New Screening/Counseling System Identifies Problem Drinkers, Results
in Major Reductions in Alcohol Consumption
A study of more than 15,000 patients by Thomas Jefferson University
and the Addiction Research Foundation of Ontario shows a superior way for
primary care physicians and nurses to screen for and counsel patients who
abuse alcohol. A paper describing the system appears in the November 15,
1996 issue of Alcoholism: Clinical and Experimental Research.
"Now, Dr. Israel, a pioneer in research on alcohol and
trauma, provides an efficient, nonthreatening means to accomplish both [early
identification/intervention and reducing costs-a means that is tailored
to both today's healthcare structure and that age-old adversary, patient
Since other studies had shown a strong link between alcohol abuse and traumatic
injury, in this new study, 42 primary care physician-nurse teams asked their
patients about previous trauma. The questions, which were simple and made
no mention of alcohol, were printed on questionnaires and given to patients
in waiting areas:
Dr. Enoch Gordis, Director the National Institute on Alcohol
Abuse and Alcoholism
Patients who answered yes to two or more of the questions above were asked
about their alcohol consumption and about alcohol-related problems. The
physicians were able to fully identify 70 percent of the expected number
of problem drinkers in the community.
- Have you had any fractures or dislocations to your bones or joints?
- Have you been injured in a road traffic accident?
- Have you injured your head?
- Have you been in a fight or assault?
"These patients had experienced alcohol-related problems for an average
of seven years, and more than 90 percent had never received counseling of
any type," said Yedy Israel, PhD, lead author of the study and Professor
of Pathology, Anatomy and Cell Biology at Jefferson. "The patients
were then referred for a lifestyle intervention given by a nurse. Such intervention,
rather than traditional alcoholism treatment, was important both to physicians
and to patients."
At one year, patients who received counseling with a nurse had reduced their
alcohol consumption by 70 percent. Psychosocial problems were reduced by
85 percent and a blood test that indicates liver abnormalities (gammaglutamyl
transferase) was reduced by an average of 32 to 58 percent. Not only did
patients feel better and drink less, they also reduced by 35 percent the
number of visits to their physicians. By contrast, patients who received
simple advice to quit or to reduce their alcohol consumption showed a 40
percent lower consumption. However, they did not show reductions in psychosocial
problems, liver test abnormalities or the number of visits to physicians.
"Generalized use of this simple screening and lifestyle counseling
system could reduce alcohol problems, abuse and dependence by a half million
persons per year in the United States," Dr. Israel explained.