Screening for alcohol problems in hospitals needs improvement

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 as needed.

"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 hazardous levels.

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, see: http://www.niaaa.nih.gov/press/2004/NASD04-04.htm.