Israel Y, Hollander O, Sanchez-Craig M, Booker S, Miller V, Gingrich R, Rankin J G
Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
Alcohol Clin Exp Res. 1996 Nov;20(8):1443-50. doi: 10.1111/j.1530-0277.1996.tb01147.x.
Present methods to screen for alcohol abuse are generally obtrusive and result in referral to services that deal mainly with alcoholics. These factors deter physicians from identifying alcohol abuse patients at an early stage. In the present study, 81% of all primary care physicians of a single city evaluated (i) the efficiency and the acceptability of a nonobtrusive screening method for the identification of problem drinkers and (ii) the effectiveness of brief cognitive behavioral counseling given by a nurse in a lifestyle context. Patients (n = 15,686) attending the private practices of 42 primary-care physicians were asked four alcohol-neutral trauma questions in the reception area. Physicians asked about alcohol use and alcohol-related problems only to patients with previous trauma. Problem drinkers by defined criteria were offered an appointment with a nurse who, by random assignment, gave either 3-hr of cognitive behavioral counseling over 1 year or simply advised patients to reduce their alcohol intake. The screening method identified 62-85% of expected number of problem drinkers in this population. Following the application of exclusion criteria, 105 problem drinkers were entered in the intervention part of the study. After 1 year, patients who received counseling showed significant reductions in reported alcohol consumption (-70%; p < 0.001), psychosocial problems (-85%; p < 0.001) and serum gamma glutamyl transferase (-32% to -58%; p < 0.02). Physician visits were reduced (-34%; p < 0.02) following counseling. Patients receiving only advice showed neither reductions in psychosocial problems nor in serum gamma glutamyl transferase or physician visits, but reported a 46% reduction (p < 0.01) in alcohol consumption. Data indicate that asking patients about recent trauma is efficient and is well accepted as the first screening instrument in the identification of the problem drinker. Cost of screening per patient is under one dollar. Counseling of 3 hr given by a nurse is markedly superior (p < 0.05) to simple advice in reducing alcohol consumption, objective indicators of alcohol-related morbidity, and the frequency of physician visits.
目前用于筛查酒精滥用的方法通常具有侵入性，且会导致患者被转介到主要针对酗酒者的服务机构。这些因素阻碍了医生在早期识别酒精滥用患者。在本研究中，对一个城市的所有初级保健医生中的81%进行了评估：(i)一种用于识别问题饮酒者的非侵入性筛查方法的效率和可接受性；(ii)护士在生活方式背景下进行的简短认知行为咨询的效果。在42名初级保健医生的私人诊所就诊的患者（n = 15,686）在候诊区被问及四个与酒精无关的创伤问题。医生仅向有既往创伤史的患者询问饮酒情况及与酒精相关的问题。根据既定标准确定的问题饮酒者会被安排与一名护士预约，该护士通过随机分配，在1年内给予3小时的认知行为咨询，或者只是建议患者减少酒精摄入量。该筛查方法识别出了该人群中预期问题饮酒者数量的62%至85%。应用排除标准后，105名问题饮酒者进入了研究的干预部分。1年后，接受咨询的患者报告的酒精消费量显著减少（-70%；p < 0.001），心理社会问题显著减少（-85%；p < 0.001），血清γ-谷氨酰转移酶显著降低（-32%至-58%；p < 0.02）。咨询后医生就诊次数减少（-34%；p < 0.02）。仅接受建议的患者在心理社会问题、血清γ-谷氨酰转移酶或医生就诊次数方面均未减少，但报告酒精消费量减少了46%（p < 0.01）。数据表明，询问患者近期创伤情况是一种有效的方法，并且作为识别问题饮酒者的首个筛查工具很容易被接受。每位患者的筛查成本低于1美元。护士进行的3小时咨询在减少酒精消费量、与酒精相关疾病的客观指标以及医生就诊频率方面明显优于简单建议（p < 0.05）。
