Doctors Urged to Screen for Alcohol Problems

An influential group of experts is recommending that primary care doctors screen all adults for alcohol problems. The advice comes from the U.S. Preventive Services Task Force. This independent group reviews medical evidence and offers advice to doctors on preventive care. The new report says there's enough evidence to show that asking one question can help show which patients may have "risky" drinking patterns. The question is: "How many times in the past year have you had five or more drinks in a day (if you're a man), or four or more drinks (if you're a woman or older than 65)?" If the person says this has happened at least once, the doctor can ask more questions to assess the degree of risk. Risky drinking may be causing current problems or may just increase the risk of problems later. The journal Annals of Internal Medicine published the study. HealthDay News wrote about it May 13.

By Howard LeWine, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

There's so much to accomplish during a routine visit to your primary care doctor. So having a simple screening tool to determine if a person is misusing alcohol is terrific.

The one question: "How many times in the past year have you had X or more drinks in a day?"

X is 5 for men and 4 for women and all adults older than 65. If the answer is at least once, then the doctor should do further questioning. The person may be misusing alcohol.

The U.S. Preventive Services Task Force identifies the following levels of misuse:

• Risky alcohol use: For men, more than 14 drinks per week or more than 4 drinks in one day. For women, more than 7 drinks per week or more than 3 drinks in one day. Risky means you are more likely to develop social or medical problems related to alcohol.
• Harmful alcohol use: Alcohol misuse has already impacted your physical or mental health or harmed your social relationships.
• Alcohol abuse includes one or more of the following:
  • Multiple times you have not met your responsibilities at home, work or school
  • Excessive alcohol use, followed by droving a vehicle, operating machinery or doing something else that put you or others in harm's way
  • Legal problems related to alcohol use
• Alcohol dependence: Physical craving for alcohol and/or symptoms of alcohol withdrawal if you try to stop drinking

Similar to all screening tests, this one-question test is not perfect. It can identify about 85% of adults who misuse alcohol. So it is a sensitive test. But about 30% of people who say that they have had more than 4 or 5 drinks at least once in the last year do not have a problem with alcohol.

What Changes Can I Make Now?

The U.S. Preventive Services Task Force wants primary care doctors to screen patients for alcohol misuse. Here's why:

• The question appears to do no harm. It might make someone feel uncomfortable, but not much else.
• Screening might identify a much more serious problem than the doctor has recognized or the patient has mentioned.
• Early, simple interventions may prevent risky alcohol use from becoming harmful use or abuse.

A little advice and encouragement may help you figure out if your drinking follows a risky pattern and what to do about it. The source of advice could be your primary care doctor. Or the doctor might refer you to an alcoholism counselor. Often a non-professional person who is knowledgeable about alcohol or had an alcohol problem can be very effective.

This is not long-term therapy. It's perhaps two or three discussions. The helper can ask you how much you are drinking and let you know how it compares with the norm. He or she might:

• Talk briefly about the consequences of more serious alcohol use
• Provide a self-help manual or workbook
• Suggest that you keep records of your drinking and choose a goal of cutting back or stopping completely

What Can I Expect Looking to the Future?

You may see increased publicity about risky alcohol use. This has been shown to be effective. In one study, people misusing alcohol were helped by little more than responding to a public appeal. The advertisement was placed in newspapers, on television, on radio and in leaflets and posters distributed in Toronto, Canada.

The ad contained a telephone number, along with the following message: "Thinking of a change in your drinking? Do you know that 75% of people change their drinking on their own? Call us for materials that can be completed at home."