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Alcohol Misuse in Patients Attending a Defence Force General Medical Clinic

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Alcohol Misuse in Patients Attending a Defence Force General Medical Clinic Original Research Alcohol misuse in patients attending a defence force general medical clinic Bekker D, MBChB, MFamMed Van Velden DP, MBChB, MPraxMed Department of Family Medicine, University of Stellenbosch Correspondence: Dr D Bekker, 3 Grobler Street, Aurora Durbanville, 7550 Tel: 021-5902635, e-mail: [email protected] Keywords: alcohol misuse; Alcohol Use Disorders Identification Test (AUDIT); general medical practice; defence force; prevalence Abstract Aim.: To determine the prevalence of alcohol misuse in adult patients attending a defence force general practice clinic. Design: Descriptive cross-sectional survey. Methods: The setting is a military sickbay situated in the Cape Town metropolitan area, South Africa. Participants included all adult patients (³ð18 years) attending the clinic during a three week period midyear. The Alcohol Use Disorders Identification Test (AUDIT) questionnaire was completed by patients. Two direct alcohol consumption questions were added determining the total drinks per week as well as the maximum number of drinks per occasion. Results: Of the 658 patients approached, 40 (6%) declined to fill in the questionnaire. 42% of the 618 patients surveyed were female and 58% were male with an average age of 41 years. The group consisted of 44% current defence force members, 25% retired defence force members, 22% medical dependents and 7% civilians. The overall rate of alcohol misuse according to the AUDIT-questionnaire was 13,27%. Among male patients, 20,6% scored as misusers of alcohol, compared with 2,7% among females. A much higher level of misuse was also found under younger age groups. 38,1% of male apprentices at the technical college and 40,0% of male current defence force members staying on the base scored 8 or more on the AUDIT. In the group scoring less than 8 on the AUDIT-questionnaire a further 9 patients reported drinking on average more than 14 drinks per week for males and more than 9 drinks per week for females. In this group (AUDIT-score <8) 76 patients reported maximum number of drinks per occasion of more than 4 for men and more than 3 for women. If these two questions are included the overall rate of alcohol misuse found was 26,05%. Conclusion: The high rate of alcohol misuse found in this group of patients is need for concern. The overall rate of alcohol misuse was not found to be higher than what was found in other studies in South Africa as well as other countries. This study supports the implementation of screening and intervention strategies in general medical clinics in the defence force. SA Fam Pract 2003;45(2):___ ○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○ INTRODUCTION dependence in the adult population.2 the only study found pertaining to However, relatively few studies have military personnel looked at the pattern Alcohol misuse may come to be been published on drinking patterns in of drug-taking of 188 drug-dependent recognized as one of the most significant South Africa. With regards to adults, national servicemen seen in the public health concerns facing South epidemiological studies in recent years department of psychiatry of 1 Military Africa over the next few years. This is have also focussed almost entirely on Hospital in Pretoria in the year 1971. a direct result of alcohols impact on the the black and coloured population while Alcohol were used by only 18% of the health services, the economy, and the they are not the only groups who have subjects.3 In our study practice we are South African society as a whole.1 high levels of risky drinking.1 not aware of many alcohol dependent Alcohol misuse is common world- There has always been a perception patients. According to the social work wide and in South Africa there is an that a high prevalence of alcohol misuse department, they have detected a high estimated prevalence of 10% of alcohol exists amidst defence force patients, but prevalence of alcohol misuse especially 10 SA Fam Pract 2003;45(2) Original Research under the younger uniformed members The Alcohol Use Disorders Identifi- compared to the Structured Clinical (age 18-25) who are busy with their cation Test (AUDIT) questionnaire29-34 Interview for DSM-III-R (used as the apprenticeship at the military technical was given for self-completion to patients gold standard for alcohol abuse or college, but no effort has been made in during normal clinic hours (07h30 - dependence).9 our practice to screen or treat for alcohol 16h00). Questions additional to those Results of the AUDIT have also been misuse as part of an organised health posed in the questionnaire were added associated with more distal indicators promotion plan. with regards to personal information as of problematic drinking. It was found Several studies have shown that well as alcohol consumption to deter- to be a good predictor of both alcohol- doctors fail to detect alcohol misuse in mine the prevalence of at-risk drinking. related social and medical problems.31,35-36 the majority of their patients. They are It has been demonstrated that direct The AUDIT questionnaire is currently particularly unlikely to identify misuse questions about average daily the only validated instrument designed in its earlier stages and therefore miss consumption or frequency of heavy to detect hazardous drinking. major opportunities for intervening.4-17 consumption are less sensitive than Research has established the effective- standard self-report screening question- Hazardous drinking ness of even brief interventions by naires in detecting alcohol misuse. Hazardous drinking is defined as a primary care physicians on patients with Biochemical markers, especially serum quantity or pattern of alcohol consump- hazardous and harmful alcohol gamma glutamyl transferase can assist tion that places individuals at risk for consumption.18-25 in identifying problem drinking but are adverse health events and is recognised New evidence continues to appear also less valid than self-report measures. by the World Health Organisation appertaining to levels and patterns of In detecting alcohol dependence or (WHO) as a distinct disorder. The alcohol use in relation to health effects, abuse, the most widely used instruments quantity or pattern of alcohol consump- social well-being, and economic costs. are the CAGE29-34 with 4 items and the tion that constitutes hazardous drinking Data from several recent large prospec- Michigan Alcoholism Screening Test is typically specified by setting tive studies suggest that alcohol (MAST)29-34 with 25 questions. They threshold values for an individuals consumption in quantities consistent have proven to be useful screening average number of drinks consumed per with hazardous and harmful drinking instruments and have revealed a higher week or per occasion.26 may increase the risk of adverse health validity compared to laboratory data. events, such as haemorrhagic stroke and They are however insensitive for Heavy drinking breast cancer.26-28 hazardous or heavy drinking. The Heavy drinking is defined as a quantity Every effort should thus be made in Alcohol Use Disorder Identification of alcohol consumption that exceeds an primary care settings to detect and treat Test (AUDIT) was developed by the established threshold value.26 The alcohol misuse in its earlier stages World Health Organisation in an Addiction Research Foundation of (heavy, hazardous and harmful drinking) international multi-site trial29 in an Ontario and Canadian Centre on because it is more common and pro- attempt to also detect earlier stages of Substance Abuse adopted threshold bably more responsive to treatment than drinking which place the patient at risk levels of more than 14 drinks per week alcohol abuse or dependence. for suffering eventual severe alcohol for men and more than 9 drinks per week By looking at the prevalence and related problems. The authors gave for women based on current scientific pattern of alcohol misuse in patients particular attention to selecting items evidence.27 Individuals whose drinking attending our clinic we aimed to generalisable across culture, gender and exceeds these guidelines are thought to determine the size and distribution of age. Most of the AUDIT questions be at increased risk for adverse health the problem to enable us to motivate for inquire about the previous year rather events. The definitions of hazardous and do proper planning towards inter- than ever in the patients lifetime, and heavy drinking are thus similar. vention as part of health promotion. thereby decreasing errors of mislabeling individuals who have already resolved However, the threshold levels set for METHODS earlier problems with alcohol. hazardous drinking in developing the Questions on the AUDIT covers the AUDIT were an average daily consump- A descriptive, cross-sectional survey three domains of consumption, alcohol tion of 60g per day (6 drinks) for men design was used. The study setting was dependence and adverse consequences and 40g (4 drinks) for women.29 If a Wingfield Military Sickbay situated at of drinking.29-34 male were to drink 3 units of alcohol Goodwood, one of the northern suburbs At a cut-off value of 8 of the possible per day for 7 days a week and have no of Cape Town. Participants in the study 40 points on the test, sensitivity and adverse consequences of drinking or included all adult patients (≥ 18 years) specificity coefficients are high. signs of dependence, he may, depending attending the general medical clinic for Saunders et al reported a 92% sensi- on the rest of his answers on the AUDIT a period of three weeks (28 June to 18 tivity and 94% specificity for hazardous questionnaire, score only 5 points. July 2000). We aimed at a minimum and harmful drinking and a 100% Although women suffer from adverse sample size of 340-350 for validity sensitivity for alcohol dependence.29 consequences of drinking at lower levels purposes. The patient population served Isaacson et al found sensitivity and of consumption than men, the AUDIT by the clinic was estimated at more than specificity of 96% in the detection of like other validated questionnaires, does 11000.
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