Although it acknowledged there are no studies that evaluated whether screening in primary care settings for “unhealthy alcohol use” leads to reduced unhealthy alcohol use, the U.S. Preventive Services Task Force (USPSTF) updated its 2014 recommendation saying doctors should screen adults 18 and older, including pregnant women, for unhealthy alcohol use.
Those patients who engage in risky or hazardous drinking should be offered brief behavioral counseling interventions to reduce unhealthy alcohol use, USPTF said. Evidence is insufficient regarding screening for alcohol use in adolescents 12 to 17 in primary care settings, it added.
But it did find that brief behavioral counseling interventions in adults who screen positive are associated with reduced unhealthy alcohol use.
There were reductions in both the odds of exceeding recommended drinking limits and heavy use episodes at 6- to 12-month follow-up. In pregnant women, brief counseling interventions increased the likelihood that women remained abstinent from alcohol use during pregnancy. The magnitude of these benefits is moderate.
Epidemiologic literature links reductions in alcohol use with reductions in risk for morbidity and mortality and provides indirect support that reduced alcohol consumption may help improve some health outcomes.
Excessive alcohol use is one of the most common causes of premature death in the United States, with an estimated 88,000 deaths attributed to alcohol occurring annually in the United States from 2006 to 2010. Alcohol use during pregnancy is also one of the major preventable causes of birth defects and developmental disabilities.
The National Institute on Alcohol Abuse & Alcoholism (NIAAA) defines “risky use” as exceeding the recommended limits of four drinks per day or 14 drinks per week for healthy adult men aged 21 to 64 years or three drinks per day or seven drinks a week for all adult women of any age and men 65 years or older.
The recommendation was published in JAMA. An editorial notes that “implementation of screening and brief intervention still remains quite low, despite the high prevalence of unhealthy alcohol use, its association with death and disability, evidence for screening and brief intervention efficacy, substantial government funding, practice guidelines, and quality measures and incentives. In the United States, one in six patients reports having discussed alcohol with their physician,” it said.
One reason for the low implementation rate, the editorial suggested, may be that “physicians may be concerned that, if they identify AUD, they will be unable to manage it or will have difficulty accessing referrals to effective care.”