Clinicians are missing alcohol problems in almost three out of four patients because they don't screen for the behavior and instead go with their gut feelings to catch the problem, according to a study published this week in the Annals of Family Medicine. Experts say asking patients a few questions about their drinking habits can lead to interventions that may help patients cut back on their risky behavior.

The study

Researchers wanted to find out how well doctors identified drinking problems in their patients. Almost 1,700 adults from 40 different primary care practices completed questionnaires at the end of an office visit. They were asked a variety of lifestyle questions and several addressed drinking habits, such as how often they drank alcohol, how many drinks they had on a typical day, and if their drinking ever put them in danger of getting hurt or causing an accident.

When doctors relied on their best guess or hunch about whether or not a person was drinking too much, they missed almost three out of four patients who screened positive for alcohol problems. When the doctors did suspect a drinking problem, however, their instincts were usually right.

"This study provides proof of what a lot of people have known, that systems and offices should really develop a way to do simple screening (for alcohol use) along with taking vital signs. It could be part of team-based care," says Dr. Dave Mersey, a family physician in Tucson, Arizona.

The bottom line

Though alcohol screening is recommended by the U.S. Preventive Services Task Force, it is generally not part of routine primary care, according to Mersey.

When doctors fail to identify cases of risky drinking they are missing out on opportunities to help patients change their drinking habits. Previous studies have shown that when family doctors identified and then provided brief counseling sessions, that patients were more likely to cut back on their alcohol.

"I hope that by papers like this, it's going to be a nudge to physician to say ... 'Maybe I should start screening.' It's not that hard to do," explains study author Dr. Daniel Vinson, professor of family and community medicine at the University of Missouri School of Medicine in Columbia, Missouri.

Risky drinking