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Am Fam Physician. 2002;66(2):209

to the editor: I would like to thank the authors of Problem Drinking and Alcoholism: Diagnosis and Treatment1 for highlighting problem drinking and alcoholism. These problems are common: 7 percent of adults in the United States meet criteria for a current diagnosis of alcohol abuse or dependence, and 15 percent have had at least one episode of very heavy drinking in the past 30 days.

This article1 makes it clear that the problems associated with alcohol abuse are often hidden, yet profoundly damaging to patients, their families, and the community. A study2 showed that brief intervention has been shown to reduce emergency department visits and hospital stays significantly, even four years later. This study also found that intervention resulted in a reduction in mortality that was significant at three years, but not at four years, and that there was a substantial reduction in health care and societal costs at all follow-up times.2

If a problem is serious but hidden, and if intervention before the patient has symptoms that are obvious to the physician makes a difference in patient-relevant outcomes, then physicians must screen for it.

Simpler screens are easier to use and more likely to become part of our office, hospital, and emergency department routines. We have developed3 and validated4 a single question that is 86 percent sensitive and 86 percent specific in identifying patients with past-month hazardous drinking and/or current alcohol abuse or dependence: “When was the last time you had more than X (five for men, four for women) drinks in one day?” The criterion we used for a “positive screen” was any time in the last three months.

Further work is needed to make brief interventions part of routine family practice but, we believe, this screening question is a very useful first step.

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This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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