NOFAS Responds to “Dear Abby” Advice on Alcohol Screening

On April 11, the following question and answer about a doctor/patient discussion of alcohol use was published in the Dear Abby column. Read the response from NOFAS below.

Original column

DEAR ABBY: What is the correct response when asked at a doctor’s office or hospital if you drink? I drink socially, maybe once a month. Should I say yes? If I do, I’m afraid it will imply that I drink more often. I always end up feeling awkward and like I need to explain myself. I’m pretty proud telling them I don’t smoke or do drugs, but the alcohol question always gets me. What do other people who drink on occasion usually say? — FILLING OUT THE FORMS IN OHIO

DEAR FILLING: In my doctor’s office I was asked that question, and my response was, “Yes, occasionally.” At that point, the follow-up question was, “How many drinks do you have a week?” Because this particular question makes you uncomfortable, mention to your physician that you indulge in alcohol only about once a month — which is practically negligible.

NOFAS Response

Dear Abby,

On April 11, 2013 a reader (FILLING OUT THE FORMS IN OHIO) wrote in asking what she should reply when her doctor asks if she drinks alcohol.  She expressed discomfort with this question and asked how her social drinking should be reported.  Your response suggested that she should “mention to your physician that you indulge in alcohol only about once a month – which is practically negligible.”

This letter highlights some important issues.  First, when your doctor asks you about your alcohol use, answer honestly and completely.  Your doctor is doing his or her job appropriately, and you should never feel uncomfortable providing him or her with honest information. This is because risky alcohol use is a huge and under-recognized problem.  In fact, on an annual basis, drinking too much costs the United States approximately $223.5 billion.  By asking the reader about her alcohol use, the doctor is recognizing that alcohol is associated with many negative health and social problems.  These include:  fetal alcohol spectrum disorders, motor vehicle crashes, violence against others, spread of HIV and sexually transmitted diseases, unplanned pregnancy, miscarriage, stillbirth, Sudden Infant Death Syndrome (SIDS), and alcohol dependence.

What the doctor might not have done was to ask the reader how much she drinks when she consumes alcohol socially on a monthly basis.  More than 38 million adults (or 1 in 6) binge drink.  For women, binge drinking is 4 or more drinks per occasion; for men, binge drinking is defined as 5 or more drinks per occasion.  Asking patients for information about how frequently and how much alcohol they consume is important and reflects good medical practice.  In addition to risking the healthy development  of your baby during pregnancy, alcohol can interfere with many medications, contribute to medical conditions (including high blood pressure, heart disease, and cancer), unintentional injuries (car crashes, falls, burns and drowning), as well as intentional injuries (firearm injuries, domestic violence and sexual assault).

While alcohol is consumed without harm by most people, some do use it in a risky manner such as during pregnancy.  If unsafe use can be identified and addressed, harmful health consequences can be prevented. If you don’t speak honestly about your alcohol use or other health matters with your doctor, it could compromise your health, and, in this case, it perpetuates the stigma surrounding alcohol problems.

So please, Abby and readers, the next time your doctor asks you about your alcohol use, know that he or she is doing so in your best interest, just like when he or she takes your blood pressure or asks you other health history questions.