Abstract
BACKGROUND: Professional organizations recommend screening and brief intervention for unhealthy alcohol use; however, brief intervention has established efficacy only for people without alcohol dependence. Whether many medical inpatients with unhealthy alcohol use have nondependent use, and thus might benefit from brief intervention, is unknown.
OBJECTIVE: To determine the prevalence and spectrum of unhealthy alcohol use in medical inpatients.
DESIGN: Interviews of medical inpatients (March 2001 to June 2003).
SUBJECTS: Adult medical inpatients (5,813) in an urban teaching hospital.
MEASUREMENTS: Proportion drinking risky amounts in the past month (defined by national standards); proportion drinking risky amounts with a current alcohol diagnosis (determined by diagnostic interview).
RESULTS: Seventeen percent (986) were drinking risky amounts; 97% exceeded per occasion limits. Most scored ≥ 8 on the Alcohol Use Disorders Identification Test, strongly correlating with alcohol diagnoses. Most of a subsample of subjects who drank risky amounts and received further evaluation had dependence (77%).
CONCLUSIONS: Drinking risky amounts was common in medical inpatients. Most drinkers of risky amounts had dependence, not the broad spectrum of unhealthy alcohol use anticipated. Screening on a medicine service largely identifies patients with dependence—a group for whom the efficacy of brief intervention (a recommended practice) is not well established.
Similar content being viewed by others
References
Saitz R. Unhealthy alcohol use. N Engl J Med. 2005;352:596–607.
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.
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. Washington, DC: National Academy Press; 1990.
Moyer A, Finney JW, Swearingen CE, Vergun P. Brief interventions for alcohol problems: a meta-analytic review of controlled investigations in treatment-seeking and non-treatment-seeking populations. Addiction. 2002;97:279–92.
National Institutes of Health. Helping Patients Who Drink Too Much: A Clinician’s Guide. Bethesda, MD: National Institutes of Health; 2005.
Friedmann PD, Saitz R, Gogineni A, Zhang JX, Stein MD. Validation of the screening strategy in the NIAAA “physicians’ guide to helping patients with alcohol problems.” J Stud Alcohol. 2001;62:234–8.
Rollnick S. Behavior change in practice: targeting individuals. Int J Obes. 1996;20(suppl 1):S22-S26.
Folstein MF, Folstein SE, McHugh PR. “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–98.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edn. Washington, DC: American Psychiatric Association; 1994.
Miller WR, Tonigan J, Longabaugh R. The Drinker Inventory of Consequences (DrInC). An Instrument for Assessing Adverse Consequences of Alcohol Abuse. Test Manual. Project MATCH Monograph Series, 4. Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism; 1995.
De Alba I, Samet JH, Saitz R. Burden of medical illness in drug- and alcohol-dependent persons without primary care. Am J Addict. 2004;13:33–45.
SAS Institute, Inc. SAS/STAT, Version 8.2 [software]. North Carolina: SAS Institute, Inc.; 1999.
Moen R, Batey R. Alcohol-related disease in hospital patients. Med J Aust. 1986;144:515–9.
McCusker J, Cherubin CE, Zimberg S. Prevalence of alcoholism in general municipal hospital population. NY State J Med. 1971;71:751–4.
Corrigan GV, Webb MG, Unwin AR. Alcohol dependence among general medical inpatients. Br J Addict. 1986;81:237–45.
Dawson NV, Dadheech G, Speroff T, Smith RL, Schubert DS. The effect of patient gender on the prevalence and recognition of alcoholism on a general medicine inpatient service. J Gen Intern Med. 1992;7:38–45.
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, In press. Available online November 23, 2005 at: doi:10.1016/j.drugalcdep.2005.10.011. Accessed December 13, 2005.
Emmen MJ, Schippers GM, Bleijenberg G, Wollersheim H. Effectiveness of opportunistic brief interventions for problem drinking in a general hospital setting: systematic review. BMJ. 2004;328:318.
Chick J, Lloyd G, Crombie E. Counselling problem drinkers in medical wards: a controlled study. BMJ (Clin Res Ed). 1985;290:965–7.
Mcmanus S, Hipkins J, Haddad P, Guthrie E, Creed F. Implementing an effective intervention for problem drinkers on medical wards. Gen Hosp Psychiatry. 2003;25:332–7.
Author information
Authors and Affiliations
Corresponding author
Additional information
The authors have no conflicts of interest to declare.
This study was supported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA RO1 12617) and a General Clinical Research Center Grant from the National Center for Research Resources (M01 RR00533).
Rights and permissions
About this article
Cite this article
Saitz, R., Freedner, N., Palfai, T.P. et al. The severity of unhealthy alcohol use in hospitalized medical patients. J Gen Intern Med 21, 381–385 (2006). https://doi.org/10.1111/j.1525-1497.2006.00405.x
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1111/j.1525-1497.2006.00405.x