Screening and intervention for alcohol problems. A national survey of primary care physicians and psychiatrists

Abstract

Objective: To describe adult primary care physicians' and psychiatrists' approach to alcohol screening and treatment, and to identify correlates of more optimal practices.

Design: Cross-sectional mailed survey.

Participants: A national systematic sample of 2,000 physicians practicing general internal medicine, family medicine, obstetrics-gynecology, and psychiatry.

Measurements: Self-reported frequency of screening new outpatients, and treatment recommendations in patients with diagnosed alcohol problems, on 5-point Likert-type scales.

Main results: Of the 853 respondent physicians (adjusted response rate, 57%), 88% usually or always ask new outpatients about alcohol use. When evaluating patients who drink, 47% regularly inquire about maximum amounts on an occasion, and 13% use formal alcohol screening tools. Only 82% routinely offer intervention to diagnosed problem drinkers. Psychiatrists had the most optimal practices; more consistent screening and intervention was also associated with greater confidence in alcohol history taking, familiarity with expert guidelines, and less concern that patients will object.

Conclusions: Most primary care physicians and psychiatrists ask patients about alcohol use, but fewer use recommended screening protocols or offer formal treatment. A substantial minority of physicians miss the opportunity to intervene in alcohol problems. Efforts to improve physicians' screening and intervention for alcohol problems should address their confidence in their skills, familiarity with expert recommendations, and beliefs that patients object to their involvement

Figures

FIGURE 1

By specialty, percentage of physicians who usually or always (left to right) ask whether a new outpatient drinks alcohol, assess the maximum alcohol consumption per occasion of patients who drink, or use formal alcohol screening questionnaires (such as CAGE, AUDIT, or MAST–24) of patients who drink. Error bars indicate standard errors.

FIGURE 2

By specialty, percentage of physicians who usually or always (left to right) recommend a 12-step program such as Alcoholics Anonymous, offer referral to a mental health professional or social worker, offer referral to a chemical dependency treatment program, or counsel the patient without other consultation or referral, for alcoholism. Error bars indicate standard errors.