Screening and Referral of Alcoholic Patients in a General Hospital

Abstract

A clinical trial investigating the evaluation and individualized referral of alcoholic patients in general medical wards, as compared to simple abstinence counselling, is reported. Individualized referral included a complete medical and psychosocial evaluation of the patient’s condition, followed by a multidisciplinary meeting aimed at defining individualized therapeutic proposals organized in a network of specific therapy and support. Screening (using the Michigan Alcoholism Screening Test) identified 107 patients. Eligible patients (n = 53), including those who refused to be randomized (n = 17) as well as those who were randomized (n = 36), were followed for 1 year. The study was limited by several problems arising from trial-related methods as well as from patient-related characteristics, such as a low rate of screening by residents, a high rate of exclusion (51 %), a high rate of randomization refusal (32%) as well as a high attrition rate after 1 year (42%). Among patients who were followed, we observed a high rate of abstinence (57%), which was longer in the intervention group, and was correlated with improved biological markers and scores in a quality-of-life questionnaire. This study emphasizes the need for other similar but larger trials; their design should take into consideration the methodological difficulties encountered in the present study, in order to limit the high exclusion and attrition rates.