Screening and Brief Intervention in Primary Care Settings

By Fleming, Michael F. | Alcohol Research, April 1, 2004 | Go to article overview

Screening and Brief Intervention in Primary Care Settings


Fleming, Michael F., Alcohol Research


Primary care practitioners are in a unique position to identify patients with potential alcohol problems and intervene when appropriate. Screening, the process by which practitioners can identify at-risk drinkers, can be followed by one-time or repeated short counseling sessions, known as brief interventions, which are designed to help the patient reduce drinking and minimize related problems. Varied levels of screening and brief intervention can be implemented in the primary care setting, depending on patient and physician factors. Although screening and brief intervention are valuable tools, they are underutilized in primary care practices. Strategies that may help increase physicians' use of these techniques in the primary care setting include skills based role-playing, performance feedback, clinical protocols, clinic-based education, and training by credible experts. KEY WORDS: identification and screening for AOD (alcohol and other drug) use; Alcohol Use Disorders Identification Test; health risk assessment; binge drinking; patient interview; primary health care; general practitioner; brief intervention; prevention; counseling

Health care practitioners who work in primary care settings have the important responsibility of overseeing their patients' general health and welfare. In this role, they must be vigilant in identifying a host of potential health problems. Because many health problems can result from the misuse of alcohol, primary care practitioners can help patients avoid these problems by recognizing problematic alcohol use early. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), men may be at risk for alcohol-related problems if their alcohol consumption exceeds 14 standard drinks' per week or 4 drinks per day, and women may be at risk if they have more than 7 standard drinks per week or 3 drinks per day (NIAAA 2003). In one study, about 20 percent of primary care patients reported levels of consumption that exceeded these guidelines (Fleming et al. 1998). In addition, 35 percent of the men and 16 percent of the women participating in the study reported binge drinking (i.e., consuming six or more drinks per occasion2) during the 90 days before the survey. Other studies of primary care patients have estimated rates of alcohol abuse or dependence at 2 percent to 9 percent of study participants (Reid et al. 1999).

Primary care clinicians are in a unique position to recognize patients with potential alcohol problems and intervene when appropriate. Screening, an interview process by which practitioners can identify at-risk drinkers, can be followed by one-time or repeated short counseling sessions, known as brief intervention, which are designed to help the patient reduce drinking and minimize related problems. This article will examine how screening and brief intervention can be implemented in the primary care setting. The levels of screening and intervention described here are summarized in the accompanying table.

SCREENING FOR AT-RISK DRINKING AND ALCOHOL ABUSE AND DEPENDENCE IN PRIMARY CARE SETTINGS

Screening in primary care can vary in scope and intensity from only one question to an extensive assessment using a standardized questionnaire. The level of screening a clinician uses can depend on the patient population, whether patients have co-occurring medical or psychiatric problems, physician skills and interest, and the amount of time available. To make the most of the opportunity to reduce or alleviate patients' alcohol problems, it is critical that physicians practice some level of screening with all patients.

Level 1 Screening

Clinicians under strict time constraints may have only enough time to ask a patient one screening question about alcohol consumption. One study (Taj et al. 1998) has shown that a positive response to the question "On any single occasion during the past 3 months, have you had more than 5 drinks containing alcohol? …

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