By guessing, clinicians may miss 3/4 of alcohol problems

By relying on hunches rather than posing a few screening questions, primary care clinicians may be missing three-fourths of the alcohol problems in their patients, a newly released analysis shows.

"It's often off the radar—people come in for hypertension and are not asked how much they drink," said study co-author Barbara J. Turner, M.D., M.S.Ed., M.A., M.A.C.P., of UT Medicine San Antonio. offices typically don't have good systems to administer questionnaires to screen for certain problems, including consumption, she noted.

UT Medicine is the clinical practice of the School of Medicine at The University of Texas Health Science Center San Antonio. Dr. Turner is a professor in the School of Medicine and director of the Research to Advance Community Health (ReACH) Center, a collaboration of the Health Science Center, the University Health System and the UT School of Public Health.

The study analyzed data from 1,664 patients in 40 primary care practices spread throughout the central part of the country from Colorado to Kentucky. Patients were asked five questions such as: "In the past 12 months, how often have you had a drink containing alcohol?" and "In the past 12 months, how often have you been under the influence of alcohol in situations where you could have caused an accident or gotten hurt?" Based on their scores, patients were classified into four drinking status categories ranging from nondrinker to harmful drinker.

Clinical intuition

Clinicians were asked, "Does this patient have problems with alcohol (check each that applies)?" Options included "yes," "hazardous drinking" and "don't know." When clinicians checked an affirmative answer, this was considered a suspicion of an alcohol problem.

If clinicians suspected a problem, they were usually right, Dr. Turner said. However, clinical intuition misses too many people, the findings indicated.

"When clinicians do assess , it is usually limited to the first encounter. Afterward, it is only assessed when there is an evident problem," Dr. Turner said.

Societal issue

Alcohol problems are insidious and pervade all aspects of society, from work productivity to health decline to family and personal issues. According to the U.S. Centers for Disease Control and Prevention, in 2010 the number of alcoholic liver disease deaths totaled 15,990 and the number of alcohol-induced deaths, excluding accidents and homicides, was 25,692.

More than half of adults age 18 and older described themselves as current regular drinkers (at least 12 drinks in the previous year), according to the 2011 National Health Interview Survey. Lost workdays related to alcohol use numbered 570 million over a 12-month period, the survey reported. According to the CDC, one in six U.S. adults binge drinks about four times a month, consuming about eight drinks per binge.

Regular screening

"Brief alcohol screening questions far outperform clinical intuition in identifying people with alcohol problems, and brief counseling interventions can significantly reduce risky drinking in these individuals," Dr. Turner said.

"Patients should be screened for on a regular basis," she added.

Although medical students and residents are increasingly being trained to ask questions that can identify patients for counseling, lack of time remains a problem. "We need to involve the entire practice team in addressing this issue," Dr. Turner said.

Related Stories

Recommended for you

Researchers study how marijuana impacts driving

date Jun 24, 2015

A new study conducted at the University of Iowa's National Advanced Driving Simulator has found drivers who use alcohol and marijuana together weave more on a virtual roadway than drivers who use either substance ...

Highly educated women stop smoking if the cost goes up

date Jun 19, 2015

Cigarette prices and images on cigarette packets have an impact on women in terms of continuing to smoke or quitting. In fact, less educated women are more responsive to pictorial labels on cigarette packets, ...

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.