Prevalence and recognition of alcohol abuse in a primary care population

The purpose of this study was to assess the prevalence, physician recognition, and treatment of alcohol abuse among patients of 19 senior medical residents practicing in a hospital-based, primary care setting.

Interviews of 242 outpatients were conducted, and alcohol abuse and dependence, as defined by the Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III), were determined using the Diagnostic Interview Schedule.

Twenty percent of the patients studied had abused or were dependent on alcohol at some time in their lives and 5 percent reported abuse or dependence within the last year. Of the techniques studied, a short screening questionnaire (Short Michigan Alcohol Screening Test [SMAST]) was the most accurate way of identifying patients who abused alcohol, and physician assessments were more accurate than laboratory tests. Although the physicians were aware of serious alcohol problems among 77 percent of their patients who met DSM-III criteria for alcohol abuse or dependence in the previous year, they identified only 36 percent of their patients with less serious problems or past alcohol abuse. They had only discussed alcohol abuse with 67 percent of the patients they identified as alcohol abusers.

We conclude that a short screening questionnaire (SMAST) is an accurate means of identifying alcohol abuse. Despite the recognition of serious alcohol problems by the physicians, the problem is not addressed routinely even among patients that are recognized as alcoholic.