Identification of and guidance for problem drinking by general medical providers: results from a national survey

Med Care. 2005 Mar;43(3):229-36. doi: 10.1097/00005650-200503000-00005.


Background: Heavy alcohol use is associated with health costs and medical problems. There has been a growing consensus that primary care patients should be screened for alcohol problems.

Objectives: We examined rates at which patients were asked about alcohol or drug use and problems, extending research in this area by using a standardized problem drinking instrument with a large national sample, examining community level variables, and assessing the extent to which patients who were identified received follow-up.

Subjects: A subsample of 7371 persons from the 1998 Healthcare for Communities survey who reported visiting a general medical provider (GMP) in the past year.

Measures: Participants completed questionnaires on demographics, mental and physical health, alcohol, drug use and problems, enrollment in a managed health care plan, whether their medical provider asked about alcohol or drug use, and whether they received advice, counseling, or referral.

Results: Being asked about alcohol and drug use was associated with being male, young, highly educated, more health problems, mental health diagnosis, and being classified as a problem drinker. Only 48% of problem drinkers received any follow-up, with most being told to "stop drinking" by their GMP.

Conclusions: Few people are queried about alcohol or drug use when they visit a GMP. When problem use is identified, most patients do not receive appropriate follow-up and aftercare. The quality of primary care could improve if GMPs were educated about providing brief advice/counseling and were given information concerning resources in their community to make appropriate referrals for patients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Alcoholism / diagnosis*
  • Alcoholism / therapy
  • Counseling / statistics & numerical data
  • Family Practice / standards*
  • Female
  • Health Care Surveys
  • Humans
  • Male
  • Mass Screening / statistics & numerical data*
  • Middle Aged
  • Odds Ratio
  • Physician-Patient Relations
  • Practice Patterns, Physicians'*
  • Primary Health Care / standards*
  • Quality of Health Care
  • Referral and Consultation
  • United States