THE MEDICAL PROFILE OF UNIDENTIFIED PROBLEM DRINKERS IN GENERAL-PRACTICE - TEST OF AN HYPOTHESIS

In order to facilitate general practitioner (GP) detection of problem drinkers the Dutch College of General Practitioners developed a standa rd specifying the differences in medical profile between problem drink er and non-problem drinkers. The standard mentions 35 Reasons for Enco unter (RFEs) and GP Evaluations (Es) that are thought to be specific f or problem drinkers. The studies referred to in the standard base thei r conclusions about differences in medical profile upon a comparison o f problem drinkers already identified by the GP with other patients. T his study tests the hypothesis that the medical profile specified by t he standard also applies to unidentified problem drinkers. All known p roblem drinkers in the practices of 16 Gps, as well as a one in 10 ran dom sample of patients considered to be non-drinkers were admitted to the study at their first surgery visit during a 1-year period. Hidden problem drinkers were detected by means of a screening questionnaire, although the results were not conveyed to the GP until the study was c ompleted. Over the 1-year study period the GPs then registered all RFE s and Es of the study population. RFE and E sum scores were then const ructed based on the Alcohol Standard. The estimated population prevale nce of problem drinking, corrected for the one in 10 sample fraction w as 7%. We found 6% problem drinkers (n = 78) in the category regarded by the GPs as non-problem drinkers (n = 1254). Differences in RFEs and Es between hidden problem drinkers and those regarded as non-problem drinkers were significant for irregular heartbeat and psychological pr oblems. Sexual problems were significant at the RFE level, social prob lems at the E level. When identified problem drinkers are compared wit h non-problem drinkers more differences in the medical profile are fou nd (four times both RFE and E; twice RFE and once E). We conclude that most of the published differences in the medical profile between prob lem drinkers and other GP patients are not found for unidentified prob lem drinkers. The observed differences between unidentified problem dr inkers and non-problem drinkers are too small to be helpful to the GP to detect problem drinkers.