Alcohol-Related Problems

Early identification of alcohol-related problems is important because these problems are prevalent, pose serious health risks to patients and their families, and are amenable to intervention. Physicians may be able to help patients change their drinking behaviors. The most effective tool for screening is a thorough history of the patient's drinking behavior, designed to identify patterns of alcohol-related difficulties with physical and mental health, family life, legal authorities and employment. Alcohol drinkers can be categorized as at-risk, problem or alcohol dependent, according to a protocol developed by the National Institute on Alcohol Abuse and Alcoholism. The severity of the alcohol problem and the patient's readiness to change should determine the intervention selected by the family physician.

Although two thirds of American men and one half of American women drink alcohol,1 three fourths of drinkers experience no serious consequences from alcohol use.2 Among those who abuse alcohol, many reduce their drinking without formal treatment after personal reflection about negative consequences.3 Physicians can help prevent the serious effects of alcohol-related problems by stimulating such reflection and moving patients toward a healthier lifestyle.4 The purpose of this review is to encourage family physicians to prevent serious consequences of alcohol-related problems by using simple screening and brief intervention strategies.

Rationale for Early Screening

Preventive efforts on the part of family physicians are important because: (1) alcohol-related problems are prevalent in patients who visit family practices; (2) heavy alcohol use contributes to many serious health and social problems; and (3) physicians can successfully influence drinking behaviors. In the United States, the one-year prevalence of alcohol-use disorders, including alcohol abuse and alcohol dependence, is about 7.4 percent in the adult population.5 In patients who visit family practices, the prevalence is higher. One study of 17 primary care practices found a 16.5 percent prevalence of "problem drinkers,"4 and another study found a 19.9 percent prevalence of alcohol-use disorders among male patients.6
Disorders related to alcohol use are estimated to affect over 7 percent of adults in the United States.




Heavy alcohol use can affect nearly every organ system and every aspect of a patient's life. Table 1 lists many direct and indirect effects of alcohol-related problems. Alcohol causes diseases such as cirrhosis of the liver and exacerbates symptoms in existing conditions such as diabetes.1,7,8 In addition, alcohol is implicated in many social and psychologic problems, including family conflict, arrests, job instability, injuries related to violence or accidents, and psychologic symptoms related to depression and anxiety.2,8 These problems take an enormous emotional toll on individuals and families, and are a great financial expense to health care systems and society.

Many of these problems may be avoided by early screening and intervention by family physicians. Several studies of early and brief physician interventions have demonstrated a reduction in alcohol consumption and improvement in alcohol-related problems among patients with drinking problems.9,10 A 40 percent reduction in alcohol consumption in nondependent problem drinkers has been demonstrated following physician advice to reduce drinking.