Screening for alcoholism in general hospitals.

In a recently completed study at the North Bay Psychiatric Hospital, a tertiary resource serving a population of about 600,000 in Northern Ontario, systematic screening on admission showed a very high proportion of past or present alcoholism. Fifty-seven percent of the patients were identified as having a life prevalence of (current or past) alcohol-related problems through a combination of a questionnaire and a liver function test. This figure is much higher than what is generally observed in mental hospitals. Does it reflect a widespread prevalence of alcoholism in Northeastern Ontario or is it distorted by the pattern of referral to the North Bay Psychiatric Hospital which typically serves an under-privileged segment of the population? In an attempt to answer this question, this study was carried out in general hospitals (medical and surgical wards). It confirms a higher prevalence of alcohol-related problems (biological, psychological and/or social) in Northern Ontario general hospitals, compared with Southern Ontario general hospitals, using identical methods of screening and assessment in both populations. The regional difference (odds ratio) is more evident in higher social classes. A diagnosis of alcohol abuse or dependence (currently active or in remission) was confirmed in 83.5% of the cases with positive screening who underwent the Diagnostic Interview Schedule (revised). This is a robust confirmation of the value of screening. These findings confirm the importance of systematic screening for alcoholism in general hospitals.