Detecting Symptoms of Alcohol Abuse in Primary Care Settings

Abstract

Many symptoms of substance use disorders are not adequately addressed in outpatient practice. Little is known about how alcohol use in varying quantities affects health care utilization and treatment of conditions commonly seen in outpatient medicine. Consequently, we lack a full appreciation of the burden of disease borne by alcohol use and have yet to achieve a universally accepted method of approaching primary and secondary prevention of alcohol-related problems.

Substance abuse treatment in human immunodeficiency virus: The role of patient–provider discussions

“…This is consistent with previous observations that physician knowledge of a patient was associated with adherence to substance abuse treatment recommendations (Safran et al, 1998). Previous studies of barriers to provider discussions of substance use issues found that many providers are cautious or uncomfortable discussing substance use issues with patients (Aalto et al, 2003;Aira, Kauhanen, Larivaara, & Rautio, 2003;Kaner et al, 2001;McQuade, Levy, Yanek, Davis, & Liepman, 2000;Volk et al, 1996). A recent qualitative study of audiotaped patient-provider discussions during visits with at-risk drinkers revealed that providers were uncomfortable discussing alcohol issues, avoided direct discussions even when patients raised the subject, and gave advice that was vague or tenuous (McCormick et al, 2006).…”

The Bayesian Alcoholism Test had better diagnostic properties for confirming diagnosis of hazardous and harmful alcohol use

“…Several studies indicate that, even after active screening, general practitioners identify maximally 60% of their alcoholic patients [7][8][9][10][11]. The main reasons for underdiagnosis are denial on the part of patients [12,13], insufficient sensitivity of screening instruments in detecting patients with less severe alcoholism [14], insufficient skills of physicians, and questioning the rationale of diagnosis and intervention in certain groups of problem drinkers, such as young hazardous drinkers [15].…”

KASL Clinical Practice Guidelines: Management of Alcoholic Liver Disease

“…Since patients frequently deny or underreport the amount of drinking, it is helpful to obtain the drinking history through questionnaires or from family members. Although currently there is no consensus on the minimum amount of alcohol required for ALD, a cutoff that is often applied is an average alcohol intake exceeding 40 g/day in men and 20 g/day in women 97,158-160. The average daily alcohol intake is calculated using the following equation: [amount consumed (mL)×alcohol by volume (%)×specific gravity of alcohol (0.785)×number of drinking days per week]÷7.…”