The medical profile of unidentified problem drinkers in general practice: test of an hypothesis

In order to facilitate general practitioner (GP) detection of problem drinkers the Dutch College of General Practitioners developed a standard specifying the differences in medical profile between problem drinker and non-problem drinkers. The standard mentions 35 Reasons for Encounter (RFEs) and GP Evaluations (Es) that are thought to be specific for problem drinkers. The studies referred to in the standard base their conclusions about differences in medical profile upon a comparison of problem drinkers already identified by the GP with other patients. This study tests the hypothesis that the medical profile specified by the standard also applies to unidentified problem drinkers. All known problem drinkers in the practices of 16 GPs, as well as a one in 10 random sample of patients considered to be non-drinkers were admitted to the study at their first surgery visit during a 1-year period. Hidden problem drinkers were detected by means of a screening questionnaire, although the results were not conveyed to the GP until the study was completed. Over the 1-year study period the GPs then registered all RFEs and Es of the study population. RFE and E sum scores were then constructed based on the Alcohol Standard. The estimated population prevalence of problem drinking, corrected for the one in 10 sample fraction was 7%. We found 6% problem drinkers (n = 78) in the category regarded by the GPs as non-problem drinkers (n = 1254). Differences in RFEs and Es between hidden problem drinkers and those regarded as non-problem drinkers were significant for irregular heartbeat and psychological problems. Sexual problems were significant at the RFE level, social problems at the E level. When identified problem drinkers are compared with non-problem drinkers more differences in the medical profile are found (four times both RFE and E; twice RFE and once E). We conclude that most of the published differences in the medical profile between problem drinkers and other GP patients are not found for unidentified problem drinkers. The observed differences between unidentified problem drinkers and non-problem drinkers are too small to be helpful to the GP to detect problem drinkers.