Smoking Status as a Clinical Indicator for Alcohol Misuse in US Adults

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Abstract
The current National Institute on Alcoholism and Alcohol Abuse (NIAAA) Clinician's Guide, Helping Patients Who Drink Too Much,1 not only recommends screening for alcohol use disorders but also advocates screening for less severe “at risk” or hazardous drinking. The US Preventive Services Task Force (USPSTF)2 recommends screening for alcohol misuse (which includes hazardous drinking, alcohol abuse, and alcohol dependence) and has assigned a grade-B recommendation for screening and brief interventions for hazardous alcohol consumption in primary care settings. Even though screening3-6 and brief interventions7,8 provided in primary care settings are effective, clinicians have low rates of adherence to the guidelines for screening for alcohol misuse.9,10 Using a national sample, Edlund et al11 estimate that only 30% of individuals who had a primary care visit reported being screened for an alcohol or drug use problem. In contrast, physicians are much more likely to screen and apply brief interventions to address smoking behavior.12,13 Studies of physician and patient reports and medical record reviews find that the majority of primary care patients are screened for smoking status (81%).14 Smoking status is more likely to be recorded in the medical chart than is drinking behavior.15,16 Studies of medical patients suggest that smoking status and alcohol misuse are highly associated, such that current smoking status may be used to help identify problem drinkers.17-21 In a sample of German medical patients, the rate of daily smoking was 47.1% in those with alcohol misuse, compared with 18.4% in the general population.20 In a sample of medical and dental patients, the rate of hazardous drinking was 20.3% in current smokers and 11.7% in current nonsmokers.21