Abstract
Objectives: To determine whether rates of addressing alcohol use differed between family medicine and internal medicine residents, and to determine whether attitudes, confidence, and perceptions affected these relationships.
Setting: Two university outpatient clinics, one staffed by family medicine and the other by primary care and categorical internal medicine residents.
Design: Cross-sectional study of consecutive patients who had been followed by second- and third-year residents for at least one year.
Measurements: Alcohol abuse was determined using the Michigan Alcoholism Screening Test (MAST), with a score a 5 considered positive. Rates of addressing alcohol use in the preceding year were determined by patient report and chart review. Attitudes were assessed using the Substance Abuse Attitude Survey (SAAS).
Results: 334 patients of 49 residents completed the MAST. Rates of alcoholism among the patient groups were: family medicine, 8.3%; primary care, 29.1%; and categorical medicine, 18.0% (p<0.001). Screening behavior varied by type of residency: 47% of the family medicine, 71% of the primary care, and 65% of the categorical residents’ patients reported being asked about alcohol use in the preceding year (p<0.001); chart documentation was present for 15% of the family medicine, 38% of the primary care, and 24% of the categorical residents’ patients (p<0.001). Perceived prevalence of alcohol abuse, confidence in intervening, and several scales on the SAAS were related to residency type and to addressing alcohol use, but controlling for these variables did not affect the association between residency type and either patient report or chart documentation of screening.
Conclusion: Rates of addressing alcohol use differed for internal medicine and family medicine residents, but were not due to differences in resident perceptions and attitudes.
Similar content being viewed by others
References
Moore RD, Malitz FE. Underdiagnosis of alcoholism by residents in an ambulatory medical practice. J Med Educ. 1986;61:46–52.
Coulehan JL, Zettler-Segal M, Block M, McClelland M, Schulberg HC. Recognition of alcoholism and substance abuse in primary care residents. Arch Intern Med. 1987;147:349–52.
Woodall HE. Alcoholics remaining anonymous: resident diagnosis of alcoholism in a family practice center. J Fam Pract. 1988;26:293–6.
Cleary PD, Miller M, Bush BT, Warburg MM, Delbanco TL, Aronson MD. Prevalence and recognition of alcohol abuse in a primary care population. Am J Med. 1988;85:466–71.
Buchsbaum DG, Buchanan RG, Poses RM, Schnoll SH, Lawton MJ. Physician detection of drinking problems in patients attending a general medicine practice. J Gen Intern Med. 1992;7:517–21.
Kristenson H, Ohlin H, Hulten-Nosslin MB, Trell E, Hood B. Identification and intervention of heavy drinking in middle-aged men: results and follow-up of 24–60 months of long-term study and randomized controls. Alcoholism. 1983;7:203–9.
Drummond DC, Thorn B, Brown C, Edwards G, Mullan MJ. Specialist versus general practitioner treatment of problem drinkers. Lancet. 1990;336:915–8.
Walsh DC, Hingson RW, Merrigan DM, et al. The impact of a physician’s warning on recovery after alcoholism treatment. JAMA. 1992;267:663–7.
Lewis DC, Niven RG, Czechowicz D, Trumble JG. Review of medical education in alcohol and other drug abuse. JAMA. 1987;257:2945–8.
McClure CL, Gall EP, Meredith KE, Gooden M, Boyer JT. Family practice and internal medicine clinical judgment in a university setting. J Fam Pract. 1986;22:443–8.
Bander KW, Goldman DS, Schwartz MA, Rabinowitz E, English JT. Survey of attitudes among three specialties in a teaching hospital toward alcoholics. J Med Educ. 1987;62:17–24.
Warburg MM, Cleary PD, Rohman M, Barnes HN, Aronson M, Delbanco TL. Residents’ attitudes, knowledge, and behavior regarding diagnosis and treatment of alcoholism. J Med Educ. 1987;62:497–503.
Geller G, Levine DM, Mamon JA, Moore RD, Bone LR, Stokes EJ. Knowledge, attitudes, and reported practices of medical students and house staff regarding the diagnosis and treatment of alcoholism. JAMA. 1989;261:3115–20.
Selzer ML. The Michigan Alcoholism Screening Test: the quest for a new diagnostic instrument. Am J Psychiatry. 1971;127:1653–8.
Selzer ML, Vinokur A, von Rooijen L. A self-administered short Michigan Alcoholism Screening Test (SMAST). J Stud Alcohol. 1975;36:117–26.
Chappel JN, Veach TL, Krug RS. The substance abuse attitude survey: an instrument for measuring attitudes. J Stud Alcohol. 1985;46:48–52.
Whiting-O’Keefe QE, Henke C, Simborg DW. Choosing the correct unit of analysis in medical care experiments. Med Care. 1984;22:1101–14.
Divine GW, Brown JT, Frazier LM. The unit of analysis error in studies about physicians’ patient care behavior. J Gen Intern Med. 1982;7:623–9.
Chappel JN, Veach TL. Effect of a course on students’ attitudes toward substance abuse and its treatment. J Med Educ. 1987;62:395–400.
Seale JP, Amodei N, Bedolla M, et al. Evaluation of residency training in substance abuse: a summary of 3 years’ experience. Subst Abuse. 1992;13:234–43.
Feinstein AR. Clinimetrics. New Haven, CT: Yale University Press, 1987.
Wechsler H, Levine S, Idelson RA, Rohman M, Taylor JO. The physician’s role in health promotion—a survey of primary-care practitioners. N Engl J Med. 1983;308:97–100.
Valente CM, Sobal J, Munie HL Jr, Levine DM, Autlitz AM. Health promotion: physicians’ beliefs, attitudes, and practices. Am J Prev Med. 1986;2:82–88.
Wells KB, Lewis CE, Leake B, Schleiter MK, Brook RH. The practices of general and subspecialty internists in counseling about smoking and exercise. Am J Public Health. 1986;76:1009–13.
Author information
Authors and Affiliations
Additional information
Supported in part by the Center for Substance Abuse Prevention, grant number AA07526.
Rights and permissions
About this article
Cite this article
Schorling, J.B., Klas, P.T., Willems, J.P. et al. Addressing alcohol use among primary care patients. J Gen Intern Med 9, 248–254 (1994). https://doi.org/10.1007/BF02599649
Issue Date:
DOI: https://doi.org/10.1007/BF02599649