Maggie McKay (Host): AUD, or Alcohol Use Disorder, is complicated, and if you or someone you know suffers from it, the more you know, the better you can take care of it.

Today, Physician's Assistant, Randi Kent, will tell us about CleanSlate, what it is, and how they treat AUD. Welcome to Stoughton Health Talk from Stoughton Health. I'm your host, Maggie McKay. Thank you so much for being here today, Randi, and making the time.

Randi Kent, PA: Yeah, I'm happy to be here.

Maggie McKay (Host): Would you please tell us, for starters, what is AUD?

Randi Kent, PA: Sure, AUD, also known as Alcohol Use Disorder, is a brain disease. It is an addiction to alcohol, so uncontrollable drinking to the point where it causes harm either to yourself, relationship, life, etc.

Host: And how does somebody get AUD or how do they have it?

Randi Kent, PA: Yeah, so AUD, some studies show, is genetic and runs in the family. Other times, it's trauma. Other times, it's drinking from an early age. There's multiple ways to, that you're predisposed to have it. Now, how do you get diagnosed with it? That's where we use our criteria from what we call the DSM 5, where you meet certain criteria to get that diagnosis, which is really long and kind of boring, so I won't get into all the steps.

But I will say that we do use that criteria in order to fit that diagnosis rather than something like binge drinking that some people have maybe heard of before.

Host: Mm hmm. And what screening tools are used?

Randi Kent, PA: Yeah, so we use a PAWS scale, which is the Prediction of Alcohol Withdrawal Severity. So we use that on anyone that comes into our clinic to see if you're a candidate for outpatient versus inpatient treatment. We also use something called the Audit C and the CAGE screening tool. We use those to see, are you fitting this diagnostic criteria in the CAGE and the Audit C, in combination with the DSM 5s to fit that diagnosis of alcohol use disorder.

Host: And Randi, what's the risk of alcohol withdrawal?

Randi Kent, PA: Alcohol withdrawal risk is very severe. There's a 5% ish risk of death with alcohol withdrawal and higher risk of seizures or hallucinations. So, I think some people think alcohol withdrawal may have a little bit of tremors, maybe nauseousness, when in reality, that could be much more severe than maybe the average person knows.

Host: And what treatment options are suggested?

Randi Kent, PA: Yeah, so treatment options for alcohol use disorder vary. There's an inpatient side of treatment and an outpatient side of treatment. Inpatient side of treatment consists of detox. So if someone scores pretty high on that PAWS score like I was talking about, you can go to medical management where they monitor you over the course of anywhere from two to five days.

Again, not hard and fast on that two to five days, sometimes longer, and they make sure that you're gonna detox safely. There's also residential treatment where you can go and stay there for about 30 to 45 days. There's therapy, there's meetings mainly what we treat at CleanSlate is outpatient treatment.

So, I see a patient starting off at once a week and eventually working their way towards monthly visits. And we use medications to help with cravings for alcohol. So, there's two medications that help with cravings. That's called naltrexone and acamprosate or Camprol. Naltrexone's a great option. A lot of people use it. It's pretty popular and works very effectively. It also comes in injectable version, which a lot of people like taking a shot once a month instead of a pill every day. There's also Antabuse, which a lot of people don't like. That is a punishment for drinking. So if someone drinks, then they are going to get very, very sick.

And in today's world, it can be any type of alcohol exposure. So even if you're using a hand sanitizer that's ethyl alcohol based, it can also cause that reaction. But it's an option for people that want a deterrent that we can provide.

Host: And how long should people be treated for?

Randi Kent, PA: Great question. It really depends on the patient. So we typically recommend a year of sobriety, at least. The reason why we do that is because the longer that you're in treatment, the better the outcomes prove to be. Some patients don't love that. And some patients want to be treated for, let's say three months or six months.

We don't have contracts at CleanSlate. So if you want to be here with us for three months and get on your sobriety journey, awesome. And if you want to be with CleanSlate for five years and hang out with me for that long, if it means you're sober and you're doing well, we are more than happy to accommodate that too.

Host: When would you suggest somebody reach out?

Randi Kent, PA: I think there's a lot of I would say obvious cues to reach out. If you're involved in the legal system for drinking. If you have to have a drink the first time that you wake up in the morning to help with withdrawal symptoms, those are good times. But I think the less obvious ones to the common person is, you know, are people annoyed by your drinking?

Do you ever, want to cut back and you really struggle in doing that? Do you ever feel guilty about how much you are drinking? If that's ever occurring, reach out. And even if those things aren't occurring and you're thinking to yourself, you know, I might be drinking too much, just call us, get an evaluation.

Again, just because you come here doesn't mean that you're locked into a treatment plan. We can always see if you fit that diagnosis for alcohol use disorder. And if you're a candidate for medications or other options.

Host: What's the demographic of patients that you see?

Randi Kent, PA: Everyone and anyone. Ages, unfortunately, 18, 19, 20, just because the legal age is 21 doesn't mean some people wait until then. We also see people in, in older age groups, 60s, 70s, and everywhere in between. And then we see anyone that's employed, unemployed in between jobs. Homeless, housed very well, there's really a wide range.

Unfortunately, in Wisconsin, alcohol is very accessible. So we have many people from all walks of life that come in.

Host: So AUD does not discriminate it sounds like.

Randi Kent, PA: Yes, unfortunately.

Host: Is there anything else you'd like to add, Randi, in closing that maybe we didn't cover or you'd like people who are considering treatment to know?

Randi Kent, PA: I think it takes a lot of guts to walk through the door and ask for help. I think as humans, we don't love to ask for help and maybe be perceived as a weakness, but this is not a willpower thing. I always tell patients if this was willpower based, then, we wouldn't have a problem because almost everyone that comes through our door says, I just want it so bad and I can't.

So we're not going to judge you here. My staff is awesome. CleanSlates throughout really the state and the country are awesome. We're not going to judge you. And we're going to just have a conversation kind of like me and you are having and figure out if there's anything that we can do to help or if we can't help, where can we refer you that can?

Host: That's great. It sounds like you've got all the bases covered. So, thank you so much for sharing your expertise and being here today to help us understand more about AUD.

Randi Kent, PA: Absolutely. It was great talking with you.

Host: Again, that's Randi Kent. For more information regarding CleanSlate, visit cleanslatecenters.com. For more information on a variety of health related topics, visit stoughtonhealth.com. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you.

I'm Maggie McKay. Thanks for listening to Stoughton Health Talk, a podcast from Stoughton Health.