce Japsen, the healthcare reporter for the Chicago Tribune and joining me today is Dr. Raymond Scalettar, who is a former chairman of the American Medical Association, but he joins us today as a medical advisor to the Distilled Spirits Council, and we're talking about the problem of underage drinking where there had been recent studies showing that this problem is reaching a crisis stage almost, if you will, and Dr. Scalettar is telling us about how physicians can address this with their patients and Dr. Scalettar was just telling us about how that is indeed a problem.

MR. JAPSEN

If you could, Dr. Scalettar, doctors always looked for research showing the effectiveness of early screening and interventions and if you could tell us a little bit about that.

DR. SCALETTAR:

Yeah, that's a very important point, you know, NIAAA has and many, many of the studies that were done by the American Society of Addiction Medicine and Family Practice have shown that just the beginning to enquire and questioning is enough to make patients, parents, and young people take notice as to what they are drinking and how much they are drinking and alcohol screening and intervention is a major thing that one can do. The problem is in our rushed practices unfortunately with physicians and practitioners seeing more than they like to, sometimes we forget that we have to have these social issues at the forefront and enquire about alcohol, but NIAAA, for example, has a wonderful pocket guide for screening and brief intervention, which is extraordinarily helpful and the other thing that's happened is that we now have a CPT code, current procedural terminology code for screening, which may be reimbursed, I am not sure of what the level of reimbursement will be, but at least this is an acknowledgement that screening and intervention is important.

MR. JAPSEN:

I was going to ask you that also, I mean is there when you talk about CPT codes for screening and that's big issue with physicians because they are constantly concerned about getting paid for the work that they do, of course, which is understandable, but is the health insurance industry, I mean, employers, is there insurance coverage for screening and help for underage drinkers.

DR. SCALETTAR:

Well, the coding just was established the last few months after battles for many years, and you can code for a lot of things, whether the insurance companies are going to reimburse you is another story. I think they will, whether it will be on level of an office visit, probably not, but it may very well be that under the supervision of the physician, one's nurse or physician's assistant can be doing the screening and using this appropriate coding that is now available.

MR. JAPSEN:

And I suppose the good news is the fact that there actually is a CPT code for underage drinking and that could be the precursor for more coverage.

DR. SCALETTAR:

Exactly, so that is really something that is of tremendous importance and I think that ought to be used in the future. We hope that not only will Medicare reimburse, CMS reimburse but we hope the insurance industry will give an adequate level of reimbursement for this.

MR. JAPSEN:

What about sort of prescriptions, if you will, or medications, or protocols or things that doctors can look for where primary care doctors or other people who don’t have a specialty in underage drinking, I mean what kind of treatment modalities or who should they refer to, what's going on in that arena?

DR. SCALETTAR:

Well, I think Addiction Medicine is a specialty in itself and in any of the guides whether it's the AMA guide or in the medical society can give the listing of specialists in psychiatry or psychology who are involved in addiction medicine and can help if there is a problem or somebody is going down the slippery slope into alcoholism, but the most important thing before he gets to that stage if physicians and practitioners just start enquiring first, I think that may be the obstacle or might be the mechanism to prevent somebody slipping into a situation where alcohol is the accepted method of their lifestyle.

MR. JAPSEN:

Well, I'd like to thank Dr. Raymond Scalettar, who has been our guest today on The Clinician's Roundtable. I am Bruce Japsen with The Chicago Tribune and we've been talking about what physicians should be looking for and what they should be doing about the problem of underage drinking and I'd like to thank him for being our guest today.

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This is Ori Brafman, the co-author of ‘Sway’ in San Francisco and you're listening to ReachMD XM 157, The Channel for Medical Professionals.