Screening for Alcohol Problems in Hospitals: Opportunities Often Missed
Many people admitted to hospitals in the U.S. have alcohol use
disorders that go undetected, according to a new study by scientists
at the National Institute on Alcohol Abuse and Alcoholism (NIAAA),
one of the National Institutes of Health (NIH). The finding, published
in the April 12, 2004 issue of the Archives of Internal Medicine,
underscores a need to screen hospital patients for alcohol problems
and refer patients for further evaluation, intervention, and treatment
"This study indicates that we are missing many opportunities
to identify and treat hospitalized individuals who have alcohol
problems," said NIAAA Director Ting-Kai Li, M.D. "By routinely
screening all hospital patients who report current alcohol use we
could help many individuals avail themselves of the alcohol misuse
therapies from which they might benefit."
The new research builds on a study concluded last year by NIAAA's
Barbara A. Smothers, Ph.D., and Harold T. Yahr, Ph.D. In that study,
the researchers surveyed data from more than 2,000 people who participated
in the 1994 National Hospital Prevalence Study, which assessed alcohol
use disorders among adults admitted to general hospitals in the
United States. Upon admission to hospital, National Hospital Prevalence
Study participants underwent a diagnostic interview to identify
current alcohol use disorders.
"We estimated that nearly one-quarter of hospitalized individuals
who identified themselves as current alcohol drinkers met standard
diagnostic criteria for alcohol use disorders," explained Dr.
Smothers. "We then were able to estimate that almost 2 million
people admitted to general hospitals in the United States in 1994
met established criteria for a current alcohol use disorder.
In this study, Drs. Smothers and Yahr teamed with Constance E. Ruhl,
M.D., Ph.D., of Social and Scientific Systems in Silver Spring,
Maryland, to analyze hospital record data for the same sample of
admissions, this time to estimate rates of alcohol use disorders
detection among patients whose diagnostic interviews indicated the
presence of alcohol use disorders.
"We found that alcohol diagnoses were reflected in the hospital
records of fewer than half of those who evidenced an alcohol use
disorder in their interview," said Dr. Smothers. "We are
concerned about the low detection rates, but we also are concerned
that only half of those detected had documentation of alcohol intervention
or treatment referral."
Dr. Smothers and her colleagues note that in recent years, effective
treatment options for alcohol dependence have been expanded to include
medications. Physician advice and other brief interventions also
have proved effective for nondependent individuals who drink at
The researchers conclude that "hospitalization provides an
excellent opportunity for identifying alcohol problems among patients
and providing them with alcohol intervention or treatment referral
services as needed." They add that screening patients for alcohol
problems should be a routine part of the hospital admission process,
and that concerted efforts are needed in education of medical students
and residents, and in continuing medical education of practicing
physicians, to address this problem.
NIAAA and the Substance Abuse and Mental Health Services Administration
(SAMHSA), this week announced a major collaborative study that will
investigate ways to screen, identify, and treat patients in hospital
emergency departments for alcohol problems. For more information,
NIAAA also has developed a Health Practitioner's Guide, titled
"Helping Patients With Alcohol Problems," to assist physicians,
nurses, and other healthcare professionals in screening patients
for alcohol problems and conducting brief interventions for those
problems. The Guide is available on the NIAAA Web site at: http://www.niaaa.nih.gov/publications/Practitioner/HelpingPatients.htm.