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Clinical recognition and recording of alcohol disorders by clinicians in primary and secondary care: meta-analysis

  • Alex J. Mitchell (a1), Nick Meader (a2), Vicky Bird (a3) and Maria Rizzo (a3)
Abstract
Background

Clinicians have considerable difficulty identifying and helping those people with alcohol problems but no previous study has looked at this systematically.

Aims

To determine clinicians' ability to routinely identify broadly defined alcohol problems.

Method

Data were extracted and rated by two authors, according to PRISMA standard and QUADAS criteria. Studies that examined the diagnostic accuracy of clinicians' opinion regarding the presence of alcohol problems as well as their written notation were evaluated.

Results

A comprehensive search identified 48 studies that looked at the routine ability of clinicians to identify alcohol problems (12 in primary care, 31 in general hospitals and 5 in psychiatric settings). A total of 39 examined alcohol use disorder, 5 alcohol dependence and 4 intoxication. We separated studies into those using self-report and those using interview. The diagnostic sensitivity of primary care physicians (general practitioners) in the identification of alcohol use disorder was 41.7% (95% CI 23.0–61.7) but alcohol problems were recorded correctly in only 27.3% (95% CI 16.9–39.1) of primary care records. Hospital staff identified 52.4% (95% CI 35.9–68.7) of cases and made correct notations in 37.2% (95% CI 28.4–46.4) of case notes. Mental health professionals were able to correctly identify alcohol use disorder in 54.7% (95% CI 16.8–89.6) of cases. There were limited data regarding alcohol dependency and intoxication. Hospital staff were able to detect 41.7% (95% CI 16.5–69.5) of people with alcohol dependency and 89.8% (95% CI 70.4–99.4) of those acutely intoxicated. Specificity data were sparse.

Conclusions

Clinicians may consider simple screening methods such as self-report tools rather than relying on unassisted clinical judgement but the added value of screening over and above clinical diagnosis remains unclear.

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Copyright
Corresponding author
Alex J. Mitchell, Leicester General Hospital, Leicester Partnership Trust, Leicester LE5 4PW, UK. Email: alex.mitchell@leicspart.nhs.uk
Footnotes
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Declaration of interest

None.

Footnotes
References
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1 Room, R, Babor, T, Rehm, J. Alcohol and public health. Lancet 2005; 365: 519–30.
2 Saitz, R. Clinical practice. Unhealthy alcohol use. New Engl J Med 2005; 352: 596607.
3 Rehm, J, Mathers, C, Popova, S, Thavorncharoensap, M, Teerawattananon, Y, Patra, J. Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. Lancet 2009; 373: 2223–33.
4 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4th edn, revised) (DSM-IV-TR). APA, 2000.
5 World Health Organization. Lexicon of Alcohol and Drug Terms Published by the World Health Organization. WHO, 2012.
6 World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. WHO, 1992.
7 Compton, WM, Conway, KP, Stinson, FS, Colliver, JD, Grant, BF. Prevalence, correlates, and comorbidity of DSM-IV antisocial personality syndromes and alcohol and specific drug use disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry 2005; 66: 677–85.
8 O'Connor, PG, Schottenfeld, RS. Patients with alcohol problems. New Engl J Med 1998; 338: 592602.
9 National Institute on Alcohol Abuse and Alcoholism. Tenth Special Report to the US Congress on Alcohol and Health. NIH Publication No. 00-3769. Department of Health and Human Services, 2000.
10 Reid, MC, Fiellin, DA, O'Connor, PG. Hazardous and harmful alcohol consumption in primary care. Arch Intern Med 1999; 159: 1681–9.
11 Buchsbaum, DG, Buchanan, RG, Lawton, MJ, Schnoll, SH. Alcohol consumption patterns in a primary care population. Alcohol Alcohol 1991; 26: 215–20.
12 Fiellin, DA, Reid, MC, O'Connor, PG. Screening for alcohol problems in primary care: a systematic review. Arch Intern Med 2000; 160: 1977–89.
13 Gerke, P, Hapke, U, Rumpf, HJ, John, U. Alcohol-related diseases in general hospital patients. Alcohol Alcohol 1997; 32: 179–84.
14 John, U, Rumpf, H-J, Hapke, U. Estimating prevalence of alcohol abuse and dependence in one general hospital: an approach to reduce sample selection bias. Alcohol Alcohol 1999; 34: 786–94.
15 Jarque-López, A, González-Reimers, E, Rodríguez-Moreno, F, Santolaria-Fernández, F, López-Lirola, A, Ros-Vilamajo, R, et al. Prevalence and mortality of heavy drinkers in a general medical hospital unit. Alcohol Alcohol 2001; 36: 335–8.
16 Smothers, BA, Yahr, HT, Sinclair, MD. Prevalence of current DSM-IV alcohol use disorders in short-stay, general hospital admissions, United States, 1994. Arch Intern Med 2003; 163: 713–9.
17 Roche, AM, Freeman, T, Skinner, N. From data to evidence, to action: findings from a systematic review of hospital screening studies for high risk alcohol consumption. Drug Alcohol Depend 2006; 83: 114.
18 Santora, PB, Hutton, HE. Longitudinal trends in hospital admissions with co-occurring alcohol/drug diagnoses, 1994-2002. J Subst Abuse Treat 2008; 35: 112.
19 Coder, B, Freyer-Adam, J, Bischof, G. Alcohol problem drinking among general hospital inpatients in northeastern Germany. Gen Hosp Psychiatry 2008; 30: 147–54.
20 Koskinen, J, Löhönen, J, Koponen, H, Isohanni, M, Miettunen, J. Prevalence of alcohol use disorders in schizophrenia - a systematic review and meta-analysis. Acta Psychiatr Scand 2009; 120: 8596.
21 Barry, KL, Fleming, MF, Greenley, J, Widlak, P, Kropp, S, McKee, D. Assessment of alcohol and other drug disorders in the seriously mentally ill. Schizophr Bull 1995; 21: 313–21.
22 Hulse, GK, Saunders, JB, Roydhouse, RM, Stockwell, TR, Basso, MR. Screening for hazardous alcohol use and dependence in psychiatric in-patients using the AUDIT questionnaire. Drug Alcohol Rev 2000; 19: 291–8.
23 McCloud, A, Barnaby, B, Omu, N, Drummond, C, Aboud, A. Relationship between alcohol use disorders and suicidality in a psychiatric population. In-patient prevalence study. Br J Psychiatry 2004; 184: 439–45.
24 Kaner, EF, Heather, N, Brodie, J, Lock, CA, McAvoy, BR. Patient and practitioner characteristics predict brief alcohol intervention in primary care. Br J Gen Pract 2001; 51: 822–7.
25 Aalto, M, Pekuri, P, Seppa, K. Primary health care professionals' activity in intervening in patients' alcohol drinking during a 3-year brief intervention implementation project. Drug Alcohol Depend 2003; 69: 914.
26 Richmond, RL, Anderson, P. Research in general practice for smokers and excessive drinkers in Australia and the UK. III. Dissemination of interventions. Addiction 1994; 89: 4962.
27 Kaner, EF, Lock, CA, McAvoy, BR, Heather, N, Gilvarry, E. An RCT of three training and support strategies to encourage implementation of screening and brief alcohol intervention by general practitioners. Br J Gen Pract 1999; 49: 699703.
28 Rydon, P, Redman, S, Sanson-Fisher, RW, Reid, AL. Detection of alcohol-related problems in general practice. J Stud Alcohol 1992; 53: 197202.
29 Berner, MM, Zeidler, C, Kriston, L, Mundle, G, Lorenz, G, Härter, M. Diagnostic and treatment approaches to alcohol-related disorders. Results of a survey in general practices [in German]. Fortschr Neurol Psychiatr 2006; 74: 157–64.
30 Aalto, M, Seppa, K. Use of laboratory markers and the audit questionnaire by primary care physicians to detect alcohol abuse by patients. Alcohol Alcohol 2005; 40: 520–3.
31 Deitz, D, Rohde, F, Bertolucci, D, Dufour, M. Prevalence of screening for alcohol use by physicians during routine physical examinations. Alcohol Health Res World 1994; 18: 162–8.
32 Taira, DA, Safran, DG, Seto, TB, Rogers, WH, Tarlov, AR. The relationship between patient income and physician discussion of health risk behaviors. JAMA 1997; 278: 1412–7.
33 Edlund, MJ, Jürgen, U, Wells, KB. Clinician screening and treatment of alcohol, drug, and mental problems in primary care: results from healthcare for communities. Med Care 2004; 42: 1158–66.
34 Hasin, DS, Grant, BF, Dufour, MG, Endicott, J. Alcohol problems increase while physician attention declines. 1967 to 1984. Arch Intern Med 1990; 150: 397400.
35 Wallace, P, Cutler, S, Haines, A. Randomized controlled trial of general practitioner intervention in patients with excessive alcohol consumption. BMJ 1988; 297: 663–8.
36 Bertholet, N, Daeppen, JB, Wietlisbach, V, Fleming, M, Burnand, B. Reduction of alcohol consumption by brief alcohol intervention in primary care: systematic review and meta-analysis. Arch Intern Med 2005; 165: 986–95.
37 D'Onofrio, G, Degutis, LC. Preventive care in the emergency department: screening and brief intervention for alcohol problems in the emergency department: a systematic review. Acad Emerg Med 2002; 9: 627–38.
38 Neumann, T, Gentilello, LM, Neuner, B, Weiss-Gerlach, E, Schürmann, H, Schröder, T, et al. Screening trauma patients with the alcohol use disorders identification test and biomarkers of alcohol use. Alcohol Clin Exp Res 2009; 33: 970–6.
39 Nielsen, SD, Gluud, C. Physician's information about alcohol problems at hospitalisation of alcohol misusers. Alcohol Alcohol 1992; 27: 659–65.
40 Ramsay, A, Vredenburgh, J, Gallagher, RM 3rd. Recognition of alcoholism among patients with psychiatric problems in a family practice clinic. J Fam Pract 1983; 17: 829–32.
41 Indig, D, Copeland, J, Conigrave, KM, Rotenko, I. Why are alcohol-related emergency department presentations under-detected? An exploratory study using nursing triage text. Drug Alcohol Rev 2008; 27: 584–90.
42 Hadida, A, Kapur, N, Mackway-Jones, K, Guthrie, E, Creed, F. Comparing two different methods of identifying alcohol related problems in the emergency department: a real chance to intervene? Emerg Med J 2001; 18: 112–5.
43 Gammeter, R, Nay, C, Bissery, A, Leutwyler, J, Bonsack, C, Besson, J, et al. Frequency of alcohol use disorders in patients admitted in a psychiatric hospital according to admission diagnosis. Schweizer Archiv Neurol Psychiatrie 2006; 157: 290–6.
44 Freimuth, M. Another missed opportunity? Recognition of alcohol use problems by mental health providers. Psychotherapy 2008; 45: 405–9.
45 Vinson, DC, Kruse, RL, Seale, JP. Simplifying alcohol assessment: two questions to identify alcohol use disorders. Alcohol Clin Exp Res 2007; 31: 1392–8.
46 Cheeta, S, Drummond, C, Oyefeso, A, Phillips, T, Deluca, P, Perryman, K, et al. Low identification of alcohol use disorders in general practice in England. Addiction 2008; 103: 766–73.
47 Moher, D, Liberati, A, Tetzlaff, J, Altman, DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009; 339: b2535.
48 Elamin, MB, Flynn, DN, Bassler, D, Briel, M, Alonso-Coello, P, Karanicolas, PJ, et al. Choice of data extraction tools for systematic reviews depends on resources and review complexity. J Clin Epidemiol 2009; 62: 506–10.
49 Whiting, P, Rutjes, AW, Reitsma, JB, Bossuyt, PM, Kleijnen, J. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol 2003; 3: 25.
50 Reitsma, JB, Glas, AS, Rutjes, AWS, Scholten, RJPM, Bossuyt, PM, Zwinderman, AH. Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. J Clin Epidemiol 2005; 58: 982–90.
51 Higgins, JPT, Thompson, SG, Deeks, JJ, Altman, DG. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557–60.
52 Begg, CB, Mazumdar, M. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994; 50: 1088–101.
53 Martin, MJ, Heymann, C, Neumann, T, Schmidt, L, Soost, F, Mazurek, B, et al. Preoperative evaluation of chronic alcoholics assessed for surgery of the upper digestive tract. Alcohol Clin Exp Res 2002; 26: 836–40.
54 Rienzi, BM. Prevalence of undetected alcohol dependence in the mental health diagnostic interview. Psychol Rep 1992; 70: 913–4.
55 Gentilello, LM, Villaveces, A, Ries, RR, Nason, KS, Daranciang, E, Donovan, DM, et al. Detection of acute alcohol intoxication and chronic alcohol dependence by trauma center staff. J Trauma 1999; 47: 1131–5.
56 Kip, MJ, Neumann, T, Jugel, C, Kleinwaechter, R, Weiss-Gerlach, E, Guill, MM, et al. New strategies to detect alcohol use disorders in the preoperative assessment clinic of a German University Hospital. Anesthesiology 2008; 109: 171–9.
57 Reyna, TM, Hollis, HW, Hulbus, RC. Alcohol-related trauma: the surgeon's responsibility. Ann Surg 1985; 201: 194–7.
58 Potvin, S, Sepehry, AA, Stip, E. A meta-analysis of negative symptoms in dual diagnosis schizophrenia. Psychol Med 2006; 36: 431–40.
59 Potvin, S, Sepehry, A, Stip, E. Meta-analysis of depressive symptoms in dual-diagnosis schizophrenia. Aust N Z J Psychiatry 2007; 41: 792–9.
60 Dixon, L. Dual diagnosis of substance abuse in schizophrenia: prevalence and impact on outcomes. Schizophr Res 1999; 35 (suppl): 93100.
61 Lubman, DI, Hides, L, Jorm, AF, Morgan, AJ. Health professionals' recognition of co-occurring alcohol and depressive disorders in youth: a survey of Australian general practitioners, psychiatrists, psychologists and mental health nurses using case vignettes. Aust N Z J Psychiatry 2007; 41: 830–5.
62 Weisner, C, Matzger, H. Missed opportunities in addressing drinking behavior in medical and mental health services. Alcohol Clin Exp Res 2003; 27: 1132–41.
63 National Audit Office. Reducing Alcohol Harm: Health Services in England for Alcohol Misuse. National Audit Office, 2008 (http://www.nao.org.uk/publications/0708/reducing_alcohol_harm.aspx).
64 Booth, BM, McLaughlin, YS. Barriers to and need for alcohol services for women in rural populations. Alcohol Clin Exp Res 2000; 24: 1267–75.
65 Berner, MM, Langlotz, M, Kriston, L, Härter, M. Diagnostics and treatment of alcohol-related disorders: results of a representative study in psychiatric and psychotherapeutic practices [in German]. Fortschr Neurol Psychiatr 2007; 75: 1825.
66 Rush, B, Ellis, K, Crowe, T, Powell, L. How general practitioners view alcohol use: clearing up the confusion. Can Fam Physician 1994; 40: 1570–8.
67 Cornuz, J, Ghali, WA, Di Carlantonio, D, Pecoud, A, Paccaud, F. Physicians' attitudes towards prevention: importance of intervention-specific barriers and physicians' health habits. Fam Pract 2000; 17: 535–40.
68 Wilson, GB, Lock, CA, Heather, N, Cassidy, P, Christie, MM, Kaner, EFS. Intervention against excessive alcohol consumption in primary health care: a survey of GPs' attitudes and practices in England 10 years on. Alcohol Alcohol 2011; 46: 570–7.
69 Aira, M, Kauhanen, J, Laricaara, P, Rautio, P. Factors influencing inquiry about patients' alcohol consumption by primary health care physicians: qualitative semi-structured interview study. Fam Pract 2003; 20: 270–5.
70 Bander, KW, Goldman, DS, Schwartz, MA, Rabinowitz, E, English, JT. Survey of attitudes among three specialties in a teaching hospital toward alcoholics. J Med Educ 1987; 62: 1724.
71 Beich, A, Gannik, D, Malterud, K. Screening and brief intervention for excessive alcohol use: qualitative interview study of the experiences of general practitioners. BMJ 2002; 325: 15.
72 Thom, B, Tellez, C. A difficult business: detecting and managing alcohol problems in general practice. Br J Addict 1986; 81: 405–18.
73 Ferguson, L, Ries, R, Russo, J. Barriers to identification and treatment of hazardous drinkers as assessed by urban/rural primary care doctors. J Addict Dis 2003; 22: 7990.
74 Miller, PM, Thomas, SE, Mallin, R. Patient attitudes towards self-report and biomarker alcohol screening by primary care physicians. Alcohol Alcohol 2006; 41: 306–10.
75 Makela, P, Havio, M, Seppa, K. Alcohol-related discussions in health care-a population view. Addiction 2011; 106: 1239–48.
76 Rush, BR, Powell, LY, Crowe, TG, Ellis, K. Early intervention for alcohol use: family physicians' motivations and perceived barriers. CAMJ 1995; 152: 863–9.
77 Herbert, C, Bass, F. Early at-risk alcohol intake. Definitions and physicians' role in modifying behavior. Can Fam Phys 1997; 43: 639–44.
78 Holmqvist, M, Bendtsen, P, Spak, F, Rommelsjö, A, Geirsson, M, Nilsen, P. Asking patients about their drinking. A national survey among primary health care physicians and nurses in Sweden. Addicti Behav 2008; 33: 301–14.
79 National Institute on Alcohol Abuse and Alcoholism. The Physician's Guide to Helping Patients with Alcohol Problems. NIH publication 95–3769. National Institutes of Health, 1995.
80 Arborelius, E, Thakker, KD. Why is it so difficult for general practitioners to discuss alcohol with patients? Fam Pract 1995; 12: 419–22.
81 Bradley, KA, Curry, SJ, Koepsell, TD, Larson, EB. Primary and secondary prevention of alcohol problems: U.S. internist attitudes and practices. J Gen Intern Med 1995; 10: 6772.
82 Wenrich, MD, Paauw, DS, Carline, JD, Curtis, JR, Ramsey, PG. Do primary care physicians screen patients about alcohol intake using the CAGE questions? J Gen Intern Med 1995; 10: 631–4.
83 Huang, M-C, Yu, C-H, Chen, C-T, Chen, C-C, Shen, WW, Chen, C-H. Prevalence and identification of alcohol use disorders among severe mental illness inpatients in Taiwan. Psychiatry Clin Neurosci 2009; 63: 94100.
84 Vinson, DC, Elder, NC, Werner, JJ, Vorel, LA, Nutting, PA. Alcohol-related discussions in primary care: a report from ASPN. J Fam Pract 2000; 49: 2833.
85 Stange, KC, Zyzanski, SJ, Jaen, CR, Callahan, EJ, Kelly, RB, Gillanders, WR, et al. Illuminating the ‘black box’. A description of 4454 patient visits to 138 family physicians. J Fam Pract 1998; 46: 377–89.
86 Arndt, S, Schultz, SK, Turvey, C, Petersen, A. Screening for alcoholism in the primary care setting are we talking to the right people? J Fam Pract 2002; 51: 41–6.
87 Larsson, US, Saljo, R, Aronsson, K. Patient-doctor communication on smoking and drinking: lifestyles in medical consultations. Soc Sci Med 1987; 25: 1129–37.
88 Lawner, K, Doot, M, Gausas, J, Doot, J, See, C. Implementation of CAGE alcohol screening in a primary care practice. Fam Med 1997; 29: 332–5.
89 Bradley, KA, Epler, AJ, Bush, KR, Sporleder, JL, Dunn, CW, Cochran, NE, et al. Alcohol-related discussions during general medicine appointments of male VA patients who screen positive for at-risk drinking. J Gen Intern Med 2002; 17: 315–26.
90 Vinson, DC, Galliher, JM, Reidinger, C, Kappus, JA. Comfortably engaging: which approach to alcohol screening should we use? Ann Fam Med 2004; 2: 398404.
91 Reid, MC, Tinetti, ME, Brown, CJ, Concato, J. Physician awareness of alcohol use disorders among older patients. J Gen Intern Med 1998; 13: 729–34.
92 Spandorfer, JM, Israel, Y, Turner, BJ. Primary care physicians' views on screening and management of alcohol abuse: inconsistencies with national guidelines. J Fam Pract 1999; 48: 899902.
93 D'Amico, EJ, Paddock, SM, Burnam, A, Kung, FY. Identification of and guidance for problems drinking by general medical providers. Results from a National Survey. Med Care 2005; 43: 229–36.
94 Bertakis, KD, Azari, R. Determinants of physician discussion regarding tobacco and alcohol abuse. J Health Commun 2007; 12: 513–25.
95 Institute of Medicine. Broadening the Base of Treatment for Alcohol Problems: Report of a Study by a Committee of the Institute of Medicine, Division of Mental Health and Behavioral Medicine. National Academy Press, 1990.
96 Council on Scientific Affairs, American Medical Association. AMA Guidelines For Physician Involvement In The Care Of Substance Abusing Patients. American Medical Association, 1979.
97 American Society of Addiction Medicine. Public Policy Statement on Screening for Addiction in Primary Care Settings. ASAM 1997.
98 Scottish Intercollegiate Guidelines Network (SIGN). The Management of Harmful Drinking and Alcohol Dependence in Primary Care. National Clinical Guidelines, 2003.
99 US Preventive Services Task Force. Guide to Clinical Preventive Services (2nd edn). International Medical Publishing, 1998.
100 US Preventive Services Task Force. Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: recommendation statement. Ann Intern Med 2004; 140: 554–6.
101 US Dept of Health and Human Services. The Physicians' Guide to Helping Patients With Alcohol Problems. US Dept of Health and Human Services, Public Health Service, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, 1995.
102 Beich, A, Thorsen, T, Rollnick, S. Screening in brief intervention trials targeting excessive drinkers in general practice: systematic review and meta-analysis. BMJ 2003; 327: 536–42.
103 Phelps, GL, Johnson, NP. Bright light in dark places: physician recognition of alcoholism. J S C Med Assoc 1990; 86: 17–8.
104 Hoeksema, HL, De Bock, GH. The value of laboratory tests for the screening and recognition of alcohol abuse in primary care patients. J Fam Pract 1993; 37: 268–76.
105 Reynaud, M, Schwan, R, Loiseaux-Meunier, M-N, Albuisson, E, Deteix, P. Patients admitted to emergency services for drunkenness: moderate alcohol users or harmful drinkers? Am J Psychiatry 2001; 158: 96–9.
106 Kunda, S. Actual problems of clinical classification and terminology of alcoholism. Alcoholism 1996; 32: 7993.
107 Morse, RM, Flavin, DK. The definition of alcoholism. JAMA 1992; 268: 1012–4.
108 Seale, JP, Shellenberger, S, Boltri, JM, Okosun, IS, Barton, B. Effects of screening and brief intervention training on resident and faculty alcohol intervention behaviours: a pre- post-intervention assessment. BMC Family Pract 2005; 6: 46.
109 Anderson, P, Laurant, M, Kaner, E, Wensing, M, Grol, R. Engaging general practitioners in the management of hazardous and harmful alcohol consumption: results of a meta-analysis. J Stud Alcohol 2004; 65: 191–9.
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Clinical recognition and recording of alcohol disorders by clinicians in primary and secondary care: meta-analysis

  • Alex J. Mitchell (a1), Nick Meader (a2), Vicky Bird (a3) and Maria Rizzo (a3)
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