SCREENING FOR ALCOHOL PROBLEMS IN PRIMARY CARE - 07/09/11

Doi : 10.1016/S0025-7125(05)70179-6

J. Harry Isaacson, MD ^a, John B. Schorling, MD, MPH ^b

^a Department of General Internal Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio (JHI)

^b Department of Internal Medicine, University of Virginia Health Sciences, Charlottesville, Virginia (JBS)

Résumé

Screening for alcohol problems is an important component of a comprehensive health care assessment. The U.S. Preventive Services Task Force has recommended that all adult and adolescent patients be screened routinely for the presence of alcohol problems.^{64 U.S. Preventive Services Task Force Guidelines from Guide to Clinical Preventive Services, Section I. Screening: Part I. Mental Disorders and Substance Abuse Baltimore: Williams & Wilkins (1996).
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Cliquez ici pour aller à la section Références} The American Medical Association, American Academy of Family Physicians, American Academy of Pediatrics, and American College of Obstetrics and Gynecology are among the many organizations advocating regular screening or discussions with patients and families about alcohol use.^{2 American Academy of Family Physicians Age Charts for Periodic Health Examination Kansas City, MO: American Academy of Family Physicians (1994).

Cliquez ici pour aller à la section Références, 3 American Academy of Pediatrics and American College of Obstetricians and Gynecologists Guidelines for Perinatal Care Washington, DC: American Academy of Pediatrics and American College of Obstetricians and Gynecologists (1992).

Cliquez ici pour aller à la section Références, 4 American Academy of Pediatrics, Committee on Adolescence Alcohol use and abuse: A pediatric concern Pediatrics 1995 ; 95 : 439-442

Cliquez ici pour aller à la section Références, 5 American Medical Association, Council on Scientific Affairs Guidelines for Alcoholism Diagnosis, Treatment and Referral Chicago: American Medical Association (1979).

Cliquez ici pour aller à la section Références} Physicians in primary care settings often fail to recognize alcohol problems, particularly early-stage ones.^{18 Cleary P.D., Miller M., Bush B.T. , et al. Prevalence and recognition of alcohol abuse in a primary care population Am J Med 1988 ; 85 : 466-471 [cross-ref]

Cliquez ici pour aller à la section Références, 19 Clement S. The identification of alcohol-related problems by general practitioners Br J Addict 1986 ; 81 : 257-264 [cross-ref]

Cliquez ici pour aller à la section Références, 22 Cyr M.G., Wartman S.A. The effectiveness of routine screening questions in the detection of alcoholism JAMA 1988 ; 259 : 51-54

Cliquez ici pour aller à la section Références, 36 Isaacson J.H., Butler R., Zacharek M. , et al. Screening with the alcohol use disorders identification test (AUDIT) in an inner-city population J Gen Intern Med 1994 ; 9 : 550-553 [cross-ref]

Cliquez ici pour aller à la section Références, 43 Moore R.D., Malitz F.E. Underdiagnosis of alcoholism by residents in an ambulatory medical practice J Med Educ 1986 ; 61 : 46-52 [cross-ref]

Cliquez ici pour aller à la section Références} Even when physicians are aware of an active alcohol problem, they may not intervene appropriately.^{15 Bush B., Shaw S., Cleary P. , et al. Screening for alcohol abuse using the CAGE questionnaire Am J Med 1987 ; 82 : 231-235 [cross-ref]

Cliquez ici pour aller à la section Références, 18 Cleary P.D., Miller M., Bush B.T. , et al. Prevalence and recognition of alcohol abuse in a primary care population Am J Med 1988 ; 85 : 466-471 [cross-ref]

Cliquez ici pour aller à la section Références, 20 Cohen M., Kern J.C., Hassett C. Identifying alcoholism in medical patients Hosp Commun Psychiatry 1986 ; 37 : 398-400

Cliquez ici pour aller à la section Références} The reasons for the poor diagnosis and intervention rates include lack of systematic screening approaches, poor knowledge of treatment resources, and the perception that patients with alcohol problems are often resistant to behavior change. Physicians easily identify as alcoholic patients with multiple medical complications from alcohol use, but they are less likely to identify patients with early alcohol problems, many of whom have no active medical problems related to their alcohol use. The Institute of Medicine reviewed alcohol problems in the United States and emphasized that “most people have no alcohol problems, many people have some alcohol problems, and a few people have many alcohol problems.”^{35 Institute of Medicine Broadening the Base of Treatment for Alcohol Problems Washington, DC: National Academy Press (1990).
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Cliquez ici pour aller à la section Références} Additionally a number of studies have shown that brief interventions by primary care physicians are simple and effective for many patients with problematic alcohol use.^{25 Fleming M.F., Barry K.M., Manwell L.B. , et al. Brief physician advice for problem alcohol drinkers: A randomized controlled trial in community-based primary care practices JAMA 1997 ; 277 : 1039-1045

Cliquez ici pour aller à la section Références, 66 Wilk A.I., Jensen N.M., Havighurst T.C. Meta-analysis of randomized control trends addressing brief inventory in heavy alcohol drinkers J Gen Intern Med 1997 ; 12 : 274-283 [cross-ref]

Cliquez ici pour aller à la section Références}

This article offers a simple model for alcohol screening designed to facilitate early identification of alcohol problems by busy primary care physicians. Integrating simple standard screening questions for alcohol problems into primary care visits is advocated, but the results should not be interpreted as a simple yes or no. Instead the emphasis is on heterogeneity of alcohol problems, and it is proposed that patients be placed along a spectrum of use that reflects that different drinking patterns are associated with different levels of risk.

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Plan

Address reprint requests to J. Harry Isaacson, MD, FACP, Department of General Internal Medicine, The Cleveland Clinic Foundation, 9500 Euclid Ave, Desk A-91, Cleveland, OH 44195