Does Alcohol Screening Help Doctors Suggesting Safer Drinking?

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Author: Justin Mckibben

Alcoholism is a very real, very serious and sometimes fatal disease that claims victims without prejudice. Families are torn to pieces, careers topple over on top of themselves, and lives are lost in the wreckage of active alcoholic rampages. The idea of moderation and ‘drinking responsibly’ can be applied to an average drinker, but to an alcoholic slipping into devastation, it is an abstract concept. So what can we expect from screening for alcohol abuse?

A recent review in the CMAJ (Canadian Medical Association Journal) is attempting to offer tips for physicians to screen for harmful high-risk drinking habits, and help patients cut down on excessive alcohol use.

The questionable part is this is a publication aimed at health care providers who are not addiction specialists. So while this may be useful to help ‘heavy drinkers’ stop from taking it too far is it an enabling strategy guide for the ‘real deal’ alcoholic patient?

The Current Guidelines for Drinking

There are some standards that are already considered to set the difference between ‘healthy’ drinking habits and high-risk drinking habits. Currently the Canadian guidelines used by the review in the CMAJ for low-risk drinking recommend:

• No more than 10 drinks a week for women (with no more than 2 drinks a day on most days)
• No more than 15 drinks a week for men (with no more than 3 drinks a day on most days)
• They recommend that pregnant women abstain from drinking

According to researchers, these guidelines aren’t being followed as closely as hoped, and it is estimated that:

• About 15%-20% of Canadian citizens actually drink more than that in the recommended guidelines.
• Harms from alcohol misuse are responsible for substantial disability and 7.1% of all deaths in Canada.

To limit the mounting average of alcohol abuse and the damages is does, action is needed. At the public health level there is the system of alcohol regulation and pricing that can be monitored, and at the individual level action can be taken through providing proper education on the dangers of alcohol and supporting effective intervention.

Is Alcohol Screening a Solution?

The experts suggest that health care practitioners should first screen patients for irregular alcohol consumption, asking patients how many days a week they drink and how many drinks they consume per day.

It is suggested that if hazardous drinking behavior has been identified, clinicians can offer counselling and feedback using a variety of resources.

The report goes on to describe the lack of education and training in Canada concerning primary care doctors, hospitals and other emergency services in regards to alcoholism and addiction. So to ensure better access to alcohol screening and interventions, the authors recommend policy changes that included:

• Training on alcohol misuse should be incorporated into medical education for medical students and residents.
• Hospitals and primary care clinics should implement screening and intervention programs.
• Hospitals and primary care clinics should also offer ways to connect those with more severe problems to ongoing treatment.
• Provinces and territories should fund first-line medications for alcohol use disorders, and make them widely accessible.

Such policy changes, according to the authors, would help to ensure equitable care for those with at-risk drinking and alcohol use disorders.

Expert Opinion

Dr. Anne Moyer from the Stony Brook University in New York, along with coauthor, Dr. John W. Finney from the Center for Innovation to Implementation, VA Palo Alto Health Care System in Menlo Park, California were some of the primary sources involved who wrote,

“A broad range of health care providers without specific addiction expertise are well-positioned to identify individuals who drink at levels that are harmful before such patients have even considered changing their alcohol consumption or seeking treatment.”

It seems as though this is actually just a first line of defense against continued problematic drinking habits, utilizing the familiar face of a family or personal doctor to stress the guidelines set for low-risk drinking habits.

What is the Point?

Although some health care professionals may find it awkward to initiate these conversations, the authors of the recent CMAJ review suggest that patients may appreciate an intervention in a primary care or hospital setting. In this forum it could be less embarrassing, stigmatizing or inconvenient than consulting an addiction specialist or entering a formal alcohol treatment program.

So is this saying that getting tips from a doctor who is not an addiction specialist should be considered an acceptable alternative to seeking help from specialists?

According to the report the answer is NO. This is not meant to be an end all solution. The authors did make note that should the problem drinker continue to drink in a way harmful to themselves and others, than they should be referred to more specialized treatment.

In a nut shell, they are simply trying to provide primary care physicians with more tools to try and off-set the possibility of alcoholism, but still acknowledging the importance of drug and alcohol treatment programs.

So does a doctor conducting an alcohol screening seem like it would prevent alcoholism? Does being more thoroughly educated on the details of alcohol abuse and addiction make a primary care physician more effective for providing support and suggestions for someone suffering with alcohol related issues or illnesses? Seems legit. But is this going to neglect the need for specialized treatment?

While physicians around the world are somewhat familiar with the effects and warning signs of alcoholism or addiction, it is still incredibly beneficial for individuals who have drinking or drug problems to seek specialized treatment for lasting recovery. If you or someone you love is struggling with substance abuse or addiction, please call toll-free 1-800-951-6135