Should Smoking Prompt Screening for Unhealthy Alcohol Use?
Primary care clinicians are more likely to screen their patients for smoking than for drinking, despite the association between the two risk behaviors. To confirm this association and determine whether smoking status could be used to detect unhealthy alcohol use, researchers assessed 42,374 U.S. adults who had participated in a national survey on alcohol and related conditions.
- Risky drinking* was significantly more common in daily (odds ratio [OR], 3.2), occasional (OR, 5.3), and former (OR, 1.2) smokers than in subjects who never smoked.
- A diagnosis of alcohol abuse or dependence was also significantly more common in daily (OR, 3.5) and occasional (OR, 5.4) smokers than in subjects who never smoked.
- Current smoking (daily or occasional) had a sensitivity and specificity** of 43% and 82%, respectively, for risky drinking and 51% and 78%, respectively, for an alcohol diagnosis.
- Forty-one percent of subjects with risky drinking and 37% of subjects with an alcohol diagnosis never smoked.
Comments:The findings from this large, population-based sample suggest healthcare providers should suspect unhealthy alcohol use among current smokers. However, a broader screening strategy is still needed because approximately 40% of the unhealthy alcohol use in this sample occurred in never smokers. Kevin L. Kraemer, MD, MSc
*Risky drinking: >14 drinks per week or ≥5 drinks per occasion for men; >7 drinks per week or ≥4 drinks per occasion for women
**Sensitivity is the proportion of patients with a condition that test positive for that condition; specificity is the proportion of patients without the condition who test negative.