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June 17, 1992

Warning Patients About Alcohol Abuse

Author Affiliations

The University of Texas Medical Branch at Galveston

JAMA. 1992;267(23):3153. doi:10.1001/jama.1992.03480230045021

To the Editor.  —In a recent issue of JAMA, Walsh et al1 presented findings from a treatment outcome study concerning the impact of a physician's warning of the harmful effects of alcohol on recovery after alcoholism treatment. This study's findings highlighted the potential for physicians in managing their alcohol-abusing patients. This simple intervention—a physician's warning—was significantly related to better patient outcomes above that explained by conventional treatments.While the findings from this study are encouraging, physicians' recognition of alcohol problems in their patients remains a necessary precursor to intervention. The subjects in this study were all previously identified as alcohol abusers.A crucial issue in recognition of alcoholism by physicians is the variability in accuracy of available self-report and biochemical screens for alcoholism across patient subgroups, a situation well known to clinical epidemiologists as "spectrum bias."2 It is entirely possible that the sensitivity and specificity of available self-report and