Healthcare System Can Catch Alcohol Problems Earlier

In order to curtail the enormous cost to society for alcohol abuse and related problems, workers in the regular healthcare system need to screen for alcohol problems in their patients before it takes a severe toll.

Most people with alcohol disorders never seek specialized alcoholism treatment, but they are seen in regular healthcare or social services settings. However, alcohol problems are often undiagnosed or ignored in the normal healthcare system, leaving the problems to progress to a crisis level.

At the June 2005 annual meeting of the Research Society of Alcoholism in Santa Barbara, California, participants discussed the need for alcohol problems to be addressed during routine healthcare.

"Alcohol problems are really common, roughly one in every 10 or 11 people drink too much, and the consequences cost us all," said William R. Miller, Distinguished Professor of psychology and psychiatry at the University of New Mexico, and chair of the discussion. "You have about a 40 percent chance of being in an alcohol-related vehicular crash, anywhere from a fender-bender to a fatal crash, at least once in your lifetime.

"For every dollar spent to purchase alcoholic beverages, Americans incur about two dollars in social and health care costs. Averaged across the population, that's about $1000 per year for every U.S. adult, whether or not they themselves drink. For those who are directly affected by their own problem drinking or that of a family member, the costs are much higher."

According to a Alcoholism: Clinical & Experimental Research report, key points discussed at the annual meeting included:

• The rates of adoption of alcohol screening and brief intervention strategies for heavy drinkers within primary-care settings remain low.

• Screening and brief interventions within a health-care setting can be especially effective for individuals who have low-to-moderate alcohol problems.

• When choosing an intervention model, programs and providers should ensure that patient confidentiality is protected, whether or not the particular components chosen are covered by federal legislation.

• With the recent approval of a third medication (acamprosate) by the Federal Drug Administration (in addition to disulfiram and naltrexone), pharmacotherapies for alcoholism may soon become part of mainstream medical practice.

• Trauma centers can provide an excellent opportunity for alcohol-disorder screening and intervention.

• "Telehealth" (interactive audio-video) and telephone (interactive audio) sessions can serve as successful long-distance delivery modes for motivational interviewing, especially for rural populations.

• The development of effective brief interventions for addictive disorders is an essential step toward improving public health, but it must be followed by the distribution and adoption of these interventions.

"Most people who drink too much don't think of themselves as having 'a problem,' let alone being an 'alcoholic,'" said Miller. "They are therefore unlikely to seek specialist treatment unless required to do so by family or the courts. Consequently, people do not usually enter specialist treatment or even A.A. until their alcohol problems and dependence have become quite serious.

"They do, however, tend to see a physician at least once a year. Accordingly, healthcare providers have the best opportunity to screen for and address heavy drinking before it takes a severe toll on the person and their family."

Opportunity to Reduce Risks

"About half of the injuries severe enough to require admission to a Level One trauma center are somehow related to drinking," said Miller. "What many people do not realize is that those who are admitted once with alcohol-related traumatic injuries are at high risk to be injured again. The short time spent in a trauma center thus provides a unique opportunity to help people reduce their risk of future traumatic injury."

"Screening sounds more complicated than it is," said Miller, "it's just asking a few simple questions as part of healthcare visits. When there is indication of heavy or problem drinking, there are some brief counseling procedures that a physician or nurse can provide, as well as referral to specialist services as needed. Through simple screening and brief counseling methods, healthcare professionals can make a substantial difference in their patients' health."

Drinking Is a Health Issue

"Thinking has changed over the years," said Miller, "in that many people [now] regard drinking as a health issue much like smoking, diet and exercise.

"There are also effective procedures that can be used within the time constraints of primary health care and family practice, and people are much more willing to talk to their doctor about their drinking than to go off to a specialist treatment program."

Source: Proceedings from the June 2005 annual meeting of the Research Society of Alcoholism are published in the February 2006 issue of Alcoholism: Clinical & Experimental Research.