Task Force Recommends Screening All Adults for Alcohol Misuse

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Questions about alcohol use should be a part of regular physical checkups, according to a panel of experts.

About 21% of American adults admit that they engage in risky drinking behaviors, from overindulging, which can lead to physical and mental harm, to alcohol dependence. And it remains the third leading cause of preventable death in the U.S.

So in an effort to address the risk, a government-backed advisory panel–the U.S. Preventive Services Task Force (USPSTF)–reviewed the existing data to determine whether more rigorous screening could identify and intervene in more cases of potential alcohol abuse.

The task force members analyzed results from trials that randomly assigned adults, adolescents, and pregnant women to different screening and behavior counseling strategies for alcohol misuse between 1985 and 2011. They also studied systematic reviews of the impact of alcohol screenings that were published between 2006 and 2011.

(MORE: Brain Scans Can Predict Which Alcoholics Are Most Likely to Relapse)

Currently, the majority of pediatricians and family caregivers say they provide alcohol prevention services to adolescents, but not to most adults on a consistent basis. Doctors may feel they don’t have time to ask about and provide information concerning alcohol misuse, and many may not be familiar with screening tools meant to pick up problem drinking. And even if they are able to identify patients who need counseling, many doctors may lack the necessary training to properly advise patients.

However, based on the findings from their review, the researchers concluded that doctors should screen all adults ages 18 an older, including women who are pregnant, in order to identify more people who have problems with alcohol. The existing data, the panel determined, supported the benefits of finding these high risk people and providing them with proper treatment or counseling to prevent more serious alcohol abuse.

“Nearly 30% of adults drink more alcohol than is considered healthy and there are serious consequences for themselves, their families, and their communities. For example, alcohol misuse contributes to more than 85,000 preventable deaths each year,” says task force member Sue Curry, Dean of the College of Public Health at the University of Iowa.

(MORE: Why Personality May Matter in Preventing Alcoholism)

She and her colleagues determined there was enough evidence to suggest behavior counseling interventions to reduce weekly drinking, as well as to limit drinking in the long-term and discourage binge drinking. Some of these counseling methods included stress management as well as drinking diaries, and face-to-face sessions or written self-help literature.

According to the researchers, the most effective behavioral interventions took no more than 10 to 15 minutes, and were delivered by the clinician and another nurse or provider.

The recommendation for widespread alcohol screening updates the USPSTF’s 2004 advice, and included a more detailed definition of alcohol misuse. The task force members expanded the scope of alcohol misuse to include any pattern of drinking — from risky binge drinking to dependence —  that interfered with an individual’s ability to meet their responsibilities.

“As an update to our 2004 recommendation, [the recommendation] will reinforce to providers that they can affect patients’ lives for the better by asking them a few simple questions and offering counseling to those who drink more alcohol than they should,” says Curry.

(MORE: Revisions to Mental Health Manual May Turn Binge Drinkers into ‘Mild’ Alcoholics)

Ironically, while pediatricians and family physicians currently focus on providing alcohol screening for adolescents since teen drinking is a serious issue, there was not enough evidence to support screening for this group.

But expanding testing could help to lower  prevalence of dangerous drinking behaviors and associated harms, say the task force members. So far, the data aren’t clear on how effective brief counseling interventions are for those with more moderate drinking habits, but adopting more consistent testing for abnormal drinking behaviors not only protects those who abuse alcohol but those who surround them as well.

Read the full USPSTF recommendation here.