Skip to main content
SpringerLink
Log in

Physician detection of drinking problems in patients attending a general medicine practice

  • Original Articles
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

Objective:To assess the patient and physician characteristics that influence physicians’ detection of problem drinking in their medical patients.

Setting:The outpatient medical clinic at an urban university teaching hospital staffed by interns and residents.

Design:Cross-sectional study of a rendomly chosen subsample of consecutive patients.

Measurement:Univariate and multivariate analysis with calculated adjusted odds ratios of factors associated with physician detection of drinking problems. A problem was diagnosed according to the patient’s results on the alcohol module of the Diagnostic Interview Schedule (DIS).

Results:Physicians detected 22% of 189 presumably inactive problems and 49% of 92 current problems, i.e., those that have occurred within the preceding year. Multivariate correlates of detection of active problems included male patient gender, presence of gastrointestinal complications of excessive drinking, number of concurrent medical disorders, and previous medical record reference to alcohol (p<0.05). Physician gender and year of training were not associated with detection.

Conclusion:Our physicians appear to rely on specific patient characteristics as well as the patient’s medical record to detect drinking problems in their ambulatory patients. Their reliance upon these factors may hinder their detection of drinking problems in women patients and less seriously impaired individuals.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Cleary PD, Miller M, Bush BT, Warburg MM, Delbanco TL, Aronson MD. Prevalence and recognition of alcohol abuse in a primary care population. Am J Med. 1988;85:466–71.

    Article  PubMed  CAS  Google Scholar 

  2. Coulehan JL, Zettler-Segal M, Block M, McClelland M, Schulberg HC. Recognition of alcoholism and substance abuse in primary care patients. Arch Intern Med. 1987;147:349–52.

    Article  PubMed  CAS  Google Scholar 

  3. Buchsbaum DG, Buchanan RG, Lawton MJ, Schnoll SH. Alcohol consumption patterns in a primary care population. Alcohol Alcohol. 1991;26:215–20.

    PubMed  CAS  Google Scholar 

  4. The pattern and range of services for problem drinkers. Report by the Advisory Committee on Alcoholism. London: Department of Health and Social Services, 1978.

    Google Scholar 

  5. Drummond DC, Thom B, Brown C, Edwards G, Mullan MJ. Specialist versus general practitioner treatment of problem drinkers. Lancet. 1990;336:915–8.

    Article  PubMed  CAS  Google Scholar 

  6. Edwards G, Orgord J, Egert S, et al. Alcoholism: a controlled trial of “treatment” and “advice”. J Stud Alcohol. 1977;38:1004–31.

    PubMed  CAS  Google Scholar 

  7. Chick J, Ritson B, Connaughton J, Stewart A, Shick J. Advice versus extended treatment for alcoholism: a controlled study. Br J Addict. 1988;83:159–70.

    Article  PubMed  CAS  Google Scholar 

  8. Moore RD, Bone LR, Geller G, Mamon JA, Stokes EJ, Levine DM. Prevalence, detection, and treatment of alcoholism in hospitalized patients. JAMA. 1989;261:403–7.

    Article  PubMed  CAS  Google Scholar 

  9. Kamerow DB, Pincus HA, Macdonald DI. Alcohol abuse, other drug abuse and mental disorders in medical practice. JAMA. 1986;255:2054–7.

    Article  PubMed  CAS  Google Scholar 

  10. Lewis DC, Niven MD, Dorynne C, Trumble JG. A review of medical education in alcohol and other drug abuse. JAMA. 1987;257:2945–8.

    Article  PubMed  CAS  Google Scholar 

  11. Robins LN, Helzer JE, Croughan J, Ratcliff KS. National Institute of Mental Health Diagnostic Interview Schedule. Arch Gen Psychiatry. 1981;38:381–9.

    PubMed  CAS  Google Scholar 

  12. Helzer JE, Burnam A. Alcohol abuse and dependence. In: Robins LN, Regier DA (eds). Psychiatric disorders in America. New York: Free Press, 1989.

    Google Scholar 

  13. Midanik L. The validity of self-reported alcohol consumption and alcohol problems: a literature review. Br J Addict. 1982;77:357–82.

    Article  PubMed  CAS  Google Scholar 

  14. Lee DJ, DeFrank RS. Interrelationships among self-reported alcohol intake, physiological indices and alcoholism screening measures. J Stud Alcohol. 1988;49:532–7.

    PubMed  CAS  Google Scholar 

  15. American Psychiatric Association, Committee on Nomenclature and Statistics. Diagnostic and statistical manual of mental disorders. Revised 3rd ed. Washington, DC: American Psychiatric Association, 1987.

    Google Scholar 

  16. Chick J, Lloyd G, Crombie E. Counseling problem drinkers in medical wards: a controlled study. Br Med J. 1985;295:965–7.

    Google Scholar 

  17. Sanchez-Craig M, Leigh G, Spivak K, Lei H. Superior outcome of females over males after brief treatment for the reduction of heavy drinking. Br J Addict. 1989;83:395–404.

    Article  Google Scholar 

  18. Buchsbaum D, Buchanan R, Centor R, Schnoll S, Lawton M. Screening for alcohol abuse using CAGE scores and likelyhood ratios. Ann Intern Med. 1991;115:774–7.

    PubMed  CAS  Google Scholar 

  19. Edwards G, et al. Long term outcome for patients with drinking problems: the search for predictors. Br J Addict. 1988;83:917–27.

    Article  PubMed  CAS  Google Scholar 

  20. Babor TF, Ritson EB, Hodgson RJ. Alcohol-related problems in the primary health care setting: a review of early intervention strategies. Br J Addict. 1986;81:23–46.

    Article  PubMed  CAS  Google Scholar 

  21. Antti-Poika I, Karaharju E, Roine R, Salaspuro M. Intervention of heavy drinking: a prospective and controlled study of 438 consecutive injured male patients. Alcohol Alcohol. 1988;23:115–21.

    PubMed  CAS  Google Scholar 

  22. Heather N. Psychology and brief interventions. Br J Addict. 1989;357–70.

  23. Skinner HA, Holt S. Early intervention for alcohol problems. J R Coll Practit. 1983;33:787–91.

    CAS  Google Scholar 

  24. Wallace P, Cutler S, Haines A. Randomised controlled trial of general practitioner intervention in patients with excessive alcohol consumption. Br Med J. 1988;297:663–8.

    CAS  Google Scholar 

  25. Awad I, Wattis JP. Alcohol histories in hospital: does the age and sex of the patient make a difference? Br J Addict. 1990;85:149–51.

    Article  PubMed  CAS  Google Scholar 

  26. Vaillant GE. The Natural history of alcoholism. Cambridge, MA: Harvard University Press, 1983.

    Google Scholar 

  27. Wilsnack RW, Cheloha R. Woman’s roles and problem drinking across the lifespan. Social Problems. 1987;34:231–48.

    Google Scholar 

  28. Wilsnack SC. Drinking and drinking problems in women: a U.S. longitudinal survey and some implications for prevention. In: Loberg T, Miller WR, Nathan PE, Marlatt G (eds). Addictive behaviors: prevention and early intervention. Amsterdam, The Netherlands: Swets an Zeitlinger, 1987;1–39.

    Google Scholar 

  29. Marlatt GA. Cognitive factors in the relapse process. In: Marlatt GA, Gordon JR (eds). Relapse prevention: maintenance strategies in addictive behavior change. New York: Guilford Press, 1985.

    Google Scholar 

  30. Screening for alcoholism in primary care settings. Report of a workshop held in Bethesda, MD. U.S. Department of Health and Human Services, 1987.

  31. Beresford TP, Blow FC, Brower KJ, Singer K. Clinical applications: screening for alcoholism. Prev Med. 1988;17:653–63.

    Article  PubMed  CAS  Google Scholar 

  32. Skinner HA, Allen BA, McIntosh MC, Palmer WH. Lifestyle assessment: just asking makes a difference. Br Med J. 1985;290:214–6.

    Article  CAS  Google Scholar 

  33. Cyr MG, Wartman SA. The effectiveness of routine screening questions in the detection of alcoholism. JAMA 1988;259:51–4.

    Article  PubMed  CAS  Google Scholar 

  34. Magruder-Habib K, Zung W, Feussner J. Improving physicians’ recognition and treatment of depression in general medical care. Med Care. 1990;28:239–50.

    Article  PubMed  CAS  Google Scholar 

  35. Pokorny AD, Miller BA, Kaplan HB. The brief MAST: a shortened version of the Michigan Alcoholism Screening Test. Am J Psychiatry. 1972;129:118–21.

    Google Scholar 

  36. Geller G, Levine DM, Mamon JA, Moore RD, Bone LR, Stokes EJ. Knowledge, attitudes, and reported practices of medical students and house staff regarding the diagnosis and treatment of alcoholism. JAMA. 1989;261:3115–20.

    Article  PubMed  CAS  Google Scholar 

  37. Galanter M, Blume S, Bissell, L. Physicians in alcoholism: a study of current status and future needs. Alcoholism. 1983;7:389–92.

    PubMed  CAS  Google Scholar 

  38. Buchsbaum DG, Clancy CM, Centor RM, Buchanan RG. House officer attitudes, beliefs, and recording behavior associated with prescribing minor tranquilizers. Teaching and Learning in Med. 1990;2:30–3.

    Article  Google Scholar 

  39. Clement S. The identification of alcohol-related problems by general practitioners. Br J Addict. 1986;81:257–64.

    Article  PubMed  CAS  Google Scholar 

  40. Linn LS, Yager J. Factors associated with physician recognition and treatment of alcoholism. West J Med. 1989;150:468–72.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. the Department of Internal Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia

    David G. Buchsbaum MD, MSHA, Robin G. Buchanan, Roy M. Poses MD & Sidney H. Schnoll MD, PhD

  2. the Department of Psychiatry, Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia

    Sidney H. Schnoll MD, PhD

  3. the Alcohol and Drug Education/Rehabilitation Program (MJL), Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia

    Marcia J. Lawton PhD

Authors
  1. David G. Buchsbaum MD, MSHA
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robin G. Buchanan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Roy M. Poses MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sidney H. Schnoll MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marcia J. Lawton PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Supported in part by Commonwealth Center on Drug Abuse Faculty Grant Program and Bureau of Health Professions, HRSA Grant for Residency Training in General Internal Medicine.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Buchsbaum, D.G., Buchanan, R.G., Poses, R.M. et al. Physician detection of drinking problems in patients attending a general medicine practice. J Gen Intern Med 7, 517–521 (1992). https://doi.org/10.1007/BF02599456

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02599456

Key words

Search

Navigation