The effect of psychiatric symptoms on the recognition of alcohol disorders in primary care patients

Objective: To determine factors related to physician recognition of alcohol abuse in a primary clinic, specifically factors associated with psychiatric illness. Method: Using a cross-sectional study design, we conducted a comprehensive chart review of an existing study sample. A total of 321 systematically sampled patients completed a patient interview. One- hundred-and-one patients scored one or more on the CAGE screening questionnaire for alcohol abuse and were eligible for the medical chart review, which assessed socio-demographic variables, psychiatric and medical diagnoses, alcohol and other substance use, laboratory tests results, and number of patient contacts. Results: 35 percent of the CAGE positive sample had a history of a psychiatric disorder documented in the chart, and an additional 17 percent had symptoms consistent with possible underlying psychopathology. Using multiple logistic regression analysis, the presence of documented psychiatric disorders was not found to be significantly associated with physician recognition (odds ratio = 1.7, 95% confidence interval, 0.5- 5.8), relative to patients without these disorders. However, patients who reported psychiatric complaints were significantly more likely to have been recognized by their physicians as having a probable alcohol disorder (odds ratio = 4.4, 95% confidence interval, 1.2-16.2), relative to those without such complaints. Other factors found to be associated with recognition are discussed. Conclusions: The evidence indicates that a large proportion of alcohol disorders go unrecognized by physicians, however it does not appear that this is due to the misclassification of alcoholism as other psychiatric disorders or symptoms. Additional studies with objective assessment of psychiatric status will be helpful in further investigating this question.