Valeur et justification du dépistage de l'alcoolisme [Value and justification of screening for alcoholism].

The Swiss are heavy alcohol consumers. Since alcohol consumption is a risk-associated behavior, it is not surprising that alcohol-related medical and psychosocial morbidities are frequently observed. Related costs are therefore also substantial. To reduce alcohol-associated morbidities and related costs, it is essential that the physician's role include both health education counseling to patients (to reduce alcohol consumption) and systematic alcohol abuse and dependence screening. This study reviews current knowledge of alcoholism screening. It emphasizes the validity of some screening instruments such as standardized questionnaires, the accuracy of which appears to be superior to that of other commonly used tests such as biological markers of alcohol intake. However, there are numerous gaps in scientific knowledge of these screening instruments, due mainly to methodological problems in studies of this subject. The results of these studies are fragmentary since they are frequently generalized without caution from studies performed in non-medical patients. While these gaps are even more serious when the effectiveness and thus the justification of alcoholism screening is reviewed, recent studies have proposed more precise methods of screening and therapy, particularly for use in multidisciplinary medical settings. The leading role of physicians in building and studying the effectiveness of these models should be emphasized, since it is well-known that alcoholics are frequently medical patients. Another factor in favour of screening for alcohol problems is the favorable trend in medical costs for alcoholics under treatment. To allow development of alcoholism screening programs by physicians, it is indispensable that their medical education provide adequate information regarding this important health matter. Medical research on the issue of alcoholism screening should be also developed; cost-effectiveness analysis of such programs should be a priority, in oder to convince public health agencies, insurance companies and physicians themselves of the necessity of such efforts