McQuade W H, Levy S M, Yanek L R, Davis S W, Liepman M R
Department of Family Medicine, Memorial Hospital of Rhode Island, 111 Brewster St, Pawtucket, RI 02860, USA.
Arch Fam Med. 2000 Sep-Oct;9(9):814-21. doi: 10.1001/archfami.9.9.814.
Studies on alcohol abuse are frequently based on patients who meet minimum diagnostic criteria, thus ignoring patients with individual symptoms of harmful or hazardous use. Consequently, we are unable to characterize alcohol-abusing patients with sufficient clarity to effectively focus screening for primary prevention.
To determine the prevalence of harmful and hazardous use of alcohol, assess screening instruments for detecting alcohol abuse or dependence, and assess the impact of alcohol use on other diagnoses treated in outpatient settings.
Survey (cross-sectional study).
Hospital-based outpatient clinic.
Three hundred randomly selected adults (aged 18 years and older).
Diagnosis of alcohol abuse or dependence based on the Diagnostic Interview Schedule (DIS).
About 18% met DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) criteria of abuse or dependence while almost 50% had at least one symptom of harmful or hazardous use. The T-ACE questionnaire, a modified version of the CAGE questionnaire, was the most effective screening instrument for both men and women. Selected diagnoses, personal characteristics such as family history of alcohol abuse, and self-reported patterns of alcohol use could identify patients likely to meet diagnostic criteria.
Many symptoms of substance use disorders are not adequately addressed in outpatient practice. Little is known about how alcohol use in varying quantities affects health care utilization and treatment of conditions commonly seen in outpatient medicine. Consequently, we lack a full appreciation of the burden of disease borne by alcohol use and have yet to achieve a universally accepted method of approaching primary and secondary prevention of alcohol-related problems.
关于酒精滥用的研究通常基于符合最低诊断标准的患者，从而忽略了有有害或危险使用个体症状的患者。因此，我们无法足够清晰地描述酒精滥用患者的特征，以便有效地聚焦于一级预防的筛查。
确定酒精有害和危险使用的患病率，评估用于检测酒精滥用或依赖的筛查工具，并评估酒精使用对门诊治疗的其他诊断的影响。
调查（横断面研究）。
医院门诊诊所。
300名随机选择的成年人（年龄在18岁及以上）。
根据诊断访谈时间表（DIS）诊断酒精滥用或依赖。
约18%的人符合《精神疾病诊断与统计手册》第四版（DSM-IV）的滥用或依赖标准，而近50%的人至少有一项有害或危险使用的症状。T-ACE问卷是CAGE问卷的改良版，对男性和女性都是最有效的筛查工具。选定的诊断、个人特征如酒精滥用家族史以及自我报告的饮酒模式可以识别可能符合诊断标准的患者。
门诊实践中对物质使用障碍的许多症状关注不足。对于不同饮酒量如何影响医疗保健利用和门诊常见疾病的治疗知之甚少。因此，我们对酒精使用所带来的疾病负担缺乏全面认识，并且尚未找到一种普遍接受的方法来进行酒精相关问题的一级和二级预防。
