Early Detection and Basic Management of Alcohol and Drug Problems

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Abstract
Traditional approaches to the treatment of alcoholism have focused on the chronic alcoholic where limited impact has been achieved in terms of improvement in health or reduction in social costs. If individuals could be identified shortly after their drinking problem develops, then successful treatment by brief intervention is more likely. Although the prevalence of alcoholism in North America is around 5 to 7% of the adult population, a much larger group (20–30%) of individuals have drinking problems without major symptoms of alcohol dependence. These problem drinkers are the target audience for early identification and brief intervention. A major thrust of my research has been the development of practical assessment tools for use by health and social service professionals. One line of research has evaluated the diagnostic value of laboratory tests and medical history data. A brief, 5‐item history of traumatic injuries (Trauma Scale) correctly identified 7 out of 10 problem drinkers, and diagnostic accuracy was further improved by combining the Trauma Scale and 3 laboratory tests in a composite index. This index could be used in medical settings as an “indirect” method of detecting excessive drinking. Another research line has produced questionnaires that directly inquire about alcohol/drug problems. These instruments can be used as case finding tools to signal the presence of an alcohol or drug problem (e.g., Drug Abuse Screening Test), or, at a subsequent stage of assessment, to provide more detailed information on the severity of the problem and treatment priorities. I have concentrated on evaluating a computerised lifestyle assessment of patients visiting their family doctor. The availability of low cost microcomputers offers considerable potential for assisting the busy clinician. A recent study found that the computerised lifestyle assessment was well accepted by patients. Moreover, the lifestyle assessment had a “priming effect” which resulted in a two‐ or three‐fold increase in patients' intentions of discussing a substance use problem with their physician. Presently, the computerised lifestyle assessment is being linked with an evaluation of three brief interventions. This project will establish cost‐effective strategies that can be readily incorporated in hospitals and family practices for dealing with the early stage problem drinker.