Screening for alcohol use disorders among medical outpatients: the influence of individual and facility characteristics

Am J Psychiatry. 2005 Aug;162(8):1521-6. doi: 10.1176/appi.ajp.162.8.1521.


Objective: Screening of adults in primary care has been recommended to reduce alcohol misuse. This study determined the rates and predictors of alcohol screening, screening positive, follow-up evaluation, and subsequently diagnosed alcohol use disorder in a national sample of Department of Veterans Affairs (VA) medical outpatients.

Method: Chart-abstracted quality improvement data from the VA's 2002 External Peer Review Program were merged with records for 15,580 medical outpatients drawn from 139 VA facilities nationwide.

Results: Nearly three-quarters of eligible patients (N=11,553) had chart-documented alcohol screening in the past year. Of these, 4.2% (N=484) screened positive. Of those who screened positive, three-fourths (N=370) received follow-up evaluation, and of these, 53.5% (N=198) were subsequently diagnosed with an alcohol use disorder-1.7% of the originally screened sample. Multivariate logistic regression revealed that several factors generally associated with increased risk of alcohol use disorders-including being younger, unmarried, and disabled, as well as having greater medical and psychiatric comorbidities-were actually associated with a decreased likelihood of alcohol screening. At the facility level, screening was less likely at more academically affiliated centers, and follow-up evaluation of a positive screening was less likely at the largest facilities.

Conclusions: Routine alcohol screening yielded relatively few positive cases, raising questions about its cost-effectiveness. Targeted strategies may increase the value of case-finding activities among patients at greatest risk for alcohol use disorders and at more academically affiliated facilities. Targeted efforts are also needed to ensure proper follow-up evaluation at larger medical centers where patients may experience greater system-level barriers.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Aged
  • Alcohol-Related Disorders / diagnosis*
  • Alcohol-Related Disorders / epidemiology*
  • Ambulatory Care*
  • Diagnosis, Dual (Psychiatry)
  • Female
  • Follow-Up Studies
  • Health Facility Size
  • Hospitals, Veterans / statistics & numerical data
  • Humans
  • Male
  • Mass Screening / methods*
  • Medical Records / statistics & numerical data
  • Mental Disorders / diagnosis
  • Mental Disorders / epidemiology
  • Middle Aged
  • Prevalence
  • Risk Factors
  • United States / epidemiology
  • United States Department of Veterans Affairs
  • Veterans / statistics & numerical data