Prevalence and characteristics of hazardous and harmful drinkers receiving general practitioners’ brief advice on and support with alcohol consumption in Germany: results of a population survey

Abstract

ObjectiveThe German treatment guideline on alcohol-related disorders recommends that general practitioners (GPs) offer brief advice on, and support with, reducing alcohol consumption to hazardous (at risk for health events) and harmful (exhibit health events) drinking patients. We aimed to estimate the implementation of this recommendation using data from the general population in Germany.DesignCross-sectional analysis of data (2021/2022) of a nationally representative household survey.SettingPopulation of Germany.ParticipantsRepresentative sample of 2,247 adult respondents (>18 years) who reported hazardous or harmful drinking according to the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C; score females: 4-12, males: 5-12).Main outcome measureEver receipt of “brief GP advice on, or support with, reducing alcohol consumption”. Differences in the likelihood of ever receiving advice and/or support (yes/no) relative to respondents’ sociodemographic, smoking, and alcohol consumption characteristics were estimated using logistic regressions.ResultsEver receipt of GP advice on/support with reducing alcohol was reported among 6.3% (95%CI=5.3%-7.4%), and the offer of support among 1.5% (95%CI=1.1%-2.1%) of the hazardous and harmful drinking respondents. The likelihood of having ever received advice/support was positively associated with being older (odds ratio (OR)=1.03 per year, 95%CI=1.01-1.04), a current or former (versus never) smoker (OR=2.36, 95%CI=1.46-3.80; OR=2.17, 95%CI=1.23-3.81), and with increasing alcohol consumption (OR=1.76 per score, 95%CI=1.59-1.95). One in two harmful drinking respondents (AUDIT-C score 10-12) reported appropriate advice/support. The likelihood was negatively associated with being female (e.g., OR=0.32, 95%CI=0.21-0.48), having a medium and high (versus low) education, and with increasing household income.ConclusionsA small proportion of people drinking at hazardous and harmful levels in Germany report having ever received brief GP advice on, or support with, reducing alcohol consumption. The implementation of appropriate advice or support seems to be strongly linked to specific sociodemographic characteristics, tobacco smoking, and the alcohol consumption level.Strengths and limitations of this studyThe principal strength of this study is the large, nationally representative population sample.The cross-sectional study design and temporality issues with our measures (alcohol consumption was measured with reference to the present and the outcome as “ever receipt of GP advice or support”) limited our ability to explore causal relationships.The outcome measure had a complex, not entirely hierarchical structure, which may have led to respondents being unsure of which response option to select.Data were collected during the COVID-19 pandemic, during which alcohol consumption in Germany seemed to have changed. It is unclear how this might have influenced GPs’ behaviour.Due to the socially loaded topic, respondents may not have answered truthfully or repressed a previous conversation with their GP on their alcohol consumption. We did not assess the GPs’ view on the topic.