The next frontier of the fight against alcoholism isn’t occurring in treatment centers. It isn’t happening in recovery hotspots like California, Arizona, or Florida. It isn’t in the rooms of Alcoholics Anonymous or in legislation being passed in Washington DC.
It’s happening in primary care physicians’ offices in every city and town across the country.
At least, that’s what this great article on identifying alcoholic patients suggests. Published on American Medical New’s website, it examines how primary care physicians are often the first ones to realize someone’s struggling with alcohol or other substances.
Except there’s a problem – many general practitioners aren’t trained properly on identifying and treating alcohol use disorders. This includes seemingly ever-prevalent binge drinking and heavy drinking.
We’re going to take a closer look at this thought provoking article, how your neighborhood doctor’s on the front lines of alcoholism, how to better train physicians on spotting alcohol abuse in all its forms, and finally on some tips doctors can use to get patients to open up about their drinking.
Primary Care Physicians are on the Front Lines
“You can’t practice primary care without seeing patients with current or past alcohol problems every day,” according to Dr. Patrick O’Connor, the Chief of General Internal Medicine at the Yale School of Medicine (American Medical News)
This is the sad truth of both America’s drinking habits and of practicing medicine today. Thanks to the prevalence of alcohol in our society and the difficulty of seeking specialized alcohol abuse treatment, the bulk of alcoholic care falls on general practitioners’ shoulders.
Another contributor to the article, Dr. Nicholas Pace, a Clinical Associate Professor at NYU’s Langone Medical Center, went on to stress the importance that primary care physicians play. He said, “In many cases, if the doctor doesn’t get involved, the patient dies” (American Medical News).
That clearly establishes the stakes our community doctors are playing with. This urgency extends even beyond the life-or-death situations. In fact, according to Dr. Raye Litten, Associate Director of the National Institute on Alcohol Abuse and Alcoholism’s Division of Treatment and Recovery Research, around 18 million people in America suffer from some sort of alcohol use disorder. An additional 40 million are what’s called high-risk drinkers (taking upwards of four drinks per day or 14 drinks per week).
It seems like primary care doctors should be able to spot, diagnose, and refer alcoholic and risky drinking patients like clockwork. This simply isn’t the case. In fact, according to a recent report from The National Center on Addiction and Substance Abuse, “a majority of health professionals are not sufficiently trained to identify or diagnose substance abuse.”
But They’re Often Undertrained
There are a number of reasons for primary care physicians lack of training and experience with substance abuse. The first and most obvious centers on the training they receive, or don’t receive, in med school.
Dr. O’Connor noted that because there’s so much to cover in the four years of med school areas like alcoholism is often thrown to the side. He went on to say, “Given that alcohol use disorders are so common in medical populations, it’s ridiculous to think that it’s ignored as much as it is” (American Medical News).
Let’s think about that for one second. A progressive and deadly medical condition that impacts as many as 40 million people, or over 10% of the entire United State’s population, isn’t given any serious consideration in medical schools and graduate/residency programs.
That just doesn’t seem right.
It’s worth noting that under training isn’t the only reason general practitioners have such a hard time identifying alcohol abuse in their patients. According to Dr. Jeff Samet, the President of the American Board of Addiction Medicine,
“With primary care, if you’re seeing a patient in a usual clinic, there are so many issues on the table that this one may be lost in the shuffle” (American Medical News).
Tips & Tricks to Help Alcoholic Patients
We’re about to explore several different ways for doctors to become more effective at identifying alcohol use disorders in their patients. Before going into specific strategies, though, Dr. Litten of the NIAAA has some very simple advice.
He recommends using the NIAAA Guide for Doctors and asking one simple question – “how many times in the past year have you had more than five drinks at one time?”
According to Dr. Litten, asking this simple questions can help general practitioners identify as many as 82% of people who have some sort of alcohol problem.
Those sound like some good numbers to me! Okay, onto other tips and tricks for identifying alcoholic patients.
GET CONFIDENTIAL HELP NOW!
The NIAAA has a four-step process for helping doctors identify patients who may be at risk for alcoholic drinking.
- Step one is as simple as asking about a patient’s drinking
- Step two is looking at how a patient’s drinking is negatively impacting their life and beginning to establish if they have symptoms of alcohol dependence
- Step three is advising patients of their condition and helping them develop a plan (this can include residential alcohol treatment)
- Step four is offering follow up and continuing support
Dr. O’Connor recommends a mix of paying attention to secondary symptoms that may indicate alcoholism (think liver issues, high blood pressure, an unhealthy diet, psychological trouble, etc.) and making it clear to patients that any and all discussions are confidential. This dual approach is likely to make patients displaying signs of problem drinking more comfortable and more likely to answer honestly when asked about their drinking habits.
Dr. David Bronson, the President of the American College of Physicians, recommends that primary care physicians be nonjudgemental on the subject of alcoholism. He says “You have to make them feel comfortable about it…It should be a routine for all of [their] patients” (American Medical News).
He goes on to note that any personal feelings about alcohol abuse, as well as asking about a patient’s alcohol use right away, may make patients feel attacked and be less likely to speak honestly about their alcohol consumption.
It’s clear that both alcohol use and the under-diagnosis of alcohol use disorders riddle every level of the medical world. There’s no silver bullet solution. This isn’t going to change overnight. Still, honest discussions and calls to action, like this one from American Medical News, are the first step to change.
What do you think? Let us know on our Facebook page!