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Primary Care Doctors Screening for Alcohol Abuse

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Primary Care Doctors Screening for Alcohol Abuse

If that wasn’t a look of sheer doubt she gave me, I don’t know what was. “How much again?” she asked. (Some friends marvel that I find any more too filling.)

“This much,” I said, showing her again. “And every day?” she repeated.

“Yes,” I answered, now annoyed and defensive.

“I write about addiction and recovery, and I don’t have a problem”, I told her. “No, no, I’m just asking,” she said, as she busily wrote on the questionnaire.

Our exchange shouldn’t have annoyed me. I know she was just doing her job—and I was especially interested that this questioning had made its way to the emergency room and that a nurse was doing it. I posted quite awhile ago about the majority of ER visits being related to some form of drug use, and that post also mentioned that doctors are now being trained to perform a quick screening during normal office visits.

After that experience, I was drawn to a headline in The New York Times late last month: “Doctors Reminded to Ask Patients About Alcohol Use.” The article said that a panel of the U.S. Preventive Services Task Force found that a third of us misuse alcohol (but fewer are addicted). Even the misuse results in 85,000 deaths a year, however. More astounding is that ”alcohol abuse is the third leading cause of preventable death in the U.S., after smoking and obesity.”

But if primary care doctors ask patients a set of questions during the person’s office visit and offer a brief counseling session (or even more than one), it could help people cut down on their drinking, the panel said. One of the questions is the all-important: “How often do you have five or more drinks on one occasion?” (That indicates binge drinking.)

The article noted that the panel doesn’t suggest this technique be used with adolescents, however, because it could cause anxiety or make them feel singled out.

I remember reading that people are prone to be honest with their doctors, and if that’s true, this should help. But I don’t know, do you think those who abuse alcohol are really honest with their GP if they’re not even honest with themselves? I think of my friend’s 20-something daughter, who years ago was met by the authorities when her plane landed because her behavior was so outrageous after a few drinks in the air. Two years later she got a DUI.  I’m not sure if she’s addicted, but she definitely abuses alcohol. Would she be honest with a doctor about the amount she drinks? And would a brief intervention help her and those like her?

I also remember reading several years ago about primary care doctors being taught about screening. The New York Times article I referred to earlier was a reminder to them, reaffirming the advice given in 2004. The article does say that the technique does not help in cases where people “are already addicted and need more extensive help…like therapy in rehabilitation clinics.” Thinking about it, it sounds like a good idea for people starting to go down the wrong path. But that includes adolescents!

Should you have thoughts on the panel’s recommendations, there’s a public comment period. Anyone in favor of this screening should take heart that the Affordable Care Act requires insurance companies to cover it.

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