Alcohol abuse and alcoholism in the primary care setting - Tips From Other Journals

Date: August, 1991

Alcohol abuse and alcoholism are CoStlY problems to society. Alcoholic patients are seen frequently in the primary care setting; but they are often not optimally diagnosed and treated. Magruder-Habib and colleagues review the recognition, diagnosis and treatment of alcoholism in primary care.

Physicians should approach the diagnosis of alcoholism by asking pertinent historical questions, by being sensitive to physical presentation and by using laboratory and other diagnostic tests. Patient history, physical examination and laboratory tests are not sensitive predictors of alcoholism, but are useful in raising suspicions of alcoholism. The most accurate screening tools are questionnaires, such as the CAGE Questionnaire (see table) and the Michigan Alcohol Screening Test, and should be used routinely by primary care physicians.

If a screening test is positive, the physician should use standard criteria to confirm the diagnosis of alcoholism. A formal diagnosis of alcoholism makes seeking care for treatment legitimate and may improve third-party payment for treatment.

Intervention is difficult, but the primary care physician should be aware of community resources and should be skilled at determining when and how to make treatment referrals. Trials of treatment and management techniques for early stage alcoholism should be conducted. One of the most effective programs in existence is Alcoholics Anonymous. Many alcoholics are unwilling to enter treatment. However, in such cases, the physician may be able to work with family members. Most treatment programs demonstrate better effectiveness with family involvement.

Although more research is needed in the recognition and treatment of alcoholism in primary care settings, diligent application of current knowledge will allow physicians to help many patients with their alcohol problems. (Journal of Family Practice, April 1991, vol. 32, p. 406.)

COPYRIGHT 1991 American Academy of Family PhysiciansCOPYRIGHT 2004 Gale Group

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