Getting Physicians to Screen for Problem Drinking

One of CDC Director Tom Freiden’s major priorities is increase the number of doctors who screen their patients for risky drinking.

Is it possible? What are the barriers? Find out from my latest post at Stanford School of Medicine’s SCOPE Blog.

Author: Keith Humphreys

Keith Humphreys is the Esther Ting Memorial Professor of Psychiatry at Stanford University and an Honorary Professor of Psychiatry at Kings College Lonon. His research, teaching and writing have focused on addictive disorders, self-help organizations (e.g., breast cancer support groups, Alcoholics Anonymous), evaluation research methods, and public policy related to health care, mental illness, veterans, drugs, crime and correctional systems. Professor Humphreys' over 300 scholarly articles, monographs and books have been cited over ten thousand times by scientific colleagues. He is a regular contributor to Washington Post and has also written for the New York Times, Wall Street Journal, Washington Monthly, San Francisco Chronicle, The Guardian (UK), The Telegraph (UK), Times Higher Education (UK), Crossbow (UK) and other media outlets.

11 thoughts on “Getting Physicians to Screen for Problem Drinking”

  1. I tend to like this sort of thing. But it has to fly under the radar– a lot of people get very defensive about doctors “invading their privacy” when the issue gets subjected to public debate. For instance, gun rights groups have pushed for laws limiting doctors’ ability to ask about guns in the home, even though there are clear safety and health issues associated with that. (Bear in mind, saying that there are clear safety and health issues associated with it does not mean that, on balance, a parent might not decide to keep a gun at home. It just means that a health care professional could give relevant advice on the issue.)

    And the fat acceptance movement, last I checked, isn’t a big fan of doctors giving unsolicited advice to obese patients to lose weight. (Indeed, this is anecdotal, but many overweight people I have known avoid medical checkups whenever they can partly because they don’t want this sort of advice; to be fair, underweight people with eating disorders also often avoid the doctor.)

    So it’s a good idea (as is just about anything that might reduce the drinking rate without abridging the freedom to drink) but it needs to be promoted quietly.

    1. Interesting point. Suppose that people know that a visit to primary care will mean questions about drinking. Will problem drinkers reduce their use of primary care in order to avoid being asked about drinking? Has this been studied by anyone?

      1. Anecdote is not data, I know, but most casual/social smokers I know tell their doctors they don’t smoke when asked, even though the question is typically phrased such that you’re supposed to say yes if you’ve smoked any tobacco product in the past year.

        1. Anecdotes are indeed not data, but they are hard to resist. I once asked someone who had denied drinking on his chart what was his favorite drink. He said “Seven and Seven,” or something like that; when asked how many he drank, he liked two or three in the evening. I felt ever so clever, just like legendary Dallas homicide detective Will Fritz (who interviewed Lee Harvey Oswald), who once extracted a confession by telephone from a homicide suspect who had been denying everything to the local cops. Fritz informally chatted with him for a while, then said, “You know, you don’t seem to me to be a violent person. This the first time you ever killed anyone?” And the suspect said , “Yessir, first time.”

      2. Interesting question. I sometimes avoid going to the dentist because I know I haven’t been flossing regularly and don’t want to be chastised for it. Looked at objectively it’s ridiculous yet there it is…

    2. ” It just means that a health care professional could give relevant advice on the issue.”

      Not so sure they can, really; A lot of the “medical” research on the subject, by the usual suspects like Kellermann, is of terribly quality. I doubt it would pass scrutiny were the subject something less politically charged, and, bluntly, more medical in nature.

      My general view is that I don’t go to criminologists for cutting edge research on vaccines, and I don’t go to doctors for cutting edge research on criminology.

      In any event, I wouldn’t call the reaction “defensive”, as such. More annoyed than anything. I don’t go to the doctor to have him launch a culture war attack on me.

  2. My favorite point in your post was the reality check that was provided to the objecting medical student in your course.

    Physicians are all about invading their patient’s privacy. If they don’t, they aren’t doing their job well. No, it isn’t any fun to be told, “You have good genes. You could live a long time if you want to. Oh, by the way, if you want to live a long time, you should lose 40 pounds.”

    Yeah, I already knew it. But I also knew I needed the antihypertensive my internist was the gatekeeper for — so I got the lecture, got the drug and dropped most of the weight. I’m working on the rest of the weight.

  3. Another anecdote (apocryphal of course): a man has been seeing a therapist for some time and has narrated all of his sexual hang-ups and odd fantasies in great detail. One day the therapist asks, “How much money do you make” and the man whirls and glares and says, “THAT’S an awfully personal question!”

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