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Screening the drinking: identifying at risk consumption and alcohol use disorders in primary care settings

Gordon AJ. Screening the drinking: identifying at risk consumption and alcohol use disorders in primary care settings. Johns Hopkins Advanced Studies in Medicine. 2006 Mar 1; 6(3):137-147.

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Abstract:

PURPOSE: To review the available evidence regarding screening tools and strategies toidentify problem alcohol consumption, at-risk alcohol consumption, binge drinking, andalcohol use disorders in primary care settings. EPIDEMIOLOGY: Alcohol consumption incurs significant individual and societal health risks and constitutes a significant economic and healthcare burden. An estimated 20% of patients in primary care settings consume enough alcohol to be considered problem drinkers. Unfortunately, in general, primary care providers poorly identify alcohol consumption among their patients and as many as three fourths of alcohol drinkers escape detection. REVIEW SUMMARY: Clinicians should be aware of the criteria to establish a patient as a problem drinker, including understanding what is meant by at-risk consumption of alcohol and an alcohol use disorder. Problem drinkers can be identified via formal screening instruments that have proven efficacious and effective in primary care settings. This review examines the support for strategies for primary care clinicians to screen for problem drinking, including binge drinking, among their patients. Effective screening strategies can promote greater identification of patients with problem drinking and treatment in primarycare settings, and encourage referral to specialized treatment. TYPE OF AVAILABLE EVIDENCE: Randomized-controlled trials, systematic reviews. GRADE OF AVAILABLE EVIDENCE: Good. CONCLUSION: Effective and efficient screening strategies for problem drinking behavior exist for primary care clinicians. Short and available screening questionnaires are effective at identifying problem drinking among outpatients. In screening for problem drinking, clinicians should assess for quantity-frequency of alcohol consumption and the presence of alcohol-related harm. Clinicians should employ a stepwise approach to screen all patients in their practice.





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