Doctors should normalize questions about drinking habits, guideline says

The guideline for family doctors encourages them to ask patients how often and how much they drink to determine potential excessive drinking patterns.

Many doctors are on board with new guidelines urging them to ask patients about alcohol use, but they also note hurdles – people lose track of how much they drink, some lie, and many don’t know what constitutes a single serving.

Dr. Ginette Poulin, a general practitioner specializing in addiction medicine in Manitoba and Ontario, said it’s important for doctors to normalize these conversations because early detection of high-risk drinking is key to preventing serious health problems, the same as routine screening for diabetes or high blood pressure.

“If people disclose to you, ‘I drink about two drinks in the evening,’ you could probably safely double what is said as a practitioner to gauge where their drinking is really at because we know people feel shameful,” she said.

Patients often minimize the amount they drink, perhaps because they don’t realize that a nine-ounce glass of wine amounts to nearly two standard drinks, said Poulin, one of nearly three dozen authors of a clinical guideline document published last week in the Canadian Medical Association Journal.

The guideline for family doctors encourages them to ask patients how often and how much they drink to determine potential excessive drinking patterns. That includes asking female patients how often, in the last year, they have had more than four drinks on one occasion, and asking male patients how often they have had more than five drinks.

The guideline recommends doctors could also delve deeper by asking four questions from the so-called CAGE questionnaire – whether the patient has ever considered cutting down, is annoyed by criticism of their drinking, feels guilty, or takes an early-morning drink to start the day.

The Canadian Centre on Substance Use and Addiction released separate guidance earlier this year saying more than two drinks per week are related to escalating health risks. An estimated 57 per cent of Canadians aged 15 and older exceed that recommendation, the guideline notes.

Hospital admissions related to alcohol use, including from injuries and seizures, suggest people should be asked about consumption, Poulin said. A form that patients complete when registering with a new doctor could include questions about alcohol use for discussion with them later, she added.