The severity of unhealthy alcohol use in hospitalized medical patients

The spectrum is narrow
  • Richard Saitz
  • Naomi Freedner
  • Tibor P. Palfai
  • Nicholas J. Horton
  • Jeffrey H. Samet
Populations At Risk


BACKGROUND: Professional organizations recommend screening and brief intervention for unhealthy alcohol use; however, brief intervention has established efficacy only for people without alcohol dependence. Whether many medical inpatients with unhealthy alcohol use have nondependent use, and thus might benefit from brief intervention, is unknown.

OBJECTIVE: To determine the prevalence and spectrum of unhealthy alcohol use in medical inpatients.

DESIGN: Interviews of medical inpatients (March 2001 to June 2003).

SUBJECTS: Adult medical inpatients (5,813) in an urban teaching hospital.

MEASUREMENTS: Proportion drinking risky amounts in the past month (defined by national standards); proportion drinking risky amounts with a current alcohol diagnosis (determined by diagnostic interview).

RESULTS: Seventeen percent (986) were drinking risky amounts; 97% exceeded per occasion limits. Most scored ≥ 8 on the Alcohol Use Disorders Identification Test, strongly correlating with alcohol diagnoses. Most of a subsample of subjects who drank risky amounts and received further evaluation had dependence (77%).

CONCLUSIONS: Drinking risky amounts was common in medical inpatients. Most drinkers of risky amounts had dependence, not the broad spectrum of unhealthy alcohol use anticipated. Screening on a medicine service largely identifies patients with dependence—a group for whom the efficacy of brief intervention (a recommended practice) is not well established.

Key words

hospital inpatient alcohol screening brief intervention 


  1. 1.
    Saitz R. Unhealthy alcohol use. N Engl J Med. 2005;352:596–607.CrossRefPubMedGoogle Scholar
  2. 2.
    US Preventive Services Task Force. Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: recommendation statement. Ann Intern Med. 2004;140:554–6.Google Scholar
  3. 3.
    Institute of Medicine. Broadening the Base of Treatment for Alcohol Problems: Report of a Study by a Committee of the Institute of Medicine, Division of Mental Health and Behavioral Medicine. Washington, DC: National Academy Press; 1990.Google Scholar
  4. 4.
    Moyer A, Finney JW, Swearingen CE, Vergun P. Brief interventions for alcohol problems: a meta-analytic review of controlled investigations in treatment-seeking and non-treatment-seeking populations. Addiction. 2002;97:279–92.CrossRefPubMedGoogle Scholar
  5. 5.
    National Institutes of Health. Helping Patients Who Drink Too Much: A Clinician’s Guide. Bethesda, MD: National Institutes of Health; 2005.Google Scholar
  6. 6.
    Friedmann PD, Saitz R, Gogineni A, Zhang JX, Stein MD. Validation of the screening strategy in the NIAAA “physicians’ guide to helping patients with alcohol problems.” J Stud Alcohol. 2001;62:234–8.PubMedGoogle Scholar
  7. 7.
    Rollnick S. Behavior change in practice: targeting individuals. Int J Obes. 1996;20(suppl 1):S22-S26.Google Scholar
  8. 8.
    Folstein MF, Folstein SE, McHugh PR. “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–98.CrossRefPubMedGoogle Scholar
  9. 9.
    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edn. Washington, DC: American Psychiatric Association; 1994.Google Scholar
  10. 10.
    Miller WR, Tonigan J, Longabaugh R. The Drinker Inventory of Consequences (DrInC). An Instrument for Assessing Adverse Consequences of Alcohol Abuse. Test Manual. Project MATCH Monograph Series, 4. Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism; 1995.Google Scholar
  11. 11.
    De Alba I, Samet JH, Saitz R. Burden of medical illness in drug- and alcohol-dependent persons without primary care. Am J Addict. 2004;13:33–45.CrossRefPubMedGoogle Scholar
  12. 12.
    SAS Institute, Inc. SAS/STAT, Version 8.2 [software]. North Carolina: SAS Institute, Inc.; 1999.Google Scholar
  13. 13.
    Moen R, Batey R. Alcohol-related disease in hospital patients. Med J Aust. 1986;144:515–9.PubMedGoogle Scholar
  14. 14.
    McCusker J, Cherubin CE, Zimberg S. Prevalence of alcoholism in general municipal hospital population. NY State J Med. 1971;71:751–4.Google Scholar
  15. 15.
    Corrigan GV, Webb MG, Unwin AR. Alcohol dependence among general medical inpatients. Br J Addict. 1986;81:237–45.CrossRefPubMedGoogle Scholar
  16. 16.
    Dawson NV, Dadheech G, Speroff T, Smith RL, Schubert DS. The effect of patient gender on the prevalence and recognition of alcoholism on a general medicine inpatient service. J Gen Intern Med. 1992;7:38–45.CrossRefPubMedGoogle Scholar
  17. 17.
    Roche AM, Freeman T, Skinner N. From data to evidence, to action: findings from a systematic review of hospital screening studies for high risk alcohol consumption. Drug Alcohol Depend, In press. Available online November 23, 2005 at: doi:10.1016/j.drugalcdep.2005.10.011. Accessed December 13, 2005.Google Scholar
  18. 18.
    Emmen MJ, Schippers GM, Bleijenberg G, Wollersheim H. Effectiveness of opportunistic brief interventions for problem drinking in a general hospital setting: systematic review. BMJ. 2004;328:318.CrossRefPubMedGoogle Scholar
  19. 19.
    Chick J, Lloyd G, Crombie E. Counselling problem drinkers in medical wards: a controlled study. BMJ (Clin Res Ed). 1985;290:965–7.CrossRefGoogle Scholar
  20. 20.
    Mcmanus S, Hipkins J, Haddad P, Guthrie E, Creed F. Implementing an effective intervention for problem drinkers on medical wards. Gen Hosp Psychiatry. 2003;25:332–7.CrossRefPubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 2006

Authors and Affiliations

  • Richard Saitz
    • 1
    • 2
    • 3
  • Naomi Freedner
    • 1
    • 2
  • Tibor P. Palfai
    • 2
    • 4
  • Nicholas J. Horton
    • 5
  • Jeffrey H. Samet
    • 1
    • 6
  1. 1.Clinical Addiction Research and Education (CARE) Unit, Section of General Internal MedicineBoston Medical Center and Boston University School of MedicineBostonUSA
  2. 2.Youth Alcohol Prevention CenterBoston University School of Public HealthBostonUSA
  3. 3.Department of EpidemiologyBoston University School of Public HealthBostonUSA
  4. 4.Department of Psychology, College of Arts and SciencesBoston UniversityBostonUSA
  5. 5.Department of MathematicsSmith CollegeNorthamptonUSA
  6. 6.Department of Social and Behavioral SciencesBoston University School of Public HealthBostonUSA

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