Missed Opportunities
posted, April 1, 2004
Many people admitted to hospitals in the United States 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, MD. "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, PhD, and Harold T. Yahr,
PhD. 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 US. 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, MD, PhD, 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: www.niaaa.nih.gov.
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. www.niaaa.nih.gov