Smoking Status as a Clinical Indicator for Alcohol Misuse in US Adults

Abstract

The current National Institute on Alcoholism and Alcohol Abuse (NIAAA) Clinician's Guide, Helping Patients Who Drink Too Much,¹ not only recommends screening for alcohol use disorders but also advocates screening for less severe “at risk” or hazardous drinking. The US Preventive Services Task Force (USPSTF)² recommends screening for alcohol misuse (which includes hazardous drinking, alcohol abuse, and alcohol dependence) and has assigned a grade-B recommendation for screening and brief interventions for hazardous alcohol consumption in primary care settings. Even though screening^3-6 and brief interventions^7,8 provided in primary care settings are effective, clinicians have low rates of adherence to the guidelines for screening for alcohol misuse.^9,10 Using a national sample, Edlund et al¹¹ estimate that only 30% of individuals who had a primary care visit reported being screened for an alcohol or drug use problem. In contrast, physicians are much more likely to screen and apply brief interventions to address smoking behavior.^12,13 Studies of physician and patient reports and medical record reviews find that the majority of primary care patients are screened for smoking status (81%).¹⁴ Smoking status is more likely to be recorded in the medical chart than is drinking behavior.^15,16 Studies of medical patients suggest that smoking status and alcohol misuse are highly associated, such that current smoking status may be used to help identify problem drinkers.^17-21 In a sample of German medical patients, the rate of daily smoking was 47.1% in those with alcohol misuse, compared with 18.4% in the general population.²⁰ In a sample of medical and dental patients, the rate of hazardous drinking was 20.3% in current smokers and 11.7% in current nonsmokers.²¹