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Primary and secondary prevention of alcohol problems

U.S. internist attitudes and practices

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Abstract

OBJECTIVE: To describe internists’ involvement in primary and secondary prevention of alcohol-related problems, and to evaluate relationships between preventive practices and training, attitudes, and work patterns.

DESIGN: Cross-sectional survey.

PARTICIPANTS: A random sample of 152 board-certified internists, ≤65 years old, who practiced primary care in the continental United States, was selected from the American Medical Association’s master list. Ten were ineligible; 99 (70%) of the remaining 142 internists completed questionnaires.

MAIN OUTCOME MEASURES: The authors evaluated the internists’ preventive practices, including the frequency with which they assessed patients’ alcohol consumption and advised patients about safe levels of alcohol consumption. The authors also evaluated the internists’ opinions about safe levels of alcohol consumption, training and attitudes regarding advising patients about safe levels of consumption, and work patterns.

RESULTS: Ninety-four percent of the respondents believed they had a responsibility to advise all patients about safe levels of alcohol consumption (primary prevention), though only 30% often/always did so. Eighty percent often/always advised patients who drank three or more drinks daily about safe levels of alcohol consumption (secondary prevention), but many (45%) did not routinely ask patients how much they drank daily. Preventive practices correlated positively with the number of hours/week internists practiced primary care, and with their belief in the effectiveness of preventive advice about alcohol consumption.

CONCLUSIONS: Internists believe they have a responsibility for primary prevention of alcohol-related problems, but only a minority actively practice it. In contrast, many internists practice secondary prevention, offering advice about safe alcohol consumption to patients who drink three or more drinks daily. The effectiveness of such secondary prevention is limited, however, by incomplete screening regarding level of alcohol consumption.

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References

  1. Barnes HN, Aronson MD, Delbanco TL. Alcoholism—A Guide for the Primary Care Physician. New York: Springer-Verlag. 1987:1–231.

    Google Scholar 

  2. Buchsbaum DG, Buchanan RG, Centor RM, Schnoll SH, Lawton MJ. Screening for alcohol abuse using CAGE scores and likelihood ratios. Ann Intern Med. 1991;115:774–7.

    PubMed  CAS  Google Scholar 

  3. Delbanco TL. Patients who drink too much. Where are their doctors? JAMA. 1992;267:702–3.

    Article  PubMed  CAS  Google Scholar 

  4. Geller G, Levine DM, Mamon JA, Moore RD. Bone LR, Stokes EJ. Knowledge, attitudes, and reported practices of medical students and house staff regarding the diagnosis and treatment of alcoholism. JAMA. 1989;261:3115–20.

    Article  PubMed  CAS  Google Scholar 

  5. Lundberg GD. Ethyl alcohol—ancient plague and modern poison. JAMA. 1984;252:1911–2.

    Article  PubMed  CAS  Google Scholar 

  6. Morse RM, Flavin DK. for the Joint Committee of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine to Study the Definition and Criteria for the Diagnosis of Alcoholism. The definition of alcoholism. JAMA. 1992;268:1012–4.

    Article  PubMed  CAS  Google Scholar 

  7. Moore RD, Malitz FE. Underdiagnosis of alcoholism by residents in an ambulatory medical practice. J Med Educ. 1986;61:46–52.

    PubMed  CAS  Google Scholar 

  8. Moore RD, Bone LR, Geller G, Mamon JA, Stokes EJ, Levine DM. Prevalence, detection, and treatment of alcoholism in hospitalized patients. JAMA. 1989;261:403–7.

    Article  PubMed  CAS  Google Scholar 

  9. Niven RG. Alcoholism—a problem in perspective. JAMA. 1984;252:1912–4.

    Article  PubMed  CAS  Google Scholar 

  10. Warburg MW, Cleary PD, Rohman M, Barnes H, Aronson M, Delbanco TL. Residents’ attitudes, knowledge, and behavior regarding diagnosis and treatment of alcoholism. J Med Educ. 1987;62:497–503.

    PubMed  CAS  Google Scholar 

  11. Bradley KA. Screening and diagnosis of alcoholism in the primary care setting. West J Med. 1992;156:166–71.

    PubMed  CAS  Google Scholar 

  12. Bradley KA. Management of alcoholism in the primary care setting. West J Med. 1992;156:273–7.

    PubMed  CAS  Google Scholar 

  13. Institute of Medicine. The community role: identification, brief intervention, and referral. In: Broadening the Base of Treatment for Alcohol Problems: A Report of the Committee for the Study of Treatment and Rehabilitation for Alcoholism. Washington, DC: National Academy Press. 1990;211–41.

    Google Scholar 

  14. National Institute on Alcohol Abuse and Alcoholism. Moderate drinking. Bethesda, MD: U.S. Department of Health and Human Services. Public Health Service, April 1992, Alcohol Alert No. 16 PH 315.

    Google Scholar 

  15. U.S. Preventive Services Task Force. Guide to Clinical Preventive Services: An Assessment of the Effectiveness of 169 Interventions. Baltimore: Williams and Wilkins. 1989;277–88.

    Google Scholar 

  16. Wells KB, Lewis CE, Leake B, Ware JE Jr. Do physicians preach what they practice? JAMA. 1984;252:2846–8.

    Article  PubMed  CAS  Google Scholar 

  17. Skinner HA. Spectrum of drinkers and intervention strategies. Can Med Assoc J. 1990;143:1054–9.

    CAS  Google Scholar 

  18. Kendell RE. Drinking sensibly. Br J Addict. 1987;82:1279–88.

    Article  PubMed  CAS  Google Scholar 

  19. Saunders JB, Aasland OG, Amundsen A, Grant M. Alcohol consumption and related problems among primary health care patients: WHO Collaborative Project on Early Detection of Harmful Alcohol Consumption—I. Addiction. 1993;88:349–62.

    Article  PubMed  CAS  Google Scholar 

  20. Bradley KA, Donovan DM, Larson EB. How much is too much? Advising patients about safe levels of alcohol consumption. Arch Intern Med. 1993;153:2734–40.

    Article  PubMed  CAS  Google Scholar 

  21. Friedman HS. Alcohol and Hypertension. Alcohol Health Res World. 1990;14:313–9.

    Google Scholar 

  22. Klatsky AL, Friedman G, Siegelaub AB. Alcohol consumption and blood pressure. N Engl J Med. 1977;296:1194–200.

    Article  PubMed  CAS  Google Scholar 

  23. Pequignot G, Tuyns AJ, Berta JL. Ascitic cirrhosis in relation to alcohol consumption. Int J Epidemiol. 1978;7:113–20.

    Article  PubMed  CAS  Google Scholar 

  24. Ashley MJ, Olin JS, leRiche H, Kornaczewski A, Schmidt W, Rankin JG. Morbidity in alcoholics. Arch Intern Med. 1977;137:883–7.

    Article  PubMed  CAS  Google Scholar 

  25. Tuyns AJ, Pequignot G. Greater risk of cirrhosis in females in relation to alcohol consumption. Int J Epidemiol. 1984;13:53–7.

    Article  PubMed  CAS  Google Scholar 

  26. Saunders JB, Aasland OG. WHO Collaborative Project on Identification and Treatment of Persons with Harmful Alcohol Consumption: Report on Phase I—Development of a Screening Instrument. Geneva: World Health Organization. Division of Mental Health. 1987. WHO/MNH/DAT/86.3.

    Google Scholar 

  27. Babor TF, Kranzler HR, Lauerman RJ. Social drinking as a health and psychosocial risk factor. Anstie’s limit revisited. In: Parades A (ed). Early Problem Drinking. New York: Plenum Press. 1987;373–402.

    Google Scholar 

  28. Wechsler H, Isaac N. Binge drinkers at Massachusetts colleges. JAMA. 1992;267:2929–31.

    Article  PubMed  CAS  Google Scholar 

  29. Surgeon General. Surgeon General’s Report on Nutrition and Health. Bethesda, MD: U.S. Department of Health and Human Services (Public Health Service). 1988. Publication No. 88-50210.

    Google Scholar 

  30. Anderson P, Scott E. The effect of general practitioners’ advice to heavy drinking men. Br J Addict. 1992;87:891–900.

    Article  PubMed  CAS  Google Scholar 

  31. Bien TH, Miller WR, Tonigan S. Brief interventions for alcohol problems: a review. Addiction. 1993;88:315–36.

    Article  PubMed  CAS  Google Scholar 

  32. Kristenson H, Ohlin H, Hulten-Nosslin M, Trell E, Hood B. Identification and intervention of heavy drinking in middle-aged men: results and follow-up of 24–60 months of long-term study with randomized controls. Alcohol Clin Exp Res. 1983;7:203–9.

    PubMed  CAS  Google Scholar 

  33. Maheswaran R, Beevers M, Beevers DG. Effectiveness of advice to reduce alcohol consumption in hypertensive patients. Hypertension. 1992;19:79–84.

    PubMed  CAS  Google Scholar 

  34. Nilssen O. The Tromso study: identification of and a controlled intervention on a population of early-stage risk drinkers. Prev Med. 1991;20:518–28.

    Article  PubMed  CAS  Google Scholar 

  35. Wallace P, Cutler S, Haines A. Randomised controlled trial of general practitioner intervention in patients with excessive alcohol consumption. BMJ. 1988;297:663–8.

    Article  PubMed  CAS  Google Scholar 

  36. Rohman ME, Cleary PD, Warburg M, Delbanco T, Aronson MD. The response of primary care physicians to problem drinkers. Am J Drug Alcohol Abuse. 1987;13:199–209.

    PubMed  CAS  Google Scholar 

  37. Lewis CE, Clancy C, Leake B, Schwartz JS. The counseling practices of internists. Ann Intern Med. 1991;114:54–8.

    PubMed  CAS  Google Scholar 

  38. Rosner B. Fundamentals of Biostatistics. Boston: PWS-Kent Publishing. 1990;655.

    Google Scholar 

  39. Wechsler H, Levine S, Idelson RK, Rohman M, Taylor JO. The physician’s role in health promotion—a survey of primary care practitioners. N Engl J Med. 1983;308:97–100.

    Article  PubMed  CAS  Google Scholar 

  40. Valente CM, Sobal J, Muncie HL, Levine DM, Antlitz AM. Health promotion: physicians beliefs, attitudes, and practices. Am J Prev Med. 1986;2:82–8.

    PubMed  CAS  Google Scholar 

  41. Kamerow D, Pincus H, Macdonald D. Alcohol abuse, other drug abuse, and mental disorders in medical practice: prevalence, costs, recognition, and treatment. JAMA. 1986;255:2054–7.

    Article  PubMed  CAS  Google Scholar 

  42. Linn LS, Yager J. Factors associated with physician recognition and treatment of alcoholism. West J Med. 1989;150:468–72.

    PubMed  CAS  Google Scholar 

  43. Schorling JB, Klas PT, Willems JP, Everett AS. Addressing alcohol use among primary care patients: differences between family medicine and internal medicine residents. J Gen Intern Med. 1994;9:248–54.

    Article  PubMed  CAS  Google Scholar 

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Supported by National Research Service Award Grant #5T32PE10002-04 and an HSR&D fellowship award from the Department of Veterans Affairs.

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Bradley, K.A., Curry, S.J., Koepsell, T.D. et al. Primary and secondary prevention of alcohol problems. J Gen Intern Med 10, 67–72 (1995). https://doi.org/10.1007/BF02600228

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