Comfortably Engaging: Which Approach to Alcohol Screening Should We Use?

The issue of screening for psychological or substance abuse problems in non psychiatric medical settings is a complex one that deserves ongoing discussion beyond this commentary. This article highlights two key issues that have just barely begun to be discussed. The first is does it matter if we screen and does such screening affect physician behavior and patient care. The second is how does a physician practice decide whether to screen and what measure to use. We are currently left with a literature that often concludes that when screening is the sole intervention without the practice reengineering neccesary to provide the treatment and disease management resources neccesary, it has little or no effect on physician behavior or patient outcome. Secondly, positive screens have been estimated as less than one third of all screenings done, and it is an expensive time consuming undertaking if not well developed. Instrument selection is of course key, but one of the last decisions to make in the decision making process. The article asists in that area but readers need to be sensitive to the other and equally important issues.

Competing interests:   None declared