The assumption that patients who have a drink problem come rolling into the surgery, stinking of booze is a popular misconception. According to Dr Alex J Mitchell, Consultant at Leicestershire Partnership NHS Trust, the reality is that doctors have difficulty spotting these patients unless they are actually drunk at the time.
A new study published in the British Journal of Psychiatry has revealed that clinicians struggle to detect alcohol problems whether or not patients volunteer information about their drinking. This probably only goes to illustrate the problem of 'denial' as described by addiction specialist Dr Robert Lefever, and the lengths that problem drinkers will go to in order to conceal their problem.
Some Sobering Alcohol Facts
- One in 4 of the adult population in England (33% of men and 16% of women) consumes alcohol in a way that is potentially harmful to their health.
- 6% of men are alcohol dependent.
- One in 6 primary care patients have an alcohol use disorder or are alcohol dependent.
- General practitioners (GPs) identified 40% of problem drinkers, hospital doctors identified 50% of problem drinkers and mental health specialists recognised 55% of problem drinkers.
- Clinicians correctly recorded a diagnosis in the case-notes for only one in 3 people who had an alcohol problem. Only alcohol intoxication was accurately identified.
- A&E clinicians were able to correctly detect patients with alcohol intoxication in 9 out of 10 patients.
- In research studies where patients admitted to a drinking problem by self-report, the same rates of under-detection occurred.
The UK Primary Care Service Framework and National Institute for Health and Clinical Excellence (NICE) recommend that healthcare professionals assess for alcohol problems by using a short questionnaire, but this is not widely used.
On the other hand, Dr Alex Mitchell also said that doctors "...can misidentify about 5% of ‘normal drinkers’ as problem drinkers". He goes on to summarise that “...there needs to be a greater awareness of the importance of carefully assessing alcohol problems for non-intoxicated patients. Patient responses to questioning about drinking habits should not be assumed to be misleading but questioning must be handled sensitively.”
