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Underutilization of Screening Tools for Alcohol Use Disorders Part I: Results from Survey of Practices among North Carolina Mental Health Providers and Brief Review of Available Instruments

Cornel N Stanciu, Thomas M Penders, Karl L Wuensch, Joshua Davis, Khalid Elnagar

Background: Alcohol is the third leading cause of preventable death worldwide. With growing co-occurrence in those with psychiatric disorders, identification of these disorders is of increasing relevance. Various screening tools have evolved for uses from detecting dependence to identifying hazardous patterns of use. Use of these tools has allowed early detection of those at risk facilitating interventions often before addictive use becomes established.

Objectives: Here we report findings from a survey of mental health providers examining the use of screening instruments for alcohol use and their correlation to prescriptions for high-risk use and alcohol use disorders. We also review the available screening tools.

Methods: An anonymous online questionnaire was distributed to providers in various settings (academic, community and chemical dependence and veterans affairs). A total of 170 participated, a response rate of 85%. Data was analysed using Qualtrics software as well as a statistician.

Results: Screening is frequently avoided. Half of psychiatric providers have never used a screening tool. Community providers (Mdm=0%) use such tools much less than academic (Mdn=25%, U=852.5, p<0.001) and chemical dependence providers (Mdn=25%, U=90.5, p=0.001). Pharmacotherapy seems to be implemented more often by those that employ screening tools (Mdm=39.2%) compared to those that do not (Mdm=23.5%), U=1284.5, p<0.001.

Conclusion: AUDs are highly prevalent and often go undiagnosed and subsequently untreated. Despite guidelines recommending use of screening tools, our survey indicates few providers have adopted them. When used, however, there seems to be a greater implementation of pharmacotherapy to address problem-drinking leading to better outcomes. All primary care and mental health professionals should consider use of screens for comorbid alcohol use.