Primary care physicians' views on screening and management of alcohol abuse - Inconsistencies with national guidelines

BACKGROUND. The effects of patients' abuse of and dependence on alcohol are well known, but screening for problem drinking by primary care physicians has been limited. The National Institute of Alcohol Abuse and Alcoholism (N IAAA) recommends that all patients be screened for alcohol use, all users b e screened with the CAGE questionnaire, and all nondependent problem drinke rs be counseled. We evaluated primary care physicians' screening methods fo r alcohol use and their management of problem drinkers to determine if they were following the NIAAA guidelines. METHODS. We mailed a questionnaire to 210 internists and family physicians to assess their alcohol screening and management methods. RESULTS. Only 64.9% of the respondents reported screening 80% to 100% of th eir patients for alcohol abuse or dependence during the initial visit; even less (34.4%) screened that many patients during an annual visit. Nearly al l respondents (95%) reported "frequently" or "always" using quantity-freque ncy questions to screen for alcohol abuse, but only 35% "frequently" or "al ways" used the CAGE questionnaire. Only 20% of the respondents rated treatm ent resources as adequate for early problem drinkers, and 72% preferred not to counsel these patients themselves. A belief that a primary care physici an could have a positive impact on an alcohol abuser was less likely to be held by respondents who were older, in a nonurban setting, or had more year s in practice (P = .05). CONCLUSIONS. A substantial proportion of the physicians in our survey sampl e were not following NIAAA recommendations. Most physicians preferred not t o do the counseling of nondependent problem drinkers themselves, but to ref er those patients to a nurse trained in behavioral interventions.