Identifying hazardous and harmful alcohol use  
3. Summary of chapter evidence

1. Should hazardous and harmful alcohol use be identified?
Since alcohol is implicated in a very wide variety of physical and mental health problems in a dose dependent manner, there is an opportunity for all primary health care providers to identify all adult patients with hazardous and harmful alcohol consumption. Numerous studies have shown that most patients with hazardous and harmful alcohol consumption are not known to their health care provider. A very conservative estimate has suggested that for one adult patient to benefit from a brief intervention for hazardous and harmful alcohol consumption, 385 need to be screened. This figure compares favourably with other screening activities; the number needed to screen for hypertension is 1250 and 3300 for colorectal cancer for one patient to benefit.  

2. In which groups of patients should hazardous and harmful alcohol use be identified?
A truly preventive approach can only be reached if all adult patients are screened for hazardous and harmful alcohol consumption, including patterns of episodic heavy drinking. If such an approach is not feasible, limiting screening to high risk groups or to some specific situations may be a feasible option. Such groups could include young to middle aged males.         

3. What are the best questions or screening instruments to identify hazardous and harmful alcohol use?
The simplest questions to use are those that ask about alcohol consumption. The first three questions of the World Health Organization's Alcohol Use Disorders Identification Test, which was designed to identify hazardous and harmful alcohol consumption in primary care settings, have been well tested and validated.   The first question asks about frequency of drinking; the second the amount of alcohol consumed on an average drinking day; and the third the frequency of episodic heavy drinking.   

4. How should questions or screening instruments be administered?
The identification of hazardous and harmful alcohol consumption works best when it is incorporated into routine clinical practices and systems, such as systematically asking all new patients when they register; all patients when they attend for a health check; or all men aged 18-44 years, when they attend for a consultation. There is no evidence available to suggest that systematic identification of hazardous and harmful alcohol consumption lead to adverse effects, such as discomfort or dissatisfaction amongst patients.   

5. Are biochemical tests useful for screening?
Biochemical tests for alcohol use disorders such as liver enzymes [e.g. serum ã-glutamyl transferase (GGT) and the aminotransferases], carbohydrate deficient transferrin (CDT) and mean corpuscular volume (MCV) are not useful for screening because elevated results have poor sensitivity, identifying only a small proportion of patients with hazardous or harmful alcohol consumption.       

Recommendations   

1. The identification of hazardous and harmful alcohol consumption and episodic heavy drinking should be offered to all adult patients of primary health care facilities. 

2. The use of first three alcohol consumption questions of the AUDIT is the preferred method to identify hazardous and harmful alcohol consumption. Male patients who score 5 or more with the AUDIT-C, or whose alcohol consumption is 350g of alcohol or more per week and female patients who score 4 or more with the AUDIT-C, or whose alcohol consumption is 210g of alcohol or more per week for men should be offered a brief intervention.   

3. The identification of hazardous and harmful alcohol consumption works best when it is incorporated into routine clinical practices and systems   

4. Biochemical tests, such as serum ã-glutamyl transferase, carbohydrate deficient transferrin (CDT) and mean corpuscular volume (MCV) should not be relied on for routine screening for hazardous or harmful alcohol consumption or alcohol dependence in primary health care.

References

 



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Last modified: 19/04/2006 | Published on: 11/06/2004 Top

 © 2008 PHEPA - Primary Health Care European Project on Alcohol