Urgent Alcohol Treatment Eludes Thousands in Need

Almost half of the 18,000 people who completed screening forms in conjunction with the 1999 National Alcohol Screening Day (NASD) engaged in problem drinking behaviors, a new study finds. In addition, about 15 percent of respondents had a score on an alcohol-abuse screening instrument that indicated the need for immediate intervention.

The study results appeared in the September American Journal of Psychiatry and offer a first-ever glimpse of who attended the nationwide screening.

Screening for Mental Health Inc., a nonprofit agency based in Wellesley, Mass., has organized the screening each year since 1999.

The first NASD took place in April 1999 at more than 1,200 community sites, most of which included general and psychiatric hospitals, and 500 college campuses across the nation. In addition to the 18,000 people who participated in the screening, more than 14,000 came to the sites just to get information for themselves or a loved one, the report noted.

People who wanted to be screened completed the Alcohol Use Disorders Identification Test (AUDIT), developed by the World Health Organization (WHO) to identify those who engage in “hazardous” or “harmful” drinking. Scores on the 10-question survey range from 0 to 40, and a trained clinician discusses individual screening results with participants on site.

Hazardous drinking is defined by WHO as a pattern of drinking in which people are at risk for significant health problems. Harmful drinking, which is considered to be more serious, describes those who have already experienced drinking-related health problems but are not yet dependent on alcohol.

Researchers found that 43 percent of the 18,043 respondents scored 8 or above on the AUDIT, indicating harmful or hazardous drinking, and 15 percent scored at or above 19, indicating the need for immediate treatment, according to the report. Clinicians at the screening referred a third of the respondents, or about 6,000 people, to services in their community for further evaluation and possible treatment.

“We know it’s difficult for people to recognize they have a problem with alcohol and seek help,” said lead researcher Shelly Greenfield, M.D., M.P.H. “Yet this event was embraced by college campuses and the community at large.”

Greenfield is an assistant professor of psychiatry at Harvard Medical School and medical director of the Alcohol and Drug Abuse Ambulatory Treatment Program at McLean Hospital in Belmont, Mass.

During the screening process, participants were informed of the opportunity to participate in a study in which researchers would evaluate their AUDIT scores and contact them by telephone about six months later for a follow-up interview.

Of those who volunteered and were eligible to participate, researchers successfully followed up with 704 people in November 1999. Of the sample, 337 respondents had originally been screened at a site in the community and 367 on a college campus.

The follow-up survey revealed that among the sample of 704 people, 59 percent (418) had an AUDIT score of 8 or above, indicating harmful or hazardous drinking (273 at community sites and 145 at college sites). About 24 percent of that subgroup (169) needed immediate intervention (126 at community sites and 43 at college sites).

Overall, Greenfield said, those who came to community sites had more serious drinking problems than those who came to college sites.

When researchers questioned the smaller sample in November, they learned that 22 percent of the subgroup said they no longer drank, and 41 percent reported cutting back on their drinking. Researchers also compared how people altered their drinking behavior in the months after the screening by type of site (see chart).

Of the people in the community who were advised to see a health care professional for a follow-up visit (136), about 50 percent complied with the recommendation, according to the report. Of those at college sites who received the same advice (35), just 20 percent complied. Reasons cited for noncompliance included denial that there was an alcohol problem and the decision to handle the problem alone.

Since the 1999 screening event, NASD has grown considerably, according to Joelle Reizes, M.A., who is director of external relations for Screening for Mental Health Inc. and a co-author of the article.

Reizes said that 102,000 people participated in the 2003 NASD—62,000 people were screened, and 40,000 came to get information for themselves or for a loved one. More than 3,000 sites offered the screening this year. “We’re on the right track,” she said of the screening.

The study was funded by the National Institute on Alcohol Abuse and Alcoholism, Robert Wood Johnson Foundation, National Institute on Drug Abuse, and the Dr. Ralph and Marian C. Falk Medical Research Trust.

More information about National Alcohol Screening Day is posted on the Web at www.mentalhealthscreening.org/alcohol.htm. “Who Comes to Voluntary, Community-Based Alcohol Screening? Results of the First Annual National Alcohol Screening Day, 1999” is posted at http://ajp.psychiatryonline.org/cgi/content/full/160/9/1677. ▪

Am J Psychiatry 2003 160 1677