Pilot alcohol clinic eliminating 83% of return emergency visits


Dr. Kim Corace, Dr. Melanie Willows, Brynna Lemmex, Slavica Popovic,Carelle Levac, and Dr. Christine Saveland. Missing: Pam Jackson, Nick Shubert,Nathaniel Leduc, Dr. John Grymala

People who work in emergency departments know there are certain people who come in needing help more often than others. 

Many of these frequent visitors at the emergency department have substance use problems, mental illness, or both. For those with substance use problems, the vast majority struggle with alcohol problems.

“We have a significant portion of people with alcohol use problems coming to the emergency department, then coming back again within 30 days for similar reasons,” says Dr. Kim Corace, director of clinical programming and research at The Royal’s Substance Use and Concurrent Disorders Program.

“This shows that these people aren’t getting the help they need.”
Back in May 2016, a new rapid-access medical alcohol withdrawal clinic opened here at The Royal.
“Since May 2016, the clinic has eliminated 83 per cent of its patients’ 30-day returns. More than that, it has reduced alcohol-related emergency visits in the system by 13 per cent.”

The Alcohol Medical Intervention Clinic (AMIC) is a smart response to a challenging question: how do we reduce the number of people coming to the emergency department repeatedly, sometimes multiple times 
a month? 

As with most smart answers, this one lay in getting a bunch of people together and coming up with a really good plan. Led by the Substance Use and Concurrent Disorders Program at The Royal, a group of community partners asked the Champlain Local Health Integration Network (LHIN) to fund the project. The clinic received pilot funding until March 2018. 

Since May 2016, the clinic has eliminated 83 per cent of its patients’ 30-day returns. More than that, it has reduced alcohol-related emergency visits in the system by 13 per cent.

“This, combined with the other numbers coming in, show that AMIC is a pilot project that patients actually find helpful,” says Dr. Corace. “It’s so exciting to see all these positive outcomes, not just for the patients you serve, but for a system as a whole.” 

Bill is a 43-year-old white man with a college degree. He lives alone and works a full-time job, but is severely dependent on alcohol. Meanwhile, he has symptoms of both depression and anxiety. 

Bill is the ‘average’ client at The Royal’s Alcohol Medical Intervention Clinic, but he’s not every client. One in five patients is under 30. One in three is female, which is significant because women with alcohol addiction are vastly underserved. One in 10 AMIC patients is at risk of losing his or her housing.

“This is a pilot that patients really find helpful, and the numbers don’t lie — it’s reducing the strain on our crowded emergency rooms by bringing these people to a place where they can get the best help at the time they need it the most.”

Dr. Kim Corace, director of clinical programming and research, Substance Use and Concurrent Disorders Program, The Royal
Here’s how it works: a patient comes in to the emergency department at one of The Ottawa Hospital’s two sites with an alcohol-related issue. They’re referred to AMIC, and told they can drop in anytime between 8 and 11a.m. Monday to Friday. An astonishing 61 per cent of them do. Most of them show up within three days of the referral, and then continue to come. 

“This is an unusually high rate, and it shows that the service is actually accessible and done in a way that’s acceptable for these clients,” says Dr. Corace.

They come to The Royal, and are met with the services of an interdisciplinary team that can provide treatment for withdrawal and triage the patient to the best location for care. Whether that’s at The Royal, or with our community partners, AMIC is the hub where they find help when they need it most.

“It’s the ideal time to intervene when someone has just had an emergency room visit related to their alcohol use. Now, they are able to get help when they need it most — right away when they are motivated to make changes and accept help,” says Dr. Melanie Willows, clinical director at The Royal’s Substance Use and Concurrent Disorders Program. 

The partnerships AMIC represents are the key to its success. Strong partnership with The Ottawa Hospital, and strong connections and support from community organizations mean that patients can get help quickly. These connections include an Ottawa Addictions Access and Referral Services (OOARS) navigator who helps connect AMIC clients with the most appropriate community resources. 

“This is a pilot that patients really find helpful, and the numbers don’t lie — it’s reducing the strain on our crowded emergency rooms by bringing these people to a place where they can get the best help at the time they need it the most,” says Dr. Corace. 

The pilot project has funding until March 2018.

Warning labels about drinking while pregnant are working


A random encounter with a warning sign at a north Eugene grocery store put Gulcan Cil on the trail of research toward her UO doctoral degree and, now, a newly published paper.

The paper, published in the Journal of Health Economics, took a deep dive into extensive federal data to probe behavioral changes that likely resulted from point-of-sale warning signs urging women who are pregnant to avoid alcohol.

In states requiring the signage, drinking by pregnant women is down 11 percent, Cil found. She also found evidence of fewer premature births coming with less than 32 weeks gestation and fewer births of babies weighing less than 3.5 pounds. The biggest effects were among women 30 and older.

Cil, now a visiting instructor in the UO Department of Economics and postdoctoral fellow in the Mikesell Environmental and Resource Economics Research Lab, recalled how her research began.

New to Eugene in 2010, she said, she wasn’t pregnant, had no plans to be and didn’t have any friends who were. But that grocery store sign that depicted a woman with a baby inside and holding a cocktail glass and topped with the words “Pregnancy & Alcohol DO NOT MIX” captivated her.

“Every time I walked in the store I saw the sign at the front door and again at the register, and I was like: What is this? I saw it enough times, I guess, that I kind of knew that you’re not supposed to drink alcohol while pregnant, but that was like a confirmation to me,” she said. “I found it very educational, and I was interested in policy behind it.”

Cil was born and raised in Turkey, where such warnings are not used because, she said, drinking by pregnant women is not considered a public health concern.

With a background in environmental economics, Cil had chosen to pursue health economics as a doctoral student. She soon learned that 23 U.S. states and Washington, D.C., required such signs at all retail stores that sell alcohol.

“So I looked in the literature to see if they actually worked,” she said. “I found that the issue had never been studied and evaluated as a public education program or public awareness program.”

Cil mined two national databases — the National Vital Statistics Natality Detail Files and the Behavioral Risk Factor Surveillance System — for clues. Her focus was on information gathered between 1985 and 2010.

Using complex analytic techniques on data related to drinking by women, she compared signage-adopting states with a group of nonadopting states. Her control group included women who had lived in nonadopting states and women who lived in adopting states before signage requirements began.

Her approach allowed her to identify the direct relationship between drinking while pregnant and birth outcomes, while also reducing the likelihood that other factors such as cigarette smoking, drug abuse, nutritional deficiencies and other risky life choices were at play in any behavioral changes.

The study, she said, suggests a likely causal relationship, which had not previously been documented in relation to signage policies, between drinking while pregnant and birth outcomes.

Cil was not able to sufficiently probe effects related to heavy drinking, which is associated with fetal alcohol spectrum disorders. The lack of statistical significance for behavioral change related to these disorders may reflect the fact that they are rarely diagnosed at birth and reported on birth certificates, she said.

Point-of-sale warning signs, she said, are an effective, low-cost approach to protecting the health of pregnant women and the babies they carry.

The signs used by states that require warnings all contain similar language. A future study, Cil said, might explore whether variations in signage — the graphics, fonts, colors and language used — may best be effective.

—By Jim Barlow, University Communications

Retrieved from:  http://around.uoregon.edu/content/warning-labels-about-drinking-while-pregnant-are-working

Fetal Alcohol Spectrum Disorder


Drinking alcohol during pregnancy can disrupt fetal development at any stage during a woman’s pregnancy — including the earliest stages before she even knows that she is pregnant. Whether it is a wine cooler, a glass of wine or a bottle of beer, any kind or amount of alcohol that a pregnant mother consumes is also being consumed by her unborn baby, as alcohol in the mother’s blood passes through the placenta and enters the embryo or fetus through the umbilical cord. Through a number of biological means, alcohol can affect the size, shape, and function of the cells that form the brain, the heart, the kidneys, and all other body organs and systems of the fetus.

Fetal Alcohol Spectrum Disorder

Fetal Alcohol Spectrum Disorder (FASD) is an umbrella term describing the range of effects that can occur in an individual whose mother drank alcohol during pregnancy. It is often a hidden disability that can be hard to diagnose, making it difficult to provide affected individuals and their families the support they desperately need. It is not a diagnostic term used by clinicians, but refers to a range of specific conditions such as fetal alcohol syndrome (FAS), alcohol-related neurodevelopmental disorder (ARND), and alcohol-related birth defects (ARBD).

FASD is most often identified by abnormal facial features, central nervous system problems and slowness of growth. These effects may include physical, mental, behavioral, and/or learning disabilities ranging from mild to severe and can have life-long implications.

You don’t have to be a heavy drinker to have a baby affected by alcohol, as there is no absolute safe amount of alcohol that a woman can drink during pregnancy. The risks of FASD increase as the amount of alcohol consumed increases, and risks are highest for women who binge drink (5 or more drinks on one drinking occasion).

The best option is not to drink any alcohol if you are pregnant. It’s also important to refrain from drinking if planning a pregnancy, since many women do not realize or find out they are pregnant until the first or second month into their pregnancies. The sooner a woman quits drinking, the better it will be for both her and her baby.

FASD cannot be cured

FASD cannot be cured, but with proper diagnosis, treatment, and a support network of family and friends, many people with an FASD can learn coping skills and have an improved quality of life.

The cost factor of raising a child with an FASD is significant. Researchers have found that, for a child with identified FAS, incurred health costs were nine times higher than for children without an FASD. The lifetime cost of caring for a person with FAS is estimated to be at least $2 million, and the overall annual cost of FASD to the U.S. healthcare system to be more than $6 billion.

Says the Institute of Medicine, “Of all substances of abuse (including cocaine, heroin, and marijuana), alcohol produces by far the most serious neurobehavioral effects in the fetus.”

The good news is FASD is not hereditary and only occurs if a woman drinks alcohol during her pregnancy. In other words, FASD is 100% preventable.

Retrieved from:  https://www.ncadd.org/about-addiction/alcohol/fetal-alcohol-spectrum-disorder

Alcohol and pregnancy: What women Veterans should know


Increasing numbers of women Veterans of childbearing age are enrolling in VA health care. Consequently, information on optimizing pregnancy outcomes is important for women Veterans, their families, and their providers. Since 1981, the surgeon general has advocated that women who are pregnant or trying to conceive not drink any alcohol. This recommendation, which was reissued in 2005, is built on a strong foundation of scientific evidence that alcohol exposure during pregnancy is harmful to the developing fetus and may result in fetal alcohol spectrum disorders (FASD).

As we continue to observe Alcohol Awareness Month during April, it is an appropriate time to learn more about FASD and its potential impact on women Veterans and others.

FASD is an umbrella term that encompasses a range of adverse outcomes related to fetal alcohol exposure. At the most severe end of the spectrum are children with fetal alcohol syndrome (FAS), a condition characterized by facial anomalies, growth deficiency and brain abnormalities. The facial features include a thin upper lip, a shortened distance between the inner and outer corners of the eye, and smoothing of the groove underneath the nose. Height, weight and head circumference are frequently reduced. Brain abnormalities result in intellectual disability, behavioral problems, and social challenges. Attention deficit hyperactivity disorder is common, and many affected children struggle with learning, memory, planning, impulse control and arithmetic.

Most children with FASD do not have the full FAS. Alcohol is harmful to the developing brain throughout pregnancy, and the characteristic facial features of FAS result from alcohol exposure during a very narrow time window—approximately day 17 of pregnancy. Children exposed to alcohol at other times during pregnancy lack the visible birth defects of FAS, yet may still experience the same intellectual, behavioral, and social challenges as children with FAS. The absence of facial abnormalities makes diagnosis of these children more difficult.

FASD is the most common preventable cause of intellectual disability in the United States. FASD experts have examined large numbers of first-grade children in communities across the United States, Europe and Africa. From these community-based studies, the prevalence of FASD in the U.S. has been estimated to be between 2 and 5 percent, a rate equal to or greater than that for autism spectrum disorder. In some communities in the wine-growing region of South Africa, the prevalence of FASD exceeds 10 percent.

Fetal alcohol exposure is sufficient to cause FASD; however, additional factors influence the severity of FASD. Perhaps the most important of these factors is maternal nutrition. Children heavily exposed to alcohol during pregnancy are more likely to have FASD if their mother was malnourished. Outcomes after heavy alcohol exposure are improved in children whose mothers take prenatal vitamin supplements. The effects of prenatal alcohol exposure may be worsened by smoking and exposure to other drugs. Animal studies suggest that cannabinoids, active ingredients of marijuana, may worsen birth defects caused by alcohol. The genetics of the mother and the child are also important. Non-identical (fraternal) twins are exposed to the same levels of alcohol during pregnancy, yet only one may be born with FASD. In contrast, if one identical twin has FASD, the other is more likely to also have FASD. Fraternal twins share half of the same genes, and identical twins have identical genes. Hence, it is likely that some genes are protective and others increase the risk for FASD. Experiences of early childhood may also improve or worsen outcomes after prenatal alcohol exposure. Children who grow up in loving homes and enriched environments are more likely to have better outcomes after prenatal alcohol exposure than those who are neglected and have few stimulating activities.

There are challenges and opportunities in the prevention of FASD. Alcohol can harm the fetus even prior to pregnancy recognition. Binge drinking produces high peak blood alcohol concentrations, both in the mother and in the fetus, and high blood alcohol concentrations are especially damaging early in pregnancy. Day 17 of pregnancy represents a particularly vulnerable period for alcohol exposure and is just two days after the first missed menstrual period—a time when many women are unaware of their pregnancy. A second concern is that approximately half of all pregnancies are unplanned. Many women of childbearing age have sex without contraception, and alcohol use increases this practice. These risks are compounded by a rising rate of binge drinking in women in their teens and 20s. Together, the high rate of unplanned pregnancies and fetal vulnerability to alcohol prior to pregnancy recognition pose a unique risk for FASD that is heightened in Veterans with alcohol use disorder. Sexually active women may choose to reduce these risks through increased contraceptive use and reduced binge drinking, especially prior to pregnancy recognition.

Is any level of alcohol exposure safe for the developing fetus?  Research studies in cells, animals and humans have not established a safe level of alcohol exposure. In fact, exposure of rat brain cells to concentrations of alcohol attained in the blood after just one drink interferes with the function of a molecule that is required for normal brain development. Some, but not all, human studies demonstrate intellectual and behavioral effects in children after mild to moderate drinking during pregnancy. The inability to demonstrate a safe level of alcohol exposure for the developing fetus reinforces the surgeon general’s warning to avoid alcohol use altogether while pregnant or trying to conceive. Sexually active women who are not trying to conceive and who choose not to use contraceptives may avoid binge drinking or not drink at all. Women who have had a few drinks before pregnancy recognition need not panic that they have harmed their unborn child. Outcomes of these pregnancies are usually good, especially if further fetal alcohol exposure is avoided and nutrition and general health are well-maintained.

Retrieved from:  http://www.blogs.va.gov/VAntage/36966/alcohol-and-pregnancy-what-women-veterans-should-know/



Volunteers needed for intervention study!

We are doing a research study on a self-regulation intervention for adolescents with Fetal Alcohol Spectrum Disorder (FASD).

We are looking for participants age 11 to 17 who have a diagnosis of FASD.

The intervention will take place over ~12 weeks and will include weekly 1-hour one-to-one intervention sessions focusing on improving self-regulation. The intervention focuses on identifying and talking about different levels of alertness as well as the use of different strategies to improve self-regulation across a variety of environments (home, school, etc.).

There will also be three testing sessions (~2.5 hours each) so we can understand the effect of the intervention. Caregivers will fill out questionnaires about their child’s history and behavior at each testing session.

If you are interested in participating or would like more information, please e-mail labfasd@gmail.com or call our FASD Research Lab 780-735-7999 ext. 15631.



Date: Tuesday May 2nd , 2017

Location: Catholic Social Services – 10320 146 Street

 Supports and Services Meeting: 8:30 – 9:30 am, AGENDA

  1. Call to order
  2. Approval last meeting minutes
  3. Reporting
  4. Finances
  5. Short-Term Crisis Intervention Worker
  6. Additions
  7. Program Updates

 EFAN Society Meeting: 9:30 – 11:30 am, AGENDA

  1. Call to order
  2. Approval last meeting minutes
  3. Finances
  4. New Research
  5. Council, Interagency, Committee Updates
  6. K Days parade, AGM, FASD day Updates
  7. Additions
  8. Program Updates

Click to download agenda:  EFAN Agenda May 2017


Challenging the conversation around FASD


Changing perceptions and challenging the conversation, Dr. Peter Choate and Dr. Jacqueline Pei spoke at the 2017 FASD Network event.

“My mind is like a filing cabinet but no one alphabetized the [darn] thing” is a phrase that welcomes you to the complex world of Fetal Alcohol Spectrum Disorder (FASD). 

The FASD Network hosted their first annual 2017 FASD session: Challenging the conversation.

Shana Mohr, Training coordinator at FASD Network, said there is still a lot of misinformation about FASD.

“The racial problem in the view of FASD in this country is still prevalent,” Mohr said.

Peter Choate, a registered social worker and member of the Clinical Registry, stated there is an urgency to get away from race based FASD because if we stay on race as the topic, we will target community where we think race is the issue. “Race is not the issue”.

“There is a bias that FASD most influences the Aboriginal population, but research actually indicates, it is young university women. Women who engage in social drinking,” Choate said.

Choate said the perpetuation of stigma rests solely on the mother, while the perpetuators of FASD are actually the males, but they are given an out.

Choate asks, why are the men being excluded from this conversation? Go to a man and have a conversation about casual sex, whose sperm is coming into the equation.

 “Denial is huge, when it comes to educating young university women and men about alcohol,” Choate said.

He said there needs to be a conversation with these people and there is a general ineffectiveness of success in preventing FASD, because we are not reaching the right people.

Facts tell us that FASD does not discriminate, people discriminate.

“I have seen the enemy and it is us [referring to the front line workers],” Choate said, noting we are the ones most in need of changing the conversation.

“We need to expand the conversation to authority figures, judges, police, frontline workers, doctors, nurses, and teachers,” Choate said.

Choate said young men need to be shown what respect for a woman looks like.

He also said poverty and addiction play a big part in the world creating people living with FASD.

“We need to help them as humans who seek support without shame, stigma, or condemnation.”

Choate said, structurally the system creates relapse. There is a need to get away from deficit-based assessments, and the need to get away from external language.

He said that frontline workers need to build relationships before and after rehab, or it just won’t work; there will be relapses because rehabilitation is a step in recovery, not a solution.  

“What front line workers need to do is to build relationships with the people that need that help,” Choate said.

Choate strongly suggested to challenge policy makers who act as barriers to support.

He said that people living with addiction need to have a purpose and for front line workers to help find that in their lives, or else there’s no reason to be sober.

“My challenge, my hope is for you to have a conversation with somebody who would not normally have that conversation.”

Retrieved from:  http://www.eaglefeathernews.com/health/index.php?detail=2709

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