Doctors to Screen for Alcohol Misuse

Alcohol misuse screenings in primary care settings recommended for adults but not teens

(RxWiki News) During routine visits to a primary care doctor, adults may be asked about their drinking habits. There’s no need to feel singled out; the questions will be asked of everyone.

The US Preventive Services Task Force has released updated guidelines on how doctors should screen for alcohol misuse in primary care settings.

The new guidelines recommend that providers screen for alcohol misuse in all adults, but not adolescents.

"Tell your doctor if you drink too much."

Virginia A. Moyer, MD, MPH, chair of the US Preventive Services Task Force (USPSTF), and colleagues released recommendations for screening for alcohol misuse in primary care settings to update the 2004 USPSTF guidelines.

According to the authors, roughly 21 percent of adults misuse alcohol and 4 percent are alcohol dependent.

Alcohol misuse contributes to a wide range of health conditions, such as high blood pressure, stomach problems, liver disease, cancer, depression and anxiety. Alcohol misuse has also been involved with high rates of death and injury from accidents, car crashes, drownings and suicides.

It is the job of the USPSTF to design guidelines for primary care providers to catch the early signs of physical and mental health problems and prevent further decline. Every few years, the USPSTF reviews any new evidence and makes recommendations to adjust current guidelines.

At this time, the USPSTF has proposed to amend the 2004 guidelines for alcohol misuse based on evaluation of multiple studies done between 2006 and 2011.

Alcohol misuse was defined as drinking more than four drinks per day or 14 drinks per week for men or more than three drinks per day or seven drinks per week for women. Harmful alcohol use was defined as a pattern of drinking that could cause damage to physical or mental health.

Based on previous studies, the research team found enough evidence that brief behavioral counseling interventions helped reduce alcohol misuse in adults.

Another part of the duties involved with updating the guidelines requires the USPSTF to gauge the benefits against the harms of primary care screening. 

The studies that the USPSTF looked at did not give any evidence of harm from primary care screenings for alcohol misuse in adults.

“The USPSTF recommends that clinicians screen adults aged 18 years or older for alcohol misuse and provide persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce alcohol misuse,” said the authors.

The USPSTF recommended the continued use of the Alcohol Use Disorders Identification Test (AUDIT) as the screening tool primary care providers should use to assess a patient’s risk for alcohol misuse.

The AUDIT screening tool is 10 questions long and takes only two to five minutes to complete. The USPSTF also recommended the use of the AUDIT-Consumption (AUDIT-C) screening tool, which is only three questions and takes only one to two minutes to complete.

The USPSTF recommended that primary care providers use behavioral counseling interventions that encourage patients to write down how much they drink, manage stress and make plans to reduce problem drinking.

At this time, the USPSTF did not find sufficient evidence for the benefits or harms of screening and behavioral counseling interventions in primary care settings to reduce alcohol misuse in adolescents.

The USPSTF recognized that alcohol misuse in adolescents has been a major public health problem for many years. But no clear methods for screening or behavioral counseling interventions have been found to reduce alcohol use in adolescents.

The USPSTF said that future research is needed to find out whether adolescents could benefit from behavioral counseling interventions for alcohol misuse in a primary care setting.

These update guidelines were published in May in the Annals of Internal Medicine.

The Agency for Healthcare Research and Quality supported this research. No conflicts of interest were declared.

Review Date: 
May 13, 2013