Medical Students May Be Ill-Prepared to Talk With Patients About Alcohol Use

By Marilynn Larkin

May 21, 2019

NEW YORK (Reuters Health) - The ability to identify various alcohol strengths and brands is "low" among UK medical students, and this may affect their confidence in dealing with patients around alcohol issues, researchers in the UK say.

"It is part of the NICE guidelines that health professionals should be competent to take an accurate alcohol history, and currently, it has been mandated by the National Health Service that (this be done) for all inpatients admitted to an acute hospital for any reason," Dr. Julia Sinclair of the University of Southampton told Reuters Health by email.

"Alcohol, like tobacco, is a category 1 carcinogen, and a major contributor factor to over 60 health conditions," she noted. "Any health encounter is an opportunity - i.e., a teachable moment - for health professionals to empower patients to improve their immediate and long-term health."

That said, she added, "Physicians generally discuss with patients the things they feel confident about and think they can help with. If they lack confidence and competence in this key area, they are more likely to avoid the discussion. Then patients then don't bring it up as they think, 'if it was important, surely my physician would discuss it with me.' We have termed this the 'collusion of denial' about the role of alcohol in many health conditions."

"As physicians also have a relatively high rate of alcohol use disorder," she said, "they may wish to be aware of their own level of alcohol consumption and monitor this!"

Dr. Sinclair and colleagues surveyed third-year (first clinical year) medical students about their own alcohol consumption, familiarity with alcohol strengths and brands, and alcohol-related harms. The survey included demographics; self-reported alcohol consumption using the AUDIT-C; a visual test of relative alcohol concentrations of wine, beer and spirits; and a free-text response asking them to list alcohol-related harms.

Participants also completed a brand recognition game recording accuracy and reaction time for identifying alcohol drink brands.

As reported online April 26 in Alcohol and Alcoholism, 150 students were included in the study. Overall, about 60% were male, 65% were white, 7% were Chinese and the rest represented varying ethnicities. In addition, 18.7% stated they never drank alcohol; 34.7% scored in the low-risk range (1-4 on AUDIT-C) and 46.7% scored in the increased-risk range (5-12 on AUDIT-C).

Significant group differences were seen with respect to ethnicity, age and gender: 48% non-white and 4% white students were non-drinkers, while 16% non-white and 62% white students scored in the increasing risk range,

Further, in the 22-24 year age group, 37% of students were nondrinkers, compared with 8.6% or less in the other age groups. The proportion of low-risk drinkers rose with each step increase in age, from 28.6% in the 19-21 age group, 31.5% in the 22-24 group, 41.7% in the 25-27 group to 71.4% among the students older than 27.

Among male students, 16.9% were non-drinkers, 23.7% were low-risk drinkers and 59.3% were increased-risk drinkers. By contrast, among females, 19.8% were non-drinkers, 41.8% were low-risk, and 38.5% were increased-risk.

There was a significant effect of ethnicity on drinking status, with close to half (48%) of non-white participants scoring zero on the AUDIT-C.

Most students (91.3%) were able correctly to rank the 250 ml drinks, suggesting a basic understanding of relative strengths of beer, wine and spirits.

Students who reported any alcohol consumption were more likely to correctly assess relative alcohol concentrations and were faster and more accurate at recognizing alcohol brands. Overall, however, only 45% correctly identified the relative alcohol strengths of the drinks presented.

Dr. Lawrence Weinstein, chief medical officer of American Addiction Centers, headquartered in Brentwood, Tennessee, told Reuters Health by email, "Personal experience has historically been an important piece in both self-selection of the substance use disorder (SUD) field - many physicians are in recovery themselves - and as a substitute for lack of standardized teaching curriculum in medical schools and residency training programs."

"Multi-cultural aspects and religious attitudes toward ethyl alcohol consumption also play a role in how equipped medical students from various backgrounds and doctors are in recognizing and dealing with SUD issues," he noted. "Stigma/insurance coverage (benefit design) and lack of focused training are all contributing factors to poor 'health literacy' as it relates to SUD."

"There needs to be a multi-pronged approach to remedying the issues brought up by the article, including updates on current policies re: coverage, improved training of medical students and residents, and expanding specialty fellowships programs," he concluded.


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