Huntley: Getting to the stable door before the horse has bolted [CMAJ

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Getting to the stable door before the horse has bolted

CMAJ 2001;164(3):323 [PDF]

Alan Ogborne has given an accurate synopsis of the identification and treatment of patients with alcohol-related problems and has delineated what is currently thought of as best practice [].¹ However, although he recognizes that much identifiable alcohol misuse is not clinically overt² he nevertheless advocates the CAGE questionnaire³ for use in primary care; a more detailed alcohol history is only indicated if such questioning or a physical examination is positive. This approach identifies only the tip of the iceberg: it misses hazardous drinkers before they start to become dependent.⁴

A more proactive method is used in the Department of Emergency Medicine at St. Mary's Hospital, London, United Kingdom, where the Paddington Alcohol Test [PDF format] has been developed over the last 7 years.^5,6,7,8 This test is easy (only 3 questions) and takes less than 1 minute to administer. It has been designed to identify misusers at an early stage, at which brief motivational interventions are more effective, and allows treatment to be started earlier. The test is given to all patients presenting with one or more of the "top 10" presenting complaints for which alcohol misuse may be considered a root cause. The test is given at the end of the consultation when the patient's initial agenda has been satisfied.

In the modern context of rationing, evidence-based care and governance, we must move more effectively (that is, earlier) on alcohol misuse.

J.S. Huntley
Senior House Officer
R. Touquet
Consultant
Department of Accident and Emergency Medicine
St. Mary's Hospital
London, UK

References

    1.    Ogborne AC. Identifying and treating patients with alcohol-related problems. CMAJ 2000;162(12):1705-8.

    2.    Malla A, Merskey H. Screening for alcoholism in family practice. Fam Pract 1987;6:138-47.

    3.    King M. At risk drinking among general practice attenders: validation of the CAGE questionnaire. Psychol Med 1986;16:213-7. [MEDLINE]

    4.    Murgraff V, Parrott A, Bennett P. Risky single-occasion drinking amongst young people — definition, correlates, policy, and intervention: a broad overview of research findings. Alcohol Alcohol 1999;34:3-14. [MEDLINE]

    5.    Green M, Setchell J, Hames P, Stiff G, Touquet R, Priest R. Management of alcohol abusing patients in accident and emergency departments. J R Soc Med 1993;86:393-5. [MEDLINE]

    6.    Smith SG, Touquet R, Wright S, Das Gupta N. Detection of alcohol misusing patients in accident and emergency departments: the Paddington alcohol test. J Accid Emerg Med 1996;13:308-12. [MEDLINE]

    7.    Wright S, Moran L, Meyrick M, O'Connor R, Touquet R. Intervention by an alcohol health worker in an accident and emergency department. Alcohol Alcohol 1998;33:651-6. [MEDLINE]

    8.    Huntley J, Blain C, Hood S, Touquet R. Paddington alcohol test. J Accid Emerg Med. In press.