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  Treating Alcohol Problems Early

People don't develop alcohol problems overnight. But like diabetes, heart disease and other chronic illnesses, there are many opportunities to prevent and treat, or intervene, at an early stage. The federal government recommends that all patients be screened for alcohol problems during routine health exams, before they are prescribed medications that interact with alcohol and when they are diagnosed with illnesses such as hypertension, depression and sleep disorders that are frequently associated with alcohol use.

  • If detected, alcohol problems can be effectively treated in ways that are less costly and prevent more serious illness. If it is not detected, alcohol-related problems and health effects can lead to very serious illnesses. For more on treatment of alcohol-related problems at later stages, see the Ensuring Solutions fact sheet What Is Alcohol Treatment And How Does It Work?
  • Voluntary screenings and brief interventions are effective strategies for treating some alcohol problems.
  • Physicians routinely measure a patient's blood pressure to diagnose hypertension but less than one in three carefully screen their patients for alcohol problems.

Why Don't More Physicians Conduct Clinically-proven Screenings and Brief Interventions?

  • Insurance reimbursement issues are one concern, particularly in emergency rooms and trauma centers, where insurance companies can deny coverage for injuries caused by alcohol impairment in 42 states and the District of Columbia.
  • Some physicians and health care workers doubt the effectiveness of alcohol screening and brief intervention. Others assume that the process is too difficult and time consuming, that they aren't qualified, or that their patients will react badly.
  • Simple screening tests (www.alcoholscreening.org), questionnaires and laboratory tests have been clinically-proven effective as methods to discern alcohol problems in patients.

Doctor's Office Effective for Screening and Brief Interventions

  • Seventy percent of Americans – 191 million people – visit a primary care physician at least once every two years.
  • One in five men and one in ten women seen by primary care physicians drink at levels that put them at risk for alcohol-related problems, including alcoholism.
  • Patients trust their health care providers and are more likely to take seriously advice about their use of alcohol when it is given during visits to their doctors' offices.

Brief Interventions Are Effective, Inexpensive

  • Patients with alcohol problems typically appreciate health care providers who express concern about their drinking, and cooperate in the brief intervention process.
  • Brief interventions at the doctor's office – an initial counseling session lasting five to 20 minutes and one or more follow-up sessions – can help problem drinkers reduce their alcohol consumption and health care utilization.
  • Brief interventions can be successful outside of the doctor's office. For emergency department and trauma center patients, identification of alcohol as a factor in their injury (either through objective tests such as blood alcohol level or screening questionnaire) along with a motivational interview upon discharge have been shown to reduce subsequent drinking and cut emergency department admissions six months later.
  • Adolescent and older populations are responsive to brief interventions.
  • Brief interventions are not designed to treat alcoholism, which requires greater expertise and more intensive case management, but they may be helpful in motivating alcoholic patients to engage in more intensive and long term treatment.

Brief Interventions Are Useful in Busy Health Care Practices

  • In a brief intervention, the health provider expresses medical concern about a patient's drinking; advises the patient to cut down his or her drinking, or in the case of a person with alcoholism, to stop drinking
  • Primary care physicians or nursing staff can conduct brief interventions in the course of five or fewer standard office visits.
  • Only five to 20 percent of patients who are screened require brief intervention.
  • If more physicians were to treat alcoholism as a chronic disease, there would be greater opportunity for early intervention among problem drinkers and better outcomes for people with alcoholism. This, in turn, would foster a public health approach that would go a long way towards reducing the stigma that prevents so many people with alcohol problems from seeking help.

Sources: U.S. Department of Health and Human Services, National Institute on Alcohol Abuse and Alcoholism, “10th Special Report to the U.S. Congress on Alcohol and Health: Highlights from Current Research,” June 2000.

U.S. Department of Health and Human Services, National Institute on Alcohol Abuse and Alcoholism, Alcohol Alert No. 49 , “New Advances in Alcoholism Treatment,” October 2000.

Babor, T & Higgins-Biddle, J, “Brief Intervention for Hazardous and Harmful Drinking: A Manual for Use in Primary Care,” World Health Organization, 2001.

Watkins, K, Pincus, H, & Tanielian, T, “Evidence Based Care Models for Recognizing and Treating Alcohol Problems in Primary Care Settings,” RAND Health, 2001.

CASA, “Missed Opportunity: National Survey of Primary Care Physicians and Patients on Substance Abuse,” The Survey Research Laboratory, University of Illinois at Chicago, May 2000.

December 2002