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More health centers screening every client for alcohol abuse

Strep Throat and Beer
March 20, 2012

Whether they're seeking care for a nasty hangover or a twisted ankle, Cornell University students can expect health center doctors to ask about their drinking habits.

Deborah Lewis, Cornell’s alcohol projects coordinator, said it’s important to screen high-risk drinking among college students. If doctors identify dangerous habits, she said, they can intervene and point that student toward counseling or other resources. And that means asking the questions even if a student has symptoms -- say a runny nose -- that don't suggest a drinking problem.

Cornell’s effort is part of a national movement to more aggressively identify risky drinking in colleges and intervene with helpful programs, but not everyone is thrilled. Dan Kuhr, a Cornell junior studying in Switzerland this spring, finds the policy unnecessary and annoying. “I don't want to be screened for alcoholism when all I need is a simple antibiotic,” he wrote in an e-mail to Inside Higher Ed.

The World Health Organization and the U.S. government have long encouraged alcohol screening to be a routine part of a doctor’s visit, but Cornell and other colleges instituted policies last year as part of the Dartmouth Learning Collaborative on High-Risk Drinking. The collaborative is a group of 32 institutions applying public health principles to college alcohol use.

At Cornell, care providers ask male patients if they’ve had more than five drinks in a sitting in the past two weeks. Women are asked if they’ve had more than four drinks in a sitting in that same timeframe. If they answer yes, they are asked to take a survey that becomes part of their permanent, confidential medical records. What they learn also helps caregivers understand the root of a medical issue.

If students’ survey answers reveal likely alcohol abuse, they may be referred to a health center counselor or an Alcoholics Anonymous meeting. It's similar to a movement that Cornell has embraced that provides depression screening to students seeking out general medical care.

The debate isn’t whether colleges should help students address dangerous drinking habits – everyone agrees they should. But, at least at Cornell, opinions vary as to whether students should be asked to disclose last Friday’s Jager bombs when being treated for athlete’s foot.

Purdue University at West Lafayette, another Dartmouth Collaborative participant, started screening students who visit the health center for alcohol use last fall. Tammy Loew, a health advocacy coordinator, wasn’t aware of any student misgivings about the new policy. It’s no different than inquiring about possible pregnancies or tobacco use, she said.

“When you’re in this age range, you need to ask those questions,” Loew said. “It’s all part of a medical visit.”

At the University of Wyoming, written screenings started last year in the counseling center and are now being done on a trial basis for all medical appointments. Lena Newlin, the director of the university’s alcohol awareness program, hopes to start screening students at academic advising appointments soon.

Alcohol abuse can contribute to issues with mental health, physical health and academic performance. By assessing students’ habits, she said, caregivers and advisers might be able to identify the reason behind a problem and then work to solve it.

“A big part of this is helping people to make the connections between alcohol use and their general health, between alcohol use and their mental health,” she said.

Laura Forbes, who chairs the American College Health Association committee on alcohol, said screening is important and applauded colleges for helping students exhibiting problems to get help. But Cornell’s situation shows that colleges walk a fine line between treating potential alcohol abuse and making students feel uncomfortable at the health center, said Forbes, who is also an associate professor at the University of Alabama at Birmingham.

“It is a positive in that the university is trying to take a proactive approach to identify high-risk drinkers,” she said. “The negative aspect is that there’s a backlash from the students. They may feel like, 'When I go to the health center, I’m being profiled.' ”

But profiling isn’t the point, Lewis said. Though it’s an elite institution, she said Cornell has the same drinking problems as any other university and its students must understand the consequences of their behavior. George Desdunes, a 19-year-old sophomore from Brooklyn, died last year after a night of heavy drinking and, his mother alleges, fraternity hazing.

Still, answering the question is optional and those who admit to underage drinking won’t be turned over to law enforcement. If a student isn’t feeling up to talking about alcohol use, Lewis said they might want to schedule another appointment to broach the topic.

The aim is to educate students who might not know their partying habits are risky and to give them a chance to confront any problems. Cornell’s Student Assembly President Natalie Raps supports that goal, though she hasn’t decided what to make of the new screening policy.

“This may be a better way to understand an undergraduate student’s mind,” Raps said. “That being said, I’m hesitant to really make my own conclusions of what it means.” She expects the student government to look into the policy after returning from spring break.

At Wyoming and Purdue, the new policies seem to have invited less dissent. Wyoming’s Newlin said college health providers often treat students who have already experienced physical, academic, mental or legal consequences from alcohol abuse. By testing more students more often for potential problems, she hopes to ward off some of those issues.

“In this case,” she said, “we’re really trying to preventatively provide this education before it gets out of hand.”

 

 

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