Intended for healthcare professionals


Alcohol consumption and alcohol counselling behaviour among US medical students: cohort study

BMJ 2008; 337 doi: (Published 07 November 2008) Cite this as: BMJ 2008;337:a2155
  1. Erica Frank, professor and Canada research chair1, professor and senior adviser2,
  2. Lisa Elon, senior associate faculty3,
  3. Timothy Naimi, medical epidemiologist4,
  4. Robert Brewer, medical epidemiologist4
  1. 1University of British Columbia, School of Population and Public Health, and Department of Family Practice, 5804 Fairview Avenue, Vancouver, BC, Canada
  2. 2Emory University School of Medicine, Department of Family and Preventive Medicine, 49 Jesse Hill Jr Drive, Atlanta, GA 30303, USA
  3. 3Emory University Rollins School of Public Health, Department of Biostatistics and Bioinformatics, 1518 Clifton Road, Atlanta, GA 30322
  4. 4National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Mail stop k-67, 4770 Buford Highway NE, Atlanta, GA 30341
  1. Correspondence to: E Frank efrank{at}
  • Accepted 7 October 2008


Objective To determine which factors affect alcohol counselling practices among medical students.

Design Cohort study.

Setting Nationally representative medical schools (n=16) in the United States.

Participants Medical students who graduated in 2003.

Interventions Questionnaires were completed (response rate 83%) at the start of students’ first year (n=1846/2080), entrance to wards (typically during the third year of training) (n=1630/1982), and their final (fourth) year (n=1469/1901).

Main outcome measures Previously validated questions on alcohol consumption and counselling.

Results 78% (3777/4847) of medical students reported drinking in the past month, and a third (1668/ 4847) drank excessively; these proportions changed little over time. The proportion of those who believed alcohol counselling was highly relevant to care of patients was higher at entrance to wards (61%; 919/1516) than in final year students (46%; 606/1329). Although students intending to enter primary care were more likely to believe alcohol counselling was highly relevant, only 28% of final year students (391/1393) reported usually or always talking to their general medical patients about their alcohol consumption. Excessive drinkers were somewhat less likely than others to counsel patients or to think it relevant to do so. In multivariate models, extensive training in alcohol counselling doubled the frequency of reporting that alcohol counselling would be clinically relevant (odds ratio 2.3, 95% confidence interval 1.6 to 3.3) and of reporting doing counselling (2.2, 1.5 to 3.3).

Conclusions Excessive drinking and binge drinking among US medical students is common, though somewhat less prevalent than among comparably aged adults in the US general population. Few students usually discussed alcohol use with patients, but greater training and confidence about alcohol counselling predicted both practising and believing in the relevance of alcohol counselling. Medical schools should consider routinely training students to screen and counsel patients for alcohol misuse and consider discouraging excessive drinking.


  • Contributors: EF was responsible for the conception, design, and interpretation of data, for drafting the article and revising it, and providing final approval of the version to be published. She is guarantor. LE contributed to study design, was responsible for data analysis and interpretation, contributed to article revision for important intellectual content, and approved the final version. TN contributed to study design, analysis and interpretation of data, drafting components of the article, critical revisions, and approved the final version. RB contributed to study design, analysis and interpretation of data, drafting components of the article, critical revisions, and approved the final version.

  • Funding: This work was supported by the American Cancer Society, Annenberg Physician Training Program, Canada Research Chair Program, and the Michael Smith Foundation for Health Research.

  • Competing interests: None declared.

  • Ethical approval: This work was approved by the institutional review board at Emory University, and informed consent was given by all participants.

  • Provenance and peer review: Not commissioned; externally peer reviewed.

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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