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—The letter from Volk et al is very much in the spirit of our article. In the context of a study conducted for altogether different purposes, we found a somewhat serendipitous blend of bad and good news: many physicians missed the drinking problems of seriously impaired patients who were ultimately identified on the job, but when they did issue a warning, it seemed to have an enduring positive effect. This points to a need for greater attention to effective strategies for earlier detection in clinical settings, whether they be the kinds of screens discussed by Volk et al or other approaches. We need carefully designed clinical trials to test alternative vehicles for enabling physicians to intervene earlier and more effectively when their patients are beginning to experience trouble with alcohol.
Walsh DC, Hingson RW. Warning Patients About Alcohol Abuse-Reply. JAMA. 1992;267(23):3153. doi:10.1001/jama.1992.03480230045022