Alcohol use disorders carry an annual cost of $223 billion dollars in the United States, due in large part because physicians have to rely on their instincts to catch them. The January/February issue of the Annals of Family Medicine, available January 14, concluded that doctor’s intuition alone misses most patients with alcohol abuse or the disease of alcoholism.
Researchers asked 94 physicians and their eligible patients to complete a short survey, separate from each other, after an office visit. Patients were given the survey asking about their use; Doctors’ surveys asked whether the clinician thought their patients had alcohol problems.
Of the 1,699 patients who filled out exit questionnaires, 10 percent screened positive for “hazardous” drinking and nearly four percent screened positive for “harmful” drinking. The difference between "hazardous" and "harmful" drinking is based on how the patient scored on various questionnaires on binge drinking, frequency and quantity. Physicians were much more likely to pick out the patients who did not have alcohol problems (98 percent of the time) than to accurately identify patients with alcohol problems (correctly identified only 27 percent of the time).
The journal calls for ways to make the screening easier. "To increase the feasibility of screening for alcohol problems in practice, a validated single screening question can be used. For example, for the question, 'When was the last time you had more than X drinks in one day?' where X is four for women and five for men, an answer of 'any time in the past three months' was 86 percent (effective) in detecting alcohol problems."
Alcohol problems are not commonly identified during the course of routine healthcare services. Doctors mainly have to rely on the patients to self-disclose, and not many people are forthcoming about drinking problems due to social stigma placed on alcoholism. Screening for alcohol consumption has not yet been integrated into routine primary care even though alcohol problems are prevalent, costly and major causes of death and disease in the U.S.
Patients may be put off by any questions about alcohol use or feel it distracts from addressing the reason for their visit. And what patients don’t disclose, doctors don’t screen for automatically due to lack of time. “Our study affirms that systems need to be in place, possibly through team-based care, to screen systematically for alcohol problems with a validated question or series of questions and to address this health threat using evidence-based approaches. This process can improve patient health and perhaps save some of the $223 billion economic cost of alcohol.”
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