A New Method for Identifying Problem Drinkers
By Randall Mikkelsen
PHILADELPHIA, Nov 14 (Reuter) – A new method for identifying problem
drinkers can lead to earlier, more effective treatment and could double
the number of people receiving help, researchers said on Thursday.
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The method, tested with success in Cambridge, Ontario, relies on
indirect questioning to identify potential drinking problems and a modest
level of “lifestyle counseling” to limit alcohol use.
“We could markedly reduce the cost of alcohol abuse in the U.S.A. by
implementing a very simple system like the one that we’ve applied,” said
Yedi Israel, a professor at Thomas Jefferson University’s medical school
and lead author of a research report on the method. “If you are a
(alcohol) dependent person, it’s like a declaration of independence.”
In the United States, where only about one million of an estimated 10
million problem drinkers are receiving treatment, another one million
people yearly could be helped through the new screening and treatment
techniques, Israel said.
The report is to be published in the Nov. 15 issue of “Alcoholism:
Clinical and Experimental Research.” It was based on a study of 15,000
people in Cambridge, a city of 90,000.
The method begins with a series of four questions asked of patients in
their doctors’ waiting rooms on whether they have had any injuries or
fights in the previous five years. This is based on research showing
about half of all injuries are alcohol-related and other research showing
both doctors and patients resist screening techniques in which every
patient is asked directly about alcohol abuse, Israel said.
In addition, he said, doctors often are not trained in treating
alcohol problems and share with their patients an aversion, because of
the stigma, to referring people to alcohol-treatment professionals until
it is too late.
“We have not had systems that allow intervention early on where the
patient — the problem drinker — doesn’t have to define herself or
himself as alcoholic,” he said. “Alcoholism is not a disease in the early
stages but it ends up being a disease at the very end, where the person
doesn’t have absolute control over drinking.”
Patients in the study were asked in the waiting-room questionnaire
whether they had broken or dislocated any bones or joints, been injured
in a traffic accident, received a head injury or been in a fight or
assault. Those who answered “yes” to two or more questions — about one
in seven — were then asked by their doctors about their alcohol
consumption and any alcohol-related problems.
About 3.5 percent of the total number of patients were identified as
problem drinkers. In this way, doctors were able to identify 70 percent
of the problem drinkers that could be expected in a group of this size,
the study said.
Patients who qualified for treatment and accepted were then given
either three hours of counseling over a year with a trained nurse or
simple advice to reduce their drinking.
Those who received the counseling, which helped drinkers to identify
and control situations in which they were likely to drink, showed
significant declines in alcohol consumption and related problems. Those
who received simple advice reported that they drank less often but that
physical and social problems related to drinking did not decline.
Israel said the screening method is inexpensive, less than $1 per
patient, and predicted its use would increase. It will be implemented in
the Philadelphia area though the Jefferson health system and he has been
teaching it to a New York health maintenance organization with 22 million
members, he said.
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