do we have a problem?

Reply Mon 12 Sep, 2005 05:32 pm
One drink too many

NIAAA scientists revise guidelines clinicians can use to assess alcohol problems.

Print version: page 62

When the World Health Organization released its 2002 "Reducing Risks: Promoting Healthy Lifestyles" report, those who treat substance use and other mental health disorders were probably not surprised by the data. The report characterized causes of disability by illness category, and alcohol use was second only to unipolar depression among 15- to 44-year-olds in the United States and Canada. Survey data collected by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) indicate that fully 30 percent of the U.S. adult population uses alcohol in a manner that places them at risk for physical, mental health and social problems, and 25 percent of that population would meet diagnostic criteria for current abuse or dependence.

What may be surprising is how much of this heavy drinking goes undetected. A 2003 New England Journal of Medicine study reported that patients with alcohol dependence received recommended standards of care, including assessment and referral, only 10 percent of the time. Based on that and other similar studies, NIAAA Director T.K. Li, MD, decided that when Mark Willenbring, MD, became the new director of the NIAAA Division of Treatment and Recovery Research, a top priority of his would be to re-evaluate and revise the division's screening guide for clinicians. The resulting 2005 edition "Helping Patients Who Drink Too Much: A Clinician's Guide" was designed to broaden the target audience and provide a simpler screening method.

A single question

The last edition of the guidelines, released in 2003, focused on primary-care practitioners, but Willenbring--a psychiatrist by training who brought a "many hands make light work" philosophy with him to NIAAA--determined that expanding the clinician base to include mental health providers would be essential. Why? Substance use disorders, primarily alcohol use disorders, are more prevalent in patients with other mental health problems than in the general population, and many mental health patients do not regularly see primary-care providers.

Indeed, two surveys conducted by the Practice Directorate (in fall 2002 and fall 2003), using its Internet-based survey system PracticeNet, found that about a quarter of patients seen by participating psychologists had either a current or past substance use problem. However, only half of those patients were assigned a substance use diagnosis--suggesting that assessing for diagnosis alone may not be sufficient in capturing the number of patients with problems. Clinicians who had obtained continuing education in substance abuse during the past year were more likely to have ever discussed substance use with their clients and to be treating someone identified as having a substance use problem. For more PracticeNet results, or to participate, go to www.apapracticenet.net.

Willenbring decided that the NIAAA guide must make it easier for clinicians to screen patients. The 2003 edition relied on a time-tested instrument, the Alcohol Use Disorders Identification Test, and heavily structured interviews. While those methods were true to the science in that they had been evaluated for sensitivity in rigorous clinical trials, they were somewhat impractical to administer in the real world.

"It's not realistic to expect busy practitioners to recall and administer structured weighted questions in detail, and requiring use of an elaborate instrument severely limits the numbers of people actually willing to do it," says Willenbring.

By examining a range of published epidemiologic and treatment research as well as NIAAA's own National Epidemiologic Survey on Alcohol Use and Related Conditions, Willenbring and his colleagues chose to pare the screening down to a single question with follow-up as required.

"We settled on a single question focused on whether any heavy drinking days had occurred in the prior 12 months, since virtually everyone with alcohol-related disorders at least occasionally engaged in heavy drinking," Willenbring says. His NIAAA colleagues, APA members Harold Perl, PhD, and Bob Huebner, PhD, who worked on the revision with Willenbring, say the decision was a good call.

"The 2005 edition achieves a good balance between the 'real' and the 'ideal' as is often the case in trying to accommodate research in evidence-based practice," says Huebner.


this isnt so much politics but this is a social issue. the stats in this artical shocked me.
  • Topic Stats
  • Top Replies
  • Link to this Topic
Type: Discussion • Score: 1 • Views: 1,413 • Replies: 2
No top replies

Brent cv
Reply Thu 15 Sep, 2005 12:27 am
I don't believe so honestly...
0 Replies
Reply Thu 15 Sep, 2005 01:02 am
I don't get what they're trying to say. Are they just pointing out the fact that today's population drinks more than past populations and someone is using deductive thinking ot come up with a normative statement in my opinion. People have always drank, people will always continue to drink. Sure some people carry it over the limit, but these are the few ones. I guess what the article is trying to point out is how too much alcohol is bad for you. Ever heard the statement "too much of a good thing is a bad thing"? Same concept here, too much of anything will cause illnesses.

I just realized I have no idea where I was going with all that, do I think we have a problem? yes. Do I have an opinion on what to do about it? no.
0 Replies

Related Topics

Obama '08? - Discussion by sozobe
Let's get rid of the Electoral College - Discussion by Robert Gentel
McCain's VP: - Discussion by Cycloptichorn
Food Stamp Turkeys - Discussion by H2O MAN
The 2008 Democrat Convention - Discussion by Lash
McCain is blowing his election chances. - Discussion by McGentrix
Snowdon is a dummy - Discussion by cicerone imposter
TEA PARTY TO AMERICA: NOW WHAT?! - Discussion by farmerman
  1. Forums
  2. » do we have a problem?
Copyright © 2023 MadLab, LLC :: Terms of Service :: Privacy Policy :: Page generated in 0.09 seconds on 06/10/2023 at 04:50:33