Primary care clinicians should screen all adults and pregnant women for alcohol misuse and refer them for counseling if necessary, according to an updated recommendation issued recently by the U.S. Preventive Services Task Force. The recommendation is published in the April 6 issue of the Annals of Internal Medicine.
Women who drink more than seven drinks per week or more than three drinks per occasion and men who drink more than 14 drinks per week or more than four drinks per occasion are considered to be risky or hazardous drinkers, according to the Task Force. The term alcohol misuse includes risky drinking as well as harmful drinking, which is behavior by individuals who are experiencing physical, social, or psychological harm from alcohol but do not meet criteria for alcohol dependence as outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.
Alcohol misuse is strongly associated with more than 100,000 preventable deaths per year, and it is linked to health problems, anxiety and depression, tobacco use, disability, motor vehicle crashes, accidents, injury, social disruption, and violence. Higher levels of alcohol consumption are linked to increased cirrhosis, diseases of the central nervous system, high blood pressure, and cancers of the head and neck, digestive tract, liver, and breast. Excessive alcohol use during pregnancy can cause fetal alcohol syndrome, which can lead to growth retardation, facial deformities, and central nervous system dysfunction. In the United States, alcohol abuse costs nearly $185 billion annually.
As many as one-fourth of all patients seen by primary care clinicians in some settings may be risky drinkers, according to studies reviewed by the Task Force. The Task Force noted that several clinical screening tools for alcohol-related problems are currently available for adults and pregnant women. These tools can be found online at the National Institute on Alcohol Abuse and Alcoholism's Web site, www.niaaa.nih.gov/publications.
According to the Task Force, effective counseling sessions for adults identified as risky drinkers should consist of multicontact behavioral interventions. These include a 15-minute initial session with advice to reduce current drinking; feedback about current drinking patterns; explicit goal-setting, usually for moderation; assistance in achieving the goal; and followup through telephone calls, repeat visits, and repeat monitoring. Counseling sessions can be delivered in the primary care setting by one or more members of the health care team, including physicians and other health practitioners, as well as health educators and others trained in alcohol-specific counseling methods. Primary care office-level system supports such as prompts, reminders, step-by-step counseling procedures, and patient education materials are helpful, according to the Task Force.
In a separate finding, the Task Force concluded that at this time, there is insufficient rigorous scientific evidence to recommend for or against screening and counseling interventions in primary care settings to curb alcohol misuse by adolescents. Although young adults ages 18-25 have the highest rates of binge and heavy drinking, the Task Force found few adequate-quality studies on interventions to reduce alcohol misuse aimed at adolescents in the primary care setting. They noted the need for additional research in this area.
The Task Force, sponsored by the Agency for Healthcare Research and Quality, is the leading independent panel of private-sector experts in prevention and primary care. The Task Force conducts rigorous, impartial assessments of the scientific evidence for a broad range of preventive services. Task Force recommendations are considered the gold standard for clinical preventive services. The Task Force based its conclusions on a report from a research team led by Evelyn P. Whitlock, M.D., M.P.H., at AHRQ's Oregon Evidence-based Practice Center, a consortium of clinicians and researchers from Oregon Health & Science University, Kaiser Permanente's Center for Health Research, and the Portland Veterans Affairs Medical Center.
The Task Force grades the strength of the evidence from "A" (strongly recommends), "B" (recommends), "C" (no recommendation for or against), "D" (recommends against) or "I" (insufficient evidence to recommend for or against screening). The Task Force recommends screening and counseling for adults and pregnant women (a "B" recommendation). The Task Force found insufficient evidence to recommend screening and counseling of adolescents (an "I" recommendation).
Select for recommendations on alcohol and materials for clinicians.
Previous Task Force recommendations, summaries of the evidence, easy-to-read fact sheets explaining the recommendations, and related materials are available from the AHRQ Publications Clearinghouse.
Clinical information is also available at AHRQ's National Guideline Clearinghouse™.
For more details, see "Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: Recommendation statement," by the U.S. Preventive Services Task Force, in the April 6, 2004, Annals of Internal Medicine 140(7), pp. 554-556; and "Behavioral counseling interventions in primary care to reduce risky/harmful alcohol use by adults: A summary of the evidence for the U.S. Preventive Services Task Force," by Dr. Whitlock, Michael R. Plen, M.A., Carla A. Green, Ph.D., and others, in the same issue, pp. 557-568.
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