Physician recognition and treatment of alcoholism
The morbidity, mortality, property damage and lost productivity attributable to alcoholism and alcohol abuse are enormous. Approximately 10 percent of adults entering a physician’s office are likely to have an alcohol problem. Little information exists about whether physicians’ attitudes, beliefs or other characteristics affect their likelihood of recognizing or treating alcoholism. Linn and Yager surveyed internists, family physicians and psychiatrists associated with a major university hospital regarding clinical experiences in assessing and treating alcohol abuse. Practice characteristics, political and religious beliefs, attitudes toward substance abuse, beliefs about the efficacy of treatment, personal experiences with substance abuse and socioeconomic variables were studied.
All full-time physician faculty in medicine and psychiatry were asked to complete self-report questionnaires. In addition, clinical faculty affiliated with the departments of general internal medicine, family medicine, gastroenterology and psychiatry were sent the same questionnaire. Of the 629 questionnaires sent, 303 were completed and returned.
Respondents had the following characteristics: 91 percent were white, 87 percent were men, 85 percent were married and 39 percent were academically based fulltime faculty. About 50 percent were board-certified in internal medicine, 24 percent in psychiatry and 14 percent in family practice; 12 percent were not board-certified. Nonrespondents were somewhat more likely to have been in full-time community-based practice than in a full-time academic setting.
The physician sample reported wide variation in attention to and treatment of alcoholism. Although most (62 percent) of the physicians reported seeing four or more patients over the previous year whose drinking had seriously interfered with their health, physician involvement with diagnosis, treatment or referral was considerably less. Nearly 30 percent of the sample reported never having diagnosed an alcohol problem in a patient who had not previously been diagnosed by another physician. About one-third neither regularly counseled patients about alcohol problems nor had referred anyone for outpatient rehabilitation. About half (52 percent) had not referred a patient for inpatient treatment of alcoholism during the year prior to the study.
The physicians who reported more diverse experiences diagnosing and treating alcoholism were significantly more likely to be in high-volume, community-based primary care practices and were significantly less likely to be engaged in academic pursuits. A high degree of physician experience with alcoholism correlated with a higher volume of patient care in the previous two weeks. A stronger belief in the efficacy of treating alcoholism, membership in the Republican party and a greater degree of religious beliefs were also associated with breadth of experience in diagnosing and treating alcoholism. Higher levels of physician experience with alcoholism were negatively related to time spent in administrative activities, classroom teaching and research.
Family physicians reported having more diverse experience working with alcoholic patients than board-certified internists or uncertified physicians. Board-certified psychiatrists and subspecialists were significantly less likely to report having such patient experiences. Recognizing and treating alcoholism were unrelated to physicians’ current or previous use of alcohol or marijuana.
The authors believe that teaching hospitals must do more to integrate the diagnosis and treatment of alcoholism into the clinical and academic environments. In addition, the authors suggest that internists, psychiatrists, subspecialists and older physicians need to raise their consciousness about alcoholism and improve their treatment skills. (Western Journal of Medicine, April 1989, vol. 150, p. 468.)