Finding and Treating Alcohol Problems in Primary Care

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The summary below is from the full report titled "Addressing Alcohol Problems in Primary Care: A Cluster Randomized, Controlled Trial of a Systems Intervention. The Screening and Intervention in Primary Care (SIP) Study." It is in the 4 March 2003 issue of Annals of Internal Medicine (volume 138, pages 372-382). The authors are R Saitz, NJ Horton, LM Sullivan, MA Moskowitz, and JH Samet.

What is the problem and what is known about it so far?

Too much alcohol damages health. It can hurt relationships; increase risks for accidents and violence; and cause problems with the liver, brain, and heart. Several standard questions can help identify people who have alcohol problems. They include asking about the following: drinking first thing in the morning, feeling guilty about drinking, feeling a need to cut back on drinking, and feeling that others are criticizing you for drinking too much. Brief advice by doctors can help people cut back or stop drinking if they are drinking too much. Unfortunately, many doctors do not routinely ask patients about their drinking habits and do not give patients who have alcohol problems brief advice about ways to cut back or quit.

Why did the researchers do this particular study?

To determine whether identifying patients with alcohol problems and then giving their doctors advice about how to manage the problems would help patients stop drinking.

Who was studied?

41 faculty and resident (trainee) doctors in an academic primary care clinic and 312 patients with drinking problems who were seeing one of these doctors.

How was the study done?

Patients filled out forms with questions about alcohol use before their primary care clinic visits. Only patients who said they drank more than recommended limits or answered yes to questions about problems with alcohol were studied. Doctors were randomly assigned to either get notes with the positive results of the alcohol screening questions and specific advice for managing patients or to not get notes with results and advice. Results and advice were printed on a sheet of paper that was attached to clinic records just before patients saw their doctors. After the patients visited their doctors, the researchers asked patients whether their doctors had talked to them about drinking problems. Six months later, the researchers called patients and asked about drinking habits during the previous month.

What did the researchers find?

Faculty doctors who got notes, but not resident doctors, tended to discuss alcohol problems and counsel patients more often than did their counterparts who were not prompted. At 6 months, however, only patients of residents who got notes had cut back on drinking. Patients of residents who had gotten notes reported drinking an average of 4 drinks on each day they drank during the previous month compared with 12 drinks on each day for patients of resident doctors who had not gotten notes. Patients of the faculty doctors who had and had not gotten notes reported drinking an average of 6 to 7 drinks per drinking day.

What were the limitations of the study?

The study was done at a single academic site. It was small and had limited ability to find differences between patients of doctors who were and were not prompted. One quarter of the patients did not have the 6-month follow-up phone call. Patients self-reported drinking habits and may have underestimated the amount they drank.

What are the implications of the study?

Notifying primary care doctors of patients' alcohol screening results and giving the doctors specific advice for managing the patients with alcohol problems is feasible. The long-term effectiveness and costs of this strategy for decreasing problem drinking are not yet clear.