Alkoholgebrauch und Konsumpermission bei Medizinstudenten

Zusammenfassung

Ziel und Methodik Um zu überprüfen, inwieweit riskante Alkoholkonsummuster von Medizinern die Konsumempfehlungen gegenüber Patienten beeinflussen, wurde eine Ad-hoc-Befragung von 80 Medizinstudierenden mittels eines standardisierten Fragebogeninstruments durchgeführt. Die Auswertung erfolgte deskriptiv und inferenzstatistisch. Ergebnisse Der eigene wöchentliche Alkoholkonsum lag im Median bei 30 g (Frauen) und 60 g (Männer). Nur eine Studentin schätzte ihren Konsum als problematisch ein. Jedoch wiesen 24 % der Studierenden im AUDIT-Fragebogen ein riskantes Konsummuster auf. Jeder 10. konsumierte einmal pro Woche mehr als 6 Drinks. Die Grenze für einen unproblematischen Alkoholkonsum wurde von den befragten Studenten im Median für Frauen bei 80 g/Woche und für Männer bei 100 g/Woche eingeschätzt. Diskussion Im Gegensatz zur Selbsteinschätzung fand sich bei Verwendung der standardisierten Instrumente eine relativ hohe Zahl von Studierenden mit problematischem Konsummuster und im Vergleich zu den WHO-Empfehlungen eine Neigung zur strengen Konsumpermission. Dies weist auf einen erhöhten präventiven Bedarf in dieser Zielgruppe sowie eine zu verbessernde Beratungskompetenz hin.

Abstract

Background An increased incidence of hazardous alcohol consumption in medical practitioners is widely discussed. We conducted a survey of 80 medical students with a standardized questionnaire in order to assess the impact of harmful drinking patterns on the ideas of recommendations about alcohol consumption intended for patients. The statistical analyses were descriptive and inferential. Results Only one of 80 medical students rated his own consumption as hazardous. The weekly alcohol median consumption was 30 g for women and 60 g for men. 24 % of students answering the AUDIT-questionnaire were found to be in the at-risk consumption category. Every 10^th student had more than 6 drinks once per week. The weekly estimated non-risk allowance for patients was 80 g of alcohol in women and 100 g for men. Discussion In contrast to the self rating we found a high percentage of hazardous drinking behaviour patterns when using standardized instruments. Compared to the WHO recommendations the students rated weekly alcohol consumption more strictly. This points both towards the need of preventive measures in this target group as well as the need to improve educative competency.

Key words

alcohol - medical students - binge drinking - AUDIT - CAGE

Literatur

• 1 Vaillant G E, Brighton J R, McArthur C. Physicians' use of mood-altering drugs: A 20-year follow-up report.  N Engl J Med. 1970;  282 365-370
• 2 McAuliffe W E, Rohman M, Santangelo S. et al . Psychoactive drug use among practicing physicians and medical students.  N Engl J Med. 1986;  315 805-810
• 3 Hughes P H, Brandenburg N, Baldwin Jr D C. et al . Prevalence of substance use among US physicians.  JAMA. 1992;  267 2333-2339
• 4 Hughes P H, Storr C, Baldwin Jr D C. et al . Patterns of substance use in the medical profession.  Md Med J. 1992;  41 311-314
• 5 O'Connor P G, Spickard Jr A. Physician impairment by substance abuse.  Med Clin North Am. 1997;  81 1037-1052
• 6 Newbury-Birch D, Walshaw D, Kamali F. Drink and drugs: from medical students to doctors.  Drug Alcohol Depend. 2001;  64 (3) 265-270
• 7 Mavroforou A, Giannoukas A, Michalodimitrakis E. Alcohol and drug abuse among doctors.  Med Law. 2006;  (4) 611-625
• 8 Bohigian G M, Croughan J L, Sanders K. Substance abuse and dependence in physicians: an overview of the effects of alcohol and drug abuse.  Mo Med. 1994;  91 (5) 233-239
• 9 Flaherty J A, Richman J A. Substance use and addiction among medical students, residents, and physicians.  Psychiatr Clin North Am. 1993;  16 (1) 189-197
• 10 Loevenich A, Schmidt R, Schifferdecker M. Physicians as patients on the problem of the mentally ill physician.  Fortschritte der Neurologie-Psychiatrie. 1996;  64 (9) 344-352
• 11 Aira M, Kauhanen J, Larivaara P, Rautio P. Factors influencing inquiry about patients' alcohol consumption by primary health care physicians: qualitative semi-structured interview study.  Fam Pract. 2003;  20 270-275
• 12 Lock C A, Kaner E, Lamont S, Bond S. A qualitative study of nurses' attitudes and practices regarding brief alcohol intervention in primary health care.  J Adv Nurs. 2002;  39 333-342
• 13 Thom B, Tellez C. A difficult business: detecting and managing alcohol problems in general practice.  Br J Addict. 1986;  81 405-418
• 14 Rush B R, Powell L Y, Crowe T G, Ellis K. Early intervention for alcohol use: family physicians' motivations and perceived barriers.  CMAJ. 1995;  152 863-869
• 15 Durand M A. General Practitioner involvement in the management of alcohol misuse: dynamics and resistences.  Drug Alcohol Depend. 1994;  35 181-189
• 16 Kaner E, Rapley T, May C. Seeing through the glass darkly? A qualitative exploration of GPs' drinking and their alcohol intervention practices.  Fam Pract. 2006;  23 (4) 481-487
• 17 Berner M M, Härter M, Kriston L. et al . Detection and management of alcohol use disorders in German primary care: influenced by non-clinical factors.  Alcohol Alcohol. 2008 (in press); 
• 18 Newbury-Birch D, Walshaw D, Kamali F. Drink and drugs: from medical students to doctors.  Drug Alcohol Depend. 2001;  64 (3) 265-270
• 19 Singh G, Singh R P. Drugs on a medical campus I. Drug use among medical undergraduates.  Drug Alcohol Depend. 1979;  4 391-398
• 20 Conard S, Hughes P, Baldwin Jr D C. et al . Substance use by fourth-year students at 13 U.S. medical schools.  J Med Educ. 1988;  63 747-758
• 21 Forney M A, Ripley W K, Forney P D. A profile and prediction study of problem drinking among first-year medical students.  Int J Addict. 1988;  23 767-779
• 22 Baldwin Jr D C, Hughes P H, Conard S E. et al . Substance use among senior medical students. A survey of 23 medical schools.  JAMA. 1991;  265 2074-2078
• 23 Pickard M, Bates L, Dorian M. et al . Alcohol and drug use in second-year medical students at the University of Leeds.  Med Educ. 2000;  34 148-150
• 24 Newbury-Birch D, White M, Kamali F. Factors influencing alcohol and illicit drug use amongst medical students.  Drug Alcohol Depend. 2000;  59 (2) 125-130
• 25 Webb E, Ashton C H, Kelly P, Kamali F. Alcohol and drug use in UK university students.  Lancet. 1996;  348 (9032) 922-925
• 26 Boland M, Fitzpatrick P, Scallan E. et al . Trends in medical student use of tobacco, alcohol and drugs in an Irish university, 1973 – 2002.  Drug Alcohol Depend. 2006;  85 (2) 123-128
• 27 Keller S, Maddock J E, Laforge R G. et al . Binge drinking and health behavior in medical students.  Addict Behav. 2007;  32 (3) 505-515
• 28 Wechsler H, Lee J E, Kuo M. et al . Trends in college binge drinking during a period of increased prevention efforts.  Am Coll Health. 2002;  50 (5) 203-217
• 29 Miller J W, Naimi T S, Brewer R D, Jones S E. Binge drinking and associated health risk behaviors among high school students.  Pediatrics. 2007;  119 (1) 76-85
• 30 Saitz R, Palfai T P, Freedner N. et al . Screening and brief intervention online for college students: the health study.  Alcohol Alcohol. 2007;  42 (1) 28-36
• 31 Ehrlich P F, Haque A, Swisher-McClure S, Helmkamp J. Screening and brief intervention for alcohol problems in a university student health clinic.  J Am Coll Health. 2006;  54 (5) 279-287
• 32 Kypri K, Saunders J B, Williams S M. et al . Web-based screening and brief intervention for hazardous drinking: a double-blind randomized controlled trial.  Addiction. 2004;  99 (11) 1410-1417
• 33 Lambert Passos S R, Alvarenga Americano do Brasil P E, Borges Dos Santos M A, Costade Aquino M T. Prevalence of psychoactive drug use among medical students in Rio de Janeiro.  Soc Psychiatry Psychiatr Epidemiol. 2006;  41 (12) 989-996
• 34 Kahan M, Midmer D, Wilson L, Borsoi D. Medical students' knowledge about alcohol and drug problems: results of the medical council of Canada examination.  Subst Abus. 2006;  27 (4) 1-7
• 35 Cape G, Hannah A, Sellman D. A longitudinal evaluation of medical student knowledge, skills and attitudes to alcohol and drugs.  Addiction. 2006;  101 (6) 841-849
• 36 Saunders J B, Aasland O G, Babor T F. et al . Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption-II.  Addiction. 1993;  88 791-804
• 37 Ewing J A. Detecting alcoholism. The CAGE Questionnaire.  JAMA. 1984;  252 1905-1907
• 38 John U. Standardisierte Verfahren zur Diagnostik der Alkoholabhaengigkeit.  Drogalkohol. 1993;  17 (1) 3-12
• 39 Saunders J B, Aasland O G, Amundsen A, Grant M. Alcohol consumption and related problems among primary health care patients: WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption – I.  Addiction. 1993;  88 349-362
• 40 Reinert D F, Allen J P. The Alcohol Use Disorders Identification Test: an update of research findings.  Alcohol Clin Exp Res. 2007;  31 185-199
• 41 Berner M M, Kriston L, Bentele M, Härter M. The Alcohol Use Disorders Identification Test for detecting at-risk drinking. A systematic review and meta-analysis.  J Stud Alcohol Drugs. 2007;  68 461-473
• 42 Rump H-J, Hapke U, Meyer C, John U. Screening for alcohol use disorders and at-risk drinking in the general population: psychometric performance of three questionnaires.  Alcohol Alcohol. 2002;  37 261-268
• 43 Dhalla S, Kopec J A. The CAGE questionnaire for alcohol misuse: a review of reliability and validity studies.  Clin Invest Med. 2007;  30 33-41
• 44 Aertgeerts B, Buntinx F, Kester A. The value of the CAGE in screening for alcohol abuse and alcohol dependence in general clinical populations: a diagnostic meta-analysis.  J Clin Epidemiol. 2004;  57 30-39
• 45 Deutsche Gesellschaft für Suchtforschung und Suchttherapie (DG-Sucht), Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde (DGPPN) . Riskanter schädlicher und abhängiger Alkoholkonsum: Screening, Diagnostik, Kurzintervention.  Sucht. 2004;  50 102-112 , (online unter http://www.uni-duesseldorf.de/WWW/AWMF/ll/076-003.htm)
• 46 Wechsler H, Dowdall G, Davenport A, Rimm E. A genderspecific measure of binge drinking among college students.  Am J Public Health. 1995;  85 982-985
• 47 Bloomfield K, Grittner U, Kramer S. Regionale Unterschiede im Alkoholkonsum von Männern und Frauen zwischen 1991 und 1998 in Deutschland.  Gesundheitswesen. 2004;  66, 08/09 77
• 48 Kraus L, Augustin R, Bloomfield K, Reese A. Der Einfluss regionaler Unterschiede im Trinkstil auf riskanten Konsum, exzessives Trinken, Missbrauch und Abhängigkeit.  Gesundheitswesen. 2001;  63 775-782
• 49 Deutsche Hauptstelle für Suchtgefahren e. V. (DHS) .Jahrbuch Sucht 2003. http://www.dhs.de
• 50 Baldwin Jr D C, Hughes P H, Conard S E. et al . Substance use among senior medical students. A survey of 23 medical schools.  JAMA. 1991;  265 (16) 2074-2078
• 51 Bundeszentrale für gesundheitliche Aufklärung (BzgA) .Entwicklung des Alkoholkonsums bei Jugendlichen unter besonderer Berücksichtigung der Konsumgewohnheiten von Alkopops. Kurzbericht. Juni 2005 http://www.bzga.de
• 52 Newbury-Birch D, White M, Kamali F. Factors influencing alcohol and illicit drug use amongst medical students.  Drug Alcohol Depend. 2000;  59 (2) 125-30
• 53 Knight J R, Wechsler H, Kuo M. et al . Alcohol abuse and dependence among US college students.  J Stud Alcohol. 2002;  63 (3) 263-270
• 54 Hrabal V, Schuppel R, Zenz H. Illness behavior and expectations on physician-patient relationships of medical students in the second and fifth year of education.  Psychotherapie, Psychosomatik, Medizinische Psychologie. 2000;  50 (7) 301-307
• 55 Wu L T, Pilowsky D J, Schlenger W E, Hasin D. Alcohol use disorders and the use of treatment services among college-age young adults.  Psychiatr Serv. 2007;  58 (2) 192-200
• 56 Ljubotina D, Galic J, Jukic V. Prevalence and risk factors of substance use among urban adolescents: questionnaire study.  Croat Med J. 2004;  45 (1) 88-98
• 57 Kokkevi A E, Arapaki A A, Richardson C. et al . Further investigation of psychological and environmental correlates of substance use in adolescence in six European countries.  Drug Alcohol Depend. 2007;  88 (2 – 3) 308-312
• 58 Challier B, Chau N, Predine R. et al . Associations of family environment and individual factors with tobacco, alcohol, and illicit drug use in adolescents.  Eur J Epidemiol. 2000;  16 (1) 33-42
• 59 Gau S S, Chong M Y, Yang P. et al . Psychiatric and psychosocial predictors of substance use disorders among adolescents: longitudinal study.  Br J Psychiatry. 2007;  190 42-48
• 60 Slutske W S. Alcohol use disorders among US college students and their non-college-attending peers.  Arch Gen Psychiatry. 2005;  62 (3) 321-327
• 61 Berner M M, Habbig S, Harter M. Quality of guidelines for the treatment of alcohol related disorders – a systematic review and content analysis.  Fortschritte der Neurologie-Psychiatrie. 2004;  72 (12) 696-704
• 62 Junger J, Kollner V. Integration of a doctor/patient-communication-training into clinical teaching. Examples from the reform-curricula of Heidelberg and Dresden Universities.  Psychotherapie, Psychosomatik, Medizinische Psychologie. 2003;  53 (2) 56-64
• 63 Schmitt G M, Kammerer E, Holtmann M. Improving medical students' interactive competence.  Psychotherapie, Psychosomatik, Medizinische Psychologie. 2003;  53 (9 – 10) 390-398