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Clinicians should improve their screening for alcohol abuse

Patient Safety Monitor Alert, August 5, 2004

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Healthcare providers miss an important opportunity to improve patient health when they don't screen patients properly for signs of "problem drinking," according to the August 2004 Harvard Mental Health Letter ("Brief treatment for problem drinkers").

Nearly a third of Americans consume more than the FDA-recommended two drinks a day. Reaching these so-called problem drinkers is important because they likely account for most of the problems caused by alcohol, such as illness, injuries, accidents, and family problems, the article notes.

And although people who fall into this group rarely think of themselves as alcoholics or seek standard treatment for alcoholism, recent studies suggest that a little advice and encouragement can help them cut down or eliminate their drinking. An estimated 75% of alcohol abusers recover without professional treatment or 12-step groups, according to the article.

Helpful advice for this group can come from a physician, counselor, or layperson who is knowledgeable about alcohol.

The Harvard Mental Health Letter provides the following widely used questionnaire, entitled CAGE (Cut down, Annoyed, Guilty, Eye-opener). A patient who answers "yes" to even one of these questions may have a problem that a closer examination will reveal.

1. Have you ever felt that you should cut down?
2. Have people annoyed you by criticizing your drinking?
3. Have you ever felt guilty about your drinking?
4. Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?

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