Levine J
Royal Free Hospital School of Medicine, London, U.K.
Alcohol Alcohol. 1990;25(5):539-53.
Alcohol is a major cause of morbidity and mortality in Britain. Consultation, questionnaires and laboratory tests may all be used to help identify alcohol abuse and thereby prevent and treat alcohol-related problems. Consultation which can identify 80% of alcohol abusers involves recording the findings of alcohol and general histories and physical examination. The accuracy of the assessment depends on the reliability of the respondent and the respondent's relations and friends, and on the skill of the investigator; however, thorough assessment is time-consuming and expensive. Questionnaires may identify up to 80% of alcoholics. They are generally based on the Michigan Alcohol Screening Test and CAGE questionnaires and are simple, rapid to complete, inexpensive and not dependent on skilled investigators; however, the principal disadvantage of using questionnaires is that a personal relationship is not developed with the subject. Finally, simple and complex laboratory tests may be used. Of the simple laboratory tests, raised GGT or MCV levels are the most useful and when these values are combined, 90% of alcoholics may be identified correctly. Complex laboratory tests may exhibit greater sensitivity and specificity and provide useful additional information; however, their restricted availability limits their widespread use. The value of each of these methods depends on the objective of the assessment. For population surveys, questionnaires are of greatest relative value and consultation and laboratory tests may be used to confirm the presence of alcohol abuse. In general practice and the hospital setting, it is imperative to include questions on alcohol intake and alcohol-related problems in all interviews with patients. Laboratory tests may be used to confirm suspected alcohol abuse and questionnaires may provide useful screening tools. Finally, in the specialist alcohol unit, consultation, questionnaires and laboratory investigations are all important for identifying alcohol abuse. In this setting, consultation is of particular importance and the alcohol history and physical examination should be recorded by a skilled investigator and the results confirmed with relatives and close friends. Questionnaires are useful as initial screening or assessment tools and computer-based systems may facilitate data collection. Simple and complex laboratory tests may be used to confirm the diagnosis and help ascertain the extent of disease. By assuming that 'all patients have alcohol-related problems until proven otherwise', and through the appropriate application of consultation, questionnaires and laboratory tests, identification of excessive alcohol consumption and the prevention of its sequelae will be facilitated.
在英国，酒精是导致发病和死亡的主要原因。咨询、问卷调查和实验室检查都可用于帮助识别酒精滥用情况，从而预防和治疗与酒精相关的问题。能识别80%酒精滥用者的咨询包括记录饮酒史、一般病史以及体格检查的结果。评估的准确性取决于受访者及其亲友的可靠性，以及调查人员的技能；然而，全面评估既耗时又昂贵。问卷调查可识别高达80%的酗酒者。它们通常基于密歇根酒精筛查测试和CAGE问卷，简单、填写迅速、成本低廉且不依赖熟练的调查人员；然而，使用问卷调查的主要缺点是无法与受试者建立个人关系。最后，可使用简单和复杂的实验室检查。在简单的实验室检查中，γ-谷氨酰转移酶（GGT）或平均红细胞体积（MCV）水平升高最为有用，当将这些值结合起来时，90%的酗酒者可能被正确识别。复杂的实验室检查可能具有更高的敏感性和特异性，并能提供有用的额外信息；然而，其可用性有限限制了它们的广泛应用。这些方法各自的价值取决于评估的目的。对于人群调查，问卷调查具有最大的相对价值，咨询和实验室检查可用于确认酒精滥用的存在。在全科医疗和医院环境中，在所有对患者的访谈中都必须包含关于酒精摄入量和与酒精相关问题的询问。实验室检查可用于确认疑似酒精滥用情况，问卷调查可提供有用的筛查工具。最后，在专业酒精治疗科室，咨询、问卷调查和实验室调查对于识别酒精滥用都很重要。在这种情况下，咨询尤为重要，酒精病史和体格检查应由熟练的调查人员记录，并与亲属和密友核实结果。问卷调查作为初始筛查或评估工具很有用，基于计算机的系统可能有助于数据收集。简单和复杂的实验室检查可用于确诊并帮助确定疾病的程度。通过假定“除非另有证明，所有患者都存在与酒精相关的问题”，并通过适当应用咨询、问卷调查和实验室检查，将有助于识别过量饮酒并预防其后果。
