Alcoholism in Hospitalized Patients Mayo Clin Proc, May 2001, Vol 76 460 Mayo Clin Proc. 2001;76:460-466 460 © 2001 Mayo Foundation for Medical Education and Research Original Article Point Prevalence of Alcoholism in Hospitalized Patients: Continuing Challenges of Detection, Assessment, and Diagnosis TERRY D. SCHNEEKLOTH, MD; ROBERT M. MORSE, MD; LINDA M. HERRICK, PHD, RN; VERA J. SUMAN, PHD; KENNETH P. OFFORD, MS; AND LEO J. DAVIS, JR, PHD From the Department of Psychiatry and Psychology (T.D.S., R.M.M., L.J.D.), Department of Nursing (L.M.H.), and Section of Biostatistics (V.J.S., K.P.O.), Mayo Clinic, Rochester, Minn. This work was supported with intramural funds from the Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minn. Address reprint requests and correspondence to Terry D. Schneek- loth, MD, Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (e-mail: schneekloth .terry@mayo.edu). • Objective: To measure a 1-day point prevalence of alcohol dependence among hospitalized patients and to assess practices of detection, evaluation, and diagnosis of alcohol problems. • Patients and Methods: On April 27, 1994, a total of 795 adult inpatients at 2 midwestern teaching hospitals were asked to complete a survey that included the Self-adminis- tered Alcoholism Screening Test (SAAST). The records of SAAST-positive patients were reviewed to determine the numbers of patients receiving laboratory screening for alcoholism, addiction consultative services, and a dis- charge diagnosis of alcoholism. • Results: The survey response rate was 84% (667/795). Of the 569 patients who provided SAAST information, 42 (7.4%) had a positive SAAST score and thus were identified as alcohol dependent. Thirteen (31%) of the 42 alcoholic patients received addiction or psychiatric consul- tative services during their hospitalization. Serum γ-gluta- myltransferase was measured in 4 (11%) of the 38 actively drinking alcoholic patients. Three (7%) of 42 alcoholic ALT = alanine aminotransferase; AMERSA = Association for Medical Education and Research in Substance Abuse; AST = aspartate aminotransferase; GGT = γ-glutamyltransferase; MAST = Michigan Alcoholism Screening Test; MCV = mean corpuscular volume; SAAST = Self-administered Alcoholism Screening Test; SMAST = Short Michigan Alcoholism Screen- ing Test patients received a discharge diagnosis of alcohol abuse or dependence. • Conclusions: The alcoholism prevalence rate was lower than those observed in several other US hospitals. Laboratory testing may be underutilized in identifying hospitalized patients who may be addicted to alcohol. Phy- sician use of consultative services and diagnosis of alcohol dependence had not improved from similar observations more than 20 years earlier. These findings may indicate persistent problems in physician detection, assessment, and diagnosis of alcoholism. Mayo Clin Proc. 2001;76:460-466 I n late 1999, Surgeon General David Satcher released the first Surgeon General’s Report on Mental Health. 1 The report documents the burden of mental illness on American health and productivity and addresses the ongoing stigmas that impede effective diagnosis and treatment. It makes specific reference to substance abuse as a major co-occur- ring problem for adults with mental illness. 1 Alcohol dependence, the second most common mental disorder following major depression, is a pervasive prob- lem in the United States and a major public health problem in many parts of the world. The National Comorbidity Survey measured the lifetime prevalence of this disorder at 14% in the US adult population. Of US males, 20% will meet Diagnostic and Statistical Manual of Mental Disor- ders, Revised Third Edition criteria for alcohol dependence during their lifetime. 2 This widespread problem has many personal and societal consequences. Alcoholism affects many lives adversely, and the cost to society of problems related to alcohol use is staggering, estimated to exceed $100 billion annually. 3 For editorial comment, see page 457. The American Medical Association designated alcohol- ism a disease more than 40 years ago. Since that time, multiple studies have assessed alcohol abuse and depen- dence among medical, surgical, and psychiatric inpatients. They show prevalence rates ranging from 7% to 47%. 4-15 This broad range of prevalence rates may reflect widely varying demographic factors, multiple criteria sets, and differing screening methods for alcoholism across studies. Despite methodologic differences, the studies commonly show prevalence rates near 20% in community hospitals, 14 whereas the 12-month prevalence of alcoholism in the community is 7.2%. 2 A comparison of the community rate of alcoholism with the rates observed among hospitalized patients indicates that disproportionately large numbers of alcoholic patients are hospitalized. These hospitaliza- For personal use. Mass reproduce only with permission from Mayo Clinic Proceedings.