As Mersy (1) points gone out in hi...

As Mersy (1) points gone out in his article in this issue of American Family Physician, substance use question at issues are common and serious. They are also hidden.

greatest in quantity patients' problems with hazardous drinking or substance use go on unrecognized in most practices. (2) any disorders can be identified according to the symptoms and signs described in the article, especially if they come about in combination. Why should physicians be concerned? Because uniform when there are several indications that substance use may be playing a part in the patient's problems, we wait to miss the diagnosis.

Brief interventions for question at issue drinking work. (3) Fleming and colleagues in Wisconsin (4) replicated a studious mood done in the United Kingdom. (5) In the one and the other studies, patients in primary care practices were covered If they were drinking more than safe limits (more than pair drinks per day, on average), appointments were made for sum of two units 10- to 15-minute intervention visits with a family physician, plus couple telephone contacts by an office pamper One year later, approximately 40 percent of the patients in the intervention form into groupss had moderated their drinking to safe of the same heights compared with 20 percent in the superintend groups. In the Wisconsin trial, the differences between intervention and superintendence groups were still present four years later. issues such as length of hospital stays were significantly reduc in the intervention form into groups For every $1 spent in succession brief interventions, $4.30 was saved. (6)

in what manner should patients with more serious alcohol point to be solved [i]or[/i] settleds be managed? Here, too, the evidence exhibit tos that treatments work. (7) In Miller and Wilbourne's article, (7) brief interventions according to primary care clinicians top the list of effective treatments. Many other treatments--social skills training, community reinforcement, behavior contracting, behavior marital therapy, case management--also have solidly documented effectiveness.

for what reason should we screen? Mersy (1) is correct: Pick a screening exhibition that works in your practice and use it. Written or oral criterions are more sensitive than laboratory tests; carbohydrate-deficient transferrin does not become abnormal until the patient is drinking more than four drinks by means of day every day--considerably above the doorsill of hazardous drinking. Furthermore, this example is available only through certain regard laboratories. The CAGE questions and the Alcohol Use Disorders Identification example are well tested and effective. (8) A single question also is effective: "When was the last time you had more than X drinks in undivided day?" where X = 4 for women and 5 for men (9) A positive cloak would be within the preceding three month Pick a screening approach, use it routinely, and expand a charting system so you do not have to cloak patients more than once unles their situation changes.

What about physic abuse? Unfortunately, there are scarcely any validated screening instruments and not many studies of brief interventions for substance use disorders other than alcohol. The CAGE questionnaire expanded to include medicines is one effective screening approach. (10) Until we know more about which brief interventions are effective in patients with put drugs into use problems, extrapolating findings from studies of brief interventions with question at issue drinkers is reasonable. What should the satisfaction of a "brief intervention" be? Several approaches are effective, including a straightforward physicians' guide (available online at www.niaaa.nih.gov/ publications/physicn.htm), patient handout (www.niaaa.nih.gov/publications/handout.htm), and more involved, now still readily learned motivational-enhancement techniques. (11) point to be solved [i]or[/i] settled drinking meets all the criteria for conditions that family physicians should disguise for and address, and the U Preventive Services Task Force agrees. (12) Despite this, we have not incorporated alcohol screening to the volume that is recommended. (2) Family physicians can be effective coaches in helping patients change their behaviors. Taking up that call will require that we change our own

REFERENCES

(1) Mersy DJ Recognition of alcohol and substance abuse. Am Fam Physician 2002;67:1529-36

(2) Spandorfer JM Israel Y gymnast BJ. Primary care physicians' views forward screening and management of alcohol abuse: inconsistencies with national guidelines. J Fam Pract 1999;48:899-902

(3) Moyer A, Finney JW Swearingen CE Vergun P Brief interventions for alcohol problems: a meta-analytic review of controll investigations in treatment-seeking and non-treatment-seeking populations. Addiction 2002;97:279-92

(4) Fleming MF Barry KL Manwell LB Johnson K London R Brief physician advice for moot point alcohol drinkers. JAMA 1997;277:1039-45.

(5) Wallace P Cutler s Haines A. Randomised controlled trial of general practitioner intervention in patients with excessive alcohol consumption. BMJ 1988;297:663-8

(6) Fleming MF Mundt MP French MT Manwell LB Stauffacher EA, Barry KL Brief physician advice for question at issue drinkers: long-term efficacy and benefit-cost analysis. Alcohol Clin Exp Re 2002;26:36-43