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More Alcohol Screening in Primary Care Could Help Reduce Unhealthy Alcohol Use

     

Alcohol use continues to be a major public health issue in the U.S. One in eight adults in the U. S. reports unhealthy alcohol use.  About 6 percent of adults (about 4 percent of women and almost 8 percent of men) meet the criteria for alcohol use disorder.

The U.S. Preventive Services Task Force (USPSTF)* recently presented updated recommendations for screening and treatment based on the results of an extensive review of research. The review involved more than 100 studies and more than 300,000 participants and found that screening tools for alcohol use are available, feasible and effective in identifying people with unhealthy alcohol use. Brief counseling interventions were found to help reduce unhealthy alcohol use.

The USPSTF recommends “screening for unhealthy alcohol use in primary care settings in adults 18 years or older, including pregnant women, and providing persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce unhealthy alcohol use.”

The 2018 recommendations updated of USPSTF’s 2013 recommendations and replaced the term alcohol misuse with unhealthy alcohol use. Unhealthy alcohol use refers to a spectrum from use of alcohol that increases the risk for health consequences (i.e., risky or hazardous drinking) to the diagnosis of alcohol use disorder. At-risk alcohol use means more than four drinks per occasion or 14 drinks per week for men 21 to 64 years and more than three drinks per occasion or seven drinks per week for adult women of all ages and men 65 and older.  

A person in a white shirt

Description automatically generatedThe review looked at several effective screening instruments, each involving only a few basic questions and taking only a few minutes to complete. Almost all the interventions reviewed by the USPSTF involved basic education, general feedback, such as how the participants’ drinking compared with recommended limits; and suggestions about how to reduce alcohol use. Other strategies included drinking diaries, action plans, stress management and problem solving.

The most commonly used element of intervention was showing patients how their alcohol use compared with that of others, referred to as personalized normative feedback. This was used in 62 percent of all interventions and 89 percent of interventions for younger adults. The most common approach used was Screening, Brief Intervention, and Referral to Treatment (SBIRT).  Motivational interviewing,  a counseling approach to help people change behaviors, was also common. Most counseling interventions involved four or fewer sessions with a median length of 30 minutes.

Despite the previous recommendations and the availability of screening tools, screening is not common in primary care. An estimated one in six patients has discussed alcohol use with their primary care physician. 

In an editorial accompanying the USPSTF recommendations, Angela Bazzi, Ph.D., and Richard Saitz, M.D., M.P.H., note that in primary care patients are often seen “for the consequences of unhealthy alcohol use, such as poorly controlled hypertension, not the alcohol use per se” and they often leave their appointment “without clear plans to cut back or abstain from alcohol use and thus improve their health.”

If you are concerned about your own drinking or that of a loved one talk with your doctor or a mental health professional.  You can take a brief online screening here.

References

*USPSTF is an independent voluntary body. Its activities are supported by the Agency for Healthcare Research and Quality (AHRQ).

     

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