The National Institute on Alcohol Abuse and Alcoholism (NIAAA) today released The Physicians' Guide to Helping Patients with Alcohol Problems, a step by step approach to aid primary care physicians during routine office visits in identifying and advising patients at risk for or experiencing alcohol problems. Developed by NIAAA with an interdisciplinary working group of alcohol researchers and health professionals, the Physicians' Guide is based on more than a decade of research on health risks associated with alcohol use and on the effectiveness of alcohol screening and intervention methods.
The 12-page manual incorporates brief screening and assessment instruments to help physicians gauge the nature and extent of alcohol problems. It also outlines physician advice for two problem drinker types: patients drinking above moderate levels who show no signs of dependence; and patients who show evidence of alcohol dependence, commonly termed alcoholism. According to the Physicians' Guide, patients with signs of alcoholism should be advised to initiate abstinence and referred for diagnostic evaluation or treatment by an alcohol specialist. At-risk drinkers who show no dependence signs may be advised to reduce consumption.
An estimated 25 percent of U.S. adults report drinking patterns that place them at risk for developing alcohol problems or currently have such problems, including the more than 7 percent of adults who meet medical diagnostic criteria for alcohol dependence and abuse. While untreated alcohol dependence and abuse often result in severe or fatal outcomes, even alcohol use can complicate treatment for medical conditions, interfere with prescribed medications, or lead to adverse side effects.
The Physicians' Guide enables physicians to apprise both high- and low-risk drinkers of these risks at the point that a patient enters the health care system, according to a letter from NIAAA Director Enoch Gordis, M.D., that accompanies the manual.
"Primary care physicians have a unique concern with overall patient health and want to practice good medicine. They also see patients more frequently than other health care specialists, and most are terribly busy," Gordis said. "This new research-based tool will enable them to intervene quickly and confidently with patients' alcohol problems, especially with drinking that exceeds moderate levels but stops short of alcohol dependence."
Research on brief interventions has shown that 10 to 30 percent of nondependent problem drinkers reduce their drinking to moderate levels following a physician's advice or counseling, or other brief interventions including behavior change strategies, patient education, and one or more counseling sessions. Controlled clinical studies have replicated findings of patient improvement at periods of up to 1 year following such interventions.
"Brief interventions to reduce alcohol consumption should be conducted by or under the supervision of a health professional. Patients who attempt to reduce their drinking should continue to be professionally evaluated and monitored," according to Richard K. Fuller, M.D., Director of NIAAA's Division of Clinical and Prevention Research.
In accordance with Dietary Guidelines for Americans, issued jointly in 1990 by the U.S. Department of Health and Human Services and the U.S. Department of Agriculture, the Physicians' Guide defines moderate drinking as no more than 2 drinks a day for men or 1 drink a day for women. Because, like women, elderly persons have a smaller proportion of body water than younger men, NIAAA also defines moderate drinking for persons aged 65 years and older as no more than 1 drink a day. A standard drink is 12 grams of pure alcohol, the amount contained in a 12-ounce beer or wine cooler, a 5-ounce glass of wine, or 1.5 ounces of distilled spirits.
The Physicians' Guide further alerts physicians that patients who engage in heavy episodic drinking (four or more drinks for men and three or more drinks for women on a single occasion) incur increased risk. In addition, the manual recommends abstinence for groups at risk from any alcohol consumption, including women who are pregnant or considering pregnancy, persons with alcohol-sensitive medical conditions, and persons taking contraindicated medications.
Physicians should inform patients of both risks and benefits associated with light to moderate alcohol use, states the manual. However, they should not encourage infrequent or nondrinkers to begin drinking solely for alcohol's cardioprotective effects. Numerous epidemiologic studies during the past decade have found that light to moderate drinking is associated with reduced coronary heart disease death rates, especially among men older than 45 years and postmenopausal women.
The Physicians' Guide to Helping Patients with Alcohol Problems is available to clinicians attending the November 9-11 annual meeting of the Association for Medical Education and Research in Substance Abuse (AMERSA) underway November 9-11 at the Sheraton City Centre in Washington, D.C. Frances Cotter, M.A., M.P.H., NIAAA, and AMERSA member Michael Fleming, M.D., M.P.H., Department of Family Medicine and Practice, University of Wisconsin, provided leadership for developing the manual.
NIAAA will work with professional organizations and constituency groups to distribute the Physicians' Guide to primary care practitioners. Members of the media may obtain single copies from NIAAA's Office of Scientific Affairs (telephone 301/443-3860, facsimile 301/480-1726).
As the lead Federal institute for alcohol research, NIAAA is charged with both research and research dissemination to a variety of audiences including health professionals. NIAAA is one of 17 Institutes comprising the National Institutes of Health, the nation's lead agency for biomedical and behavioral research.