'Hazardous' drinking and drug use are much less severe but much more common than dependence

Research has found that individuals with alcohol and drug dependencies have a greater occurrence of injuries, hypertension, HIV, hepatitis, acid-related peptic disorders, liver cirrhosis, depression, anxiety disorders, and major psychoses.

These individuals also tend to have higher health care costs, particularly for more costly services such as hospitalizations and emergency-room use. A study in the June issue of Alcoholism: Clinical & Experimental Research has found that primary-care patients with less severe drinking and drug use also have several serious health problems.

• Individuals with alcohol and drug dependencies tend to have a greater incidence of health-related problems as well as higher health-care costs.
• New research has found that primary-care patients with less severe drinking and drug use still have several serious health problems.
• The same patients also have a high incidence of co-occurring psychiatric problems.

"The World Health Organization defines 'hazardous drinking' as 'alcohol consumption which confers the risk of physical and/or psychological harm,'" explained Jennifer R. Mertens, a researcher with the Kaiser Permanente Medical Care Program's division of research and corresponding author for the study. "Hazardous drinking and drug use are much less severe, yet much more common, than dependence disorders. For example, a hazardous drinker might be someone who drank four or more times a week, drank three drinks on a typical day that they drank, and had a relative or friend, a doctor or other health worker express concern about their drinking or suggest they cut down in the past year."

Mertens said there is a growing recognition of the importance of screening and intervention for individuals who have these less severe, but still harmful, problems with alcohol and other drugs. "We know that screening for these problems provides an opportunity to intervene, prevent worsening of problems, and improve overall health," she said. "Yet we know very little about the associated health problems of those with these less severe alcohol and drug problems."

Researchers screened a representative sample of 1,419 patients (563 males, 856 females) who visited Kaiser Permanente primary-care clinics in the Sacramento area from July 1999 to August 2000 for hazardous drinking and drug use. A comparison group of 13,347 patients (5602 males, 7745 females) was selected from the same clinics during the same time period. Medical conditions and health-care use during the year prior to screening were compared.

"First, we found that one in 10 patients in private, primary-care clinics were either hazardous drinkers or drug users," said Mertens. "This was consistent with an earlier study in similar primary-care clinics for privately insured patients." The prevalence of hazardous drinking and drug use was similar to hypertension and diabetes, she said.

"Second, we found that hazardous drinkers and drug users in primary care were more likely than other patients to have had several serious health problems," said Mertens, "including injuries, hypertension, pneumonia, chronic obstructive pulmonary disease, depression, anxiety disorders, and major psychoses." This finding would indicate that screening and brief intervention at the lower threshold of hazardous drinking and drug use would sooner detect individuals with health risks, she added.

"Third," she said, "hazardous drinkers and drug users had more visits to psychiatric clinics. This high prevalence of psychiatric comorbidities and the accompanying use of mental-health care suggest that interventions for hazardous drinking and drug use need to take into account the need for mental-health treatment in these patients."

In their totality, said Mertens, the study's findings suggest that there are important health benefits for screening in primary care and conducting interventions among hazardous drinkers and drug users. "In addition," she noted, "the beneficial effects of moderate alcohol consumption should be considered in the context of potential negative health consequences."