IDENTIFYING DRINKING PROBLEMS IN VA HOSPITAL PATIENTS

To assess clinicians'' identification of problem drinking in inpatients in Veterans Administration (V.A.) hospitals, clinicians'' ratings of 147 1st admissions to the Gainesville, Florida, V.A. Hospital were compared with the patients'' alcohol problem score (APS). Clinicians'' ratings were based on data in medical records, which were reviewed according to a protocol coding specific physical, behavioral, social and psychological criteria, while the APS was derived from patients'' responses to highly discriminatory items in the Michigan Alcoholism Screening Test and the Self-Administered Alcoholism Screening Test. The 147 men studied included 120 whites and 25 blacks. Most were lower middle class or of lower socioeconomic status. Their mean age was 51, slightly higher than the veterans'' national average of 46. Although the clinicians identified 28 patients as problem drinkers, onlh 16 of these received APS indicative of drinking problems. Of the 119 patients identified by clinicians as being normal drinkers or nondrinkers, 9 received APS indicative of problem drinking. Clinicians were fairly accurate in identifying patients whose alcoholism was more severe, from the standpoint of social problems, but they tended to miss milder cases. Possible explanations for the discrepancies between the clinicians'' ratings and the APS focuses on the APS cutoff point, clinicians'' interest in drinking problems and their use of medical rather than social and behavioral critieria to assess problem drinking, and differences in the clinicians'' and patients'' socioeconomic status.