Screening for Alcohol Use Disorders Important, Simple

WASHINGTON – When it comes to screening patients for alcohol use disorders, the small check box on the patient history form sometimes fails to tell physicians what they need to know about the patient’s alcohol use, experts said at the annual meeting of the American Society of Addiction Medicine. 

That’s partly why Dr. Keith A. Nichols screens all of his adolescent and adult patients for alcohol use disorders beyond the patient history form in his private family practice in upstate New York. Often, Dr. Nichols’ questions lead to a conversation.

"Do not stop at taking history," Dr. Nichols said. "Delve into and find out if there’s a problem. Don’t take the person’s snap response. People in general aren’t offended if you ask them. In fact, you get a lot of people who are grateful if you help them."

Because of the key role alcohol plays in a variety of problems, diseases, and injuries, early identification is critical, said John P. Allen, Ph.D. Why? "Because the chances of treating problem drinking are likely most favorable before the drinking becomes more ingrained," said Dr. Allen, associate chief consultant for addictive disorders at the Veterans Health Administration’s (VHA’s) Office of Mental Health Services.

The importance of primary care as an entry point for treating these patients is well established. For example, screening and behavioral counseling interventions in primary care settings to reduce alcohol misuse are top recommendations of the U.S. Preventive Services Task Force. At the VHA, more than 96% of the patients are screened for alcohol use disorders. In addition, roughly two-thirds of patients with a diagnosis of substance use disorder at the VHA are treated in primary care or in general mental health services.

Providers at the VHA use a simple screening instrument called the Alcohol Use Disorders Identification Test (AUDIT-C), which includes three questions inquiring about the frequency of drinking, the usual level of alcohol consumption, and the frequency of very heavy alcohol use. 

Despite physicians’ awareness of the importance of screening and probing for alcohol use disorders, one problem that might explain the failure of screening to become routine could be that physicians "aren’t sure what to do once they obtain a history" that suggests a problem, Dr. Nichols said. "I think there might be a concern that it’s not a priority for the patient, and the doctor might not want to go there."

For many physicians faced with 15-minute limits for each patient visit in order to make a viable practice, the biggest challenge is time. And the problem doesn’t end there. "Even if you have enough time to figure out the problem, there’s not enough time to delve into its origins," said Dr. Jose M. Partida Corona, an internist who practices in Las Vegas.

Other barriers also interfere, such as lack of an integrated system or access to specialty care.

Yet, screening advocates stress the importance of taking that first step.

"It’s important for health care providers to ask about drinking, because it plays a huge role in many physical and mental health problems," Dr. Partida Corona said. "And obviously, treatment for them will be very different if alcohol is playing a significant role."

Dr. Nichols, Dr. Allen, and Dr. Partida Corona reported no conflicts of interest.

WASHINGTON – When it comes to screening patients for alcohol use disorders, the small check box on the patient history form sometimes fails to tell physicians what they need to know about the patient’s alcohol use, experts said at the annual meeting of the American Society of Addiction Medicine. 

That’s partly why Dr. Keith A. Nichols screens all of his adolescent and adult patients for alcohol use disorders beyond the patient history form in his private family practice in upstate New York. Often, Dr. Nichols’ questions lead to a conversation.

"Do not stop at taking history," Dr. Nichols said. "Delve into and find out if there’s a problem. Don’t take the person’s snap response. People in general aren’t offended if you ask them. In fact, you get a lot of people who are grateful if you help them."

Because of the key role alcohol plays in a variety of problems, diseases, and injuries, early identification is critical, said John P. Allen, Ph.D. Why? "Because the chances of treating problem drinking are likely most favorable before the drinking becomes more ingrained," said Dr. Allen, associate chief consultant for addictive disorders at the Veterans Health Administration’s (VHA’s) Office of Mental Health Services.

The importance of primary care as an entry point for treating these patients is well established. For example, screening and behavioral counseling interventions in primary care settings to reduce alcohol misuse are top recommendations of the U.S. Preventive Services Task Force. At the VHA, more than 96% of the patients are screened for alcohol use disorders. In addition, roughly two-thirds of patients with a diagnosis of substance use disorder at the VHA are treated in primary care or in general mental health services.

Providers at the VHA use a simple screening instrument called the Alcohol Use Disorders Identification Test (AUDIT-C), which includes three questions inquiring about the frequency of drinking, the usual level of alcohol consumption, and the frequency of very heavy alcohol use. 

Despite physicians’ awareness of the importance of screening and probing for alcohol use disorders, one problem that might explain the failure of screening to become routine could be that physicians "aren’t sure what to do once they obtain a history" that suggests a problem, Dr. Nichols said. "I think there might be a concern that it’s not a priority for the patient, and the doctor might not want to go there."

For many physicians faced with 15-minute limits for each patient visit in order to make a viable practice, the biggest challenge is time. And the problem doesn’t end there. "Even if you have enough time to figure out the problem, there’s not enough time to delve into its origins," said Dr. Jose M. Partida Corona, an internist who practices in Las Vegas.

Other barriers also interfere, such as lack of an integrated system or access to specialty care.

Yet, screening advocates stress the importance of taking that first step.

"It’s important for health care providers to ask about drinking, because it plays a huge role in many physical and mental health problems," Dr. Partida Corona said. "And obviously, treatment for them will be very different if alcohol is playing a significant role."

Dr. Nichols, Dr. Allen, and Dr. Partida Corona reported no conflicts of interest.

WASHINGTON – When it comes to screening patients for alcohol use disorders, the small check box on the patient history form sometimes fails to tell physicians what they need to know about the patient’s alcohol use, experts said at the annual meeting of the American Society of Addiction Medicine. 

That’s partly why Dr. Keith A. Nichols screens all of his adolescent and adult patients for alcohol use disorders beyond the patient history form in his private family practice in upstate New York. Often, Dr. Nichols’ questions lead to a conversation.

"Do not stop at taking history," Dr. Nichols said. "Delve into and find out if there’s a problem. Don’t take the person’s snap response. People in general aren’t offended if you ask them. In fact, you get a lot of people who are grateful if you help them."

Because of the key role alcohol plays in a variety of problems, diseases, and injuries, early identification is critical, said John P. Allen, Ph.D. Why? "Because the chances of treating problem drinking are likely most favorable before the drinking becomes more ingrained," said Dr. Allen, associate chief consultant for addictive disorders at the Veterans Health Administration’s (VHA’s) Office of Mental Health Services.

The importance of primary care as an entry point for treating these patients is well established. For example, screening and behavioral counseling interventions in primary care settings to reduce alcohol misuse are top recommendations of the U.S. Preventive Services Task Force. At the VHA, more than 96% of the patients are screened for alcohol use disorders. In addition, roughly two-thirds of patients with a diagnosis of substance use disorder at the VHA are treated in primary care or in general mental health services.

Providers at the VHA use a simple screening instrument called the Alcohol Use Disorders Identification Test (AUDIT-C), which includes three questions inquiring about the frequency of drinking, the usual level of alcohol consumption, and the frequency of very heavy alcohol use. 

Despite physicians’ awareness of the importance of screening and probing for alcohol use disorders, one problem that might explain the failure of screening to become routine could be that physicians "aren’t sure what to do once they obtain a history" that suggests a problem, Dr. Nichols said. "I think there might be a concern that it’s not a priority for the patient, and the doctor might not want to go there."

For many physicians faced with 15-minute limits for each patient visit in order to make a viable practice, the biggest challenge is time. And the problem doesn’t end there. "Even if you have enough time to figure out the problem, there’s not enough time to delve into its origins," said Dr. Jose M. Partida Corona, an internist who practices in Las Vegas.

Other barriers also interfere, such as lack of an integrated system or access to specialty care.

Yet, screening advocates stress the importance of taking that first step.

"It’s important for health care providers to ask about drinking, because it plays a huge role in many physical and mental health problems," Dr. Partida Corona said. "And obviously, treatment for them will be very different if alcohol is playing a significant role."

Dr. Nichols, Dr. Allen, and Dr. Partida Corona reported no conflicts of interest.