Screening and intervention for alcohol problems - A national survey of primary care physicians and psychiatrists

OBJECTIVE: To describe adult primary care physicians' and psychiatrists' ap proach to alcohol screening and treatment, and to identify correlates of mo re optimal practices. DESIGN: Cross-sectional mailed survey. PARTICIPANTS: A national systematic sample of 2,000 physicians practicing g eneral internal medicine, family medicine, obstetrics-gynecology, and psych iatry. MEASUREMENTS: Self-reported frequency of screening new outpatients, and tre atment recommendations in patients with diagnosed alcohol problems, on 5-po int Likert-type scales. MAIN RESULTS: Of the 853 respondent physicians (adjusted response rate, 57% ), 88% usually or always ask new outpatients about alcohol use. When evalua ting patients who drink, 47% regularly inquire about maximum amounts on an occasion, and 13% use formal alcohol screening tools, Only 82% routinely of fer intervention to diagnosed problem drinkers. Psychiatrists had the most optimal practices: more consistent screening and intervention was also asso ciated with greater confidence in alcohol history taking, familiarity with expert guidelines, and less concern that patients will object. CONCLUSIONS: Most primary care physicians and psychiatrists ask patients ab out alcohol use, but fewer use recommended screening protocols or offer for mal treatment. A substantial minority of physicians miss the opportunity to intervene in alcohol problems. Efforts to improve physicians' screening an d intervention for alcohol problems should address their confidence in thei r skills, familiarity with expert recommendations, and beliefs that patient s object to their involvement.