Differences between hospital patients with alcohol problems referred for counselling by physicians' routine clinical practice versus screening questionnaires

Aims. To test the hypothesis that screening for alcohol-related disorders i n a general hospital with questionnaires generates a target group of patien ts for alcohol counselling which differs from patients referred by physicia ns' routine clinical practice. Design. A prospective study with follow-up a fter 12 months. Setting. Medical and surgical wards of a general hospital. Participants. A sample of 298 patients detected by screening questionnaires (CAGE, MAST) was compared with a sample of 87 patients referred by physici ans. Measurements. The main measurements were a diagnostic interview (SCAN) , two questionnaires to estimate the severity of dependence and the motivat ion to change drinking behaviour (RCQ, LAS), and socio-demographic variable s. Outcome criteria were utilization of remedial programmes, decreases in h azardous and excessive drinking and abstinence rates. Findings and conclusi ons. Patients referred by physicians were move often separated and unemploy ed, were more likely to be alcohol-dependent and to be more severely depend ent, had a higher rate of alcohol-related diseases as reasons for admission , were more often motivated to change drinking behaviour, had a higher part icipation rate in remedial programmes and more often exhibited improvements in drinking behaviour compared with the sample identified by screening que stionnaires. However, there was evidence of improvements in drinking in bot h samples. Data show that while screening reaches a less problematic sample with lower motivation to change, it is a worthwhile activity which extends the spectrum of patients eligible for brief interventions.