title: Identification of smokers, drinkers and risky drinkers by general practitioners.
abstract: BACKGROUND
  Identification of risky substance users by general practitioners (GPs) is important for providing brief interventions or to refer cases to specialized care, but detection rates of risky users are low, with alcohol users being identified less frequently than smokers.
  
  
  METHODS
  We compared GPs' assessment and patient self-report concerning tobacco use, number of cigarettes smoked daily, alcohol use, alcohol use disorder, and different risky use definitions of 8476 primary care patients from six European countries. Further, we carried out a logistic regression predicting the GPs perception of the patients' alcohol problems.
  
  
  RESULTS
  GPs identified 88.4% (95% confidence interval (CI): 87.1-89.6%; κ=0.84, 95% CI: 0.83-0.86) of all self-reported smokers but only 64.6% (95% CI: 63.2-65.9%; κ=0.35, 95% CI: 0.33-0.37) of all current drinkers, while they were unable to judge the drinking status of every ninth patient. The GPs' estimation of number of cigarettes smoked daily was slightly lower than the self-report (Δ=0.23 cigarettes/day, p<.001) but both measures were correlated with each other. Of all risky drinkers, defined as having alcohol-related problems or showing risky drinking patterns, 28.7% (95% CI: 25.9-31.4%; κ=0.34, 95% CI: 0.31-0.37) were perceived as having problems with alcohol by the GPs. Patients' self-reported health and social consequences, as well as drinking patterns predicted the GPs' perception of alcohol problems.
  
  
  CONCLUSIONS
  GPs were more accurate in identifying smokers than drinkers. Concerning risky drinkers, GPs failed to diagnose a sizeable proportion but were able to detect other drinkers whom common recognition approaches had not recognized.
authors.affiliation: Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany. Electronic address: jakobmanthey@snappyquest.org.
authors.forename: Jakob
authors.initials: J
authors.lastname: Manthey
authors.affiliation: Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany; Center for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1, Canada. Electronic address: charlotte.probst@tu-dresden.de.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Probst
authors.affiliation: University of Leipzig, Department of Psychosomatic Medicine and Psychotherapy, Semmelweisstr. 10, 04103 Leipzig, Germany. Electronic address: franz.hanschmidt@medizin.uni-leipzig.de.
authors.forename: Franz
authors.initials: F
authors.lastname: Hanschmidt
authors.affiliation: Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany; Center for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1, Canada; Addiction Policy, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON M5T 3M7, Canada; Institute of Medical Science, University of Toronto, Faculty of Medicine, Medical Sciences Building, 1 King's College Circle, Room 2374, Toronto, ON M5S 1A8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON M5T 1R8, Canada. Electronic address: jtrehm@gmail.com.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Rehm
mesh_terms: D000328:Adult; D000428:Alcohol Drinking; D000437:Alcoholism / Q000175:diagnosis*; D005060:Europe; D005260:Female; D058005:General Practitioners; D006801:Humans; D016015:Logistic Models; D008297:Male; D012309:Risk-Taking; D057566:Self Report; D012907:Smoking; D014029:Tobacco Use Disorder / Q000175:diagnosis
keywords: Alcohol; Binge drinking; General practitioner; Screening; Smoking; Tobacco