To tackle Maine’s alcohol-related health problems, the Lunder-Dineen Health Education Alliance in collaboration with Mass General hopes to make conversations about alcohol an integral part of primary care appointments.

About 30 to 60 percent of hospital visits and 30 to 40 percent of primary care visits in Maine are alcohol-related. But most healthcare providers aren’t trained on how to have a compassionate and caring conversation with their patients about the health consequences of their alcohol use.

“The evidence tells us that having a meaningful conversation about alcohol can often positively influence patients to reconsider their consumption.”

To create awareness and fill that gap, the Lunder-Dineen Health Education Alliance of Maine (Lunder-Dineen), in collaboration with Massachusetts General Hospital, is partnering with stakeholders across Maine to create a first-of-its-kind pilot program. Called Time to Ask, it will include education and training for providers as well as expert consultation to assist primary care practices in making this transformation.

The education program will be geared to all busy professionals on the primary care team — including physicians, physician assistants, nurses, nurse practitioners, medical assistants and social workers. A comprehensive needs assessment was conducted at three pilot sites — located in Fairfield, Caribou and Bucksport — and experts convened by Mass General and Lunder-Dineen will begin developing the education later this year.

They’ve also created an informative website with short videos featuring addiction experts from Maine and Mass General. Topics include the health impacts of alcohol use long before a substance use disorder appears, alcohol’s risks at various ages, and why treatment is not always about willpower. Primary care practice providers will learn how to intervene early to prevent costly and devastating health challenges.

James Dineen, MD, left, and Peter Lunder
James Dineen, MD, left, and Peter Lunder

Most Common Misused Substance

Maine’s problem with alcohol use mirrors national statistics. Of the 23 million Americans with a substance use disorder, 20 million are misusing alcohol. “Despite all the attention on opioids, alcohol is by far the most common substance to be misused in the United States,” says Noah Nesin, MD, FAAFP, vice president of medical affairs at Penobscot Community Health Care in Maine. Dr. Nesin is also a member of the Lunder-Dineen advisory group.

“The evidence tells us that having a meaningful conversation about alcohol can often positively influence patients to reconsider their consumption,” Dr. Nesin says.

He adds that the collaboration with Mass General has been vital. Mass General’s expertise on professional health education, such as through the Norman Knight Nursing Center for Clinical and Professional Development, and on substance use and addiction has helped the planning team raise awareness and enlist stakeholder support. Mass General launched a strategic plan to identify and treat substance use disorders in 2014.

Primary care practitioners believe alcohol education is important, Dr. Nesin points out. “But there’s a lot of pressure to deliver care in a limited time. It’s going to take changes in work flow.”

Noah Nesin, MD, FAAFP
Noah Nesin, MD, FAAFP

Alliance Forged by the Lunders

Even patients who don’t meet the criteria for misuse or addiction can benefit from knowledge that alcohol can affect all organs of the body, not just the liver. “Alcohol is a known carcinogen but this isn’t talked about,” says James J. Dineen, MD, a Maine native who practiced primary care at Mass General for 45 years until retiring in 2008. Drinking alcohol is linked to cancers of the mouth, esophagus, larynx, pharynx, liver and breast.

Lunder-Dineen, founded in 2011, was spearheaded by Paula and Peter Lunder and their Lunder Foundation in honor of the exemplary care Dr. Dineen provided to Mr. Lunder at Mass General. Its goal is “to improve the health of Maine residents by expanding their health knowledge and by advancing the skills and expertise of Maine health professionals.”

Dr. Dineen is co-chair of Lunder-Dineen along with fellow Maine native Jeanette Ives Erickson, RN, DNP, who is chief nurse and senior vice president for patient care at Mass General, and Robert J. Birnbaum, MD, PhD, director of continuing professional development at Partners HealthCare.

From left, Lunder-Dineen co-chairs Jeannette Ives Erickson, RN, DNP, and Robert Birnbaum, MD, PhD,, and Gino Chisari, RN, DNP, chief learning officer and director of Mass General's Norman Knight Nursing Center for Clinical and Professional Development.
From left, Lunder-Dineen co-chairs Jeannette Ives Erickson, RN, DNP, and Robert Birnbaum, MD, PhD, and Gino Chisari, RN, DNP, chief learning officer and director of Mass General’s Norman Knight Nursing Center for Clinical and Professional Development.

“I took care of many people with painful cancers related to alcohol use, like esophageal cancer,” Dr. Dineen explains. “It would have been much preferable if I had known to talk to them earlier in life about their alcohol use when there was a chance at stopping the cancers from happening.”

Facts Not Judgment

It’s important to learn how to have these conversations with patients in a way they don’t feel “judged” and are more likely to open up, points out Time to Ask’s senior program manager, Denise O’Connell. “We may think that patients will be offended, but in fact they rate their providers higher for asking.”

Drinking alcohol is pervasive in our culture. As Ms. Ives Erickson says, “It is our hope through Time to Ask that we can get everybody thinking more about its consequences.”

For more information about the Lunder-Dineen Health Alliance of Maine’s Time to Ask program, please contact us.