Prevalence and recognition of alcohol abuse in a primary care population.

PURPOSE: The purpose of this study was to assess the prevalence, physician recognition, and treatment of alcohol abuse among patients of 19 senior medical residents practicing in a hospital-based, primary care setting. PATIENTS AND METHODS: Interviews of 242 outpatients were conducted, and alcohol abuse and dependence, as defined by the Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III), were determined using the Diagnostic Interview Schedule. RESULTS: Twenty percent of the patients studied had abused or were dependent on alcohol at some time in their lives and 5 percent reported abuse or dependence within the last year. Of the techniques studied, a short screening questionnaire (Short Michigan Alcohol Screening Test [SMAST]) was the most accurate way of identifying patients who abused alcohol, and physician assessments were more accurate than laboratory tests. Although the physicians were aware of serious alcohol problems among 77 percent of their patients who met DSM-III criteria for alcohol abuse or dependence in the previous year, they identified only 36 percent of their patients with less serious problems or past alcohol abuse. They had only discussed alcohol abuse with 67 percent of the patients they identified as alcohol abusers. CONCLUSION: We conclude that a short screening questionnaire (SMAST) is an accurate means of identifying alcohol abuse. Despite the recognition of serious alcohol problems by the physicians, the problem is not addressed routinely even among patients that are recognized as alcoholic.

Residents' attitudes, knowledge, and behavior regarding diagnosis and treatment of alcoholism.

Few studies have addressed the variables that affect physicians' practice behavior in treating alcoholism. In the study reported here, the authors hypothesized that alcohol-related training and experience would influence practice behavior more significantly than attitudes or knowledge. In order to assess the most important predictors of practice behavior, the authors conducted a survey of 163 junior and senior medical residents at five training hospitals affiliated with Harvard Medical School. Of these residents, 123 responded (75 percent). Negative attitudes toward alcoholics and knowledge of alcoholism were not significantly related to the residents' estimates of the prevalence of alcoholism among their patients, to their rate of treating alcoholic patients, or to their rate of referring patients for alcoholism therapy. There was a significant relationship between having supervised clinical experience in alcoholism and these three behaviors. These results are consistent with the authors' hypothesis that changing physicians' practice in treating alcoholics may be best achieved by providing relevant clinical experience in alcoholism.