Should your doctor ask about alcohol use to screen for risky drinking?
While Canada has its share of guidelines on heavy drinking, Canadian doctors are suggesting more needs to be done to shed light on the issue.
Canadian guidelines call for no more than 10 drinks per week for women and a maximum of 15 drinks per week for men, but it’s estimated that up to 20 per cent of the country is drinking more than the recommendations.
“A lot of people don’t meet criteria for alcohol use disorder but they’re at risk because they’re drinking more than the safe amount,” Dr. Sheryl Spithoff, a family physician at Toronto’s Women’s College Hospital, said.
“It happens in all age groups. It is common in younger adults but it definitely happens in older adults, too. People who participate in binge drinking have stable lives, relationships and jobs but they drink heavily intermittently. They don’t perceive themselves to be at risk from this but they are,” she warned.
In a commentary published Monday in the Canadian Medical Association Journal, Spithoff and her St. Michael’s Hospital colleague Dr. Suzanne Turner urge frontline health care workers to do more to screen for at-risk drinkers.
Their piece accompanies an American review – also published in the CMAJ – that provides tips for doctors who aren’t addictions specialists so they can pay attention to potential red flags.
The doctors reason that family doctors should be the point-person to screen for heavy drinking – patients are more likely to be receptive because of the established relationship.
Doctors should ask at annual checkups but also during appointments. It’s a matter of asking patients if they drink, and if so, how often and how much. It’d take roughly five to 15 minutes and if a risk is identified, doctors can hand over materials to help with changing behaviour or strategies to cut down on drinking.
In follow-up, if the problem worsens, the U.S. doctors say patients can be referred to specialized treatment. Keep in mind, patients would probably appreciate intervention at the primary care setting than entering a formal addictions program down the road, they note.
Canada already has a laundry list of guidelines for identifying at-risk drinkers. The problem is, the conversation can be awkward for some physicians, so outlined procedures aren’t often carried out, Spithoff said.
Right now, addictions education is scant in Canadian medical schools, few primary care clinics and emergency departments screen for alcohol abuse and not all hospitals have addictions medicine specialists, she warned.
“Physician studies show they feel uncomfortable bringing [binge drinking] up, but patients do expect their doctors to ask about something like this. It’s very simple and doesn’t take a lot to do,” Spithoff said.
There isn’t a lot of Canadian data on alcohol screening, but a large U.S. survey found that only 30 per cent of doctors were regularly asking about alcohol use and an even smaller portion of that group was using validated screening tests.
“It’s all self-reported so we don’t actually know what’s happening out there,” Spithoff said.
In her family practice, she’s already taken to asking her patients about their drinking habits. Putting it on her patients’ radar has helped them make adjustments.
Short-term risks of over-drinking include car crashes and alcohol poisoning. In the long run, binge drinking can be tied to eight types of cancers, along with liver disease and high blood pressure, Spithoff says.
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