Task Force recommends screening all adults for alcohol misuse

Clinicians should screen all adults 18 and over, including pregnant women, for alcohol misuse and should provide brief behavioral counseling interventions to patients engaged in risky or hazardous drinking, the U.S. Preventive Services Task Force recently announced.

These recommendations differ from the 2004 statement in that the Task Force redefined alcohol misuse to include a broader spectrum of drinking habits from risky to dependent, rather than limiting the definition to just risky, hazardous or harmful drinking.

Although pregnant women are included, this recommendation is related to decreasing risky or hazardous drinking, not to complete abstinence, which is recommended for all pregnant women. These recommendations do not apply to persons who are actively seeking evaluation or treatment for alcohol misuse.

The Grade B recommendation appeared online first May 14 at Annals of Internal Medicine.

The Task Force found adequate evidence that brief behavioral counseling interventions are effective in reducing heavy drinking episodes in adults engaging in risky or hazardous drinking. These interventions also reduce weekly alcohol consumption rates and increase adherence to recommended drinking limits.

The most effective interventions were 10 to 15 minutes per contact delivered by primary care physicians with some additional support from a nurse or health educator. Limited evidence suggests that brief behavioral counseling interventions are generally ineffective as singular treatments for alcohol abuse or dependence. The Task Force did not formally evaluate other interventions (pharmacotherapy or outpatient treatment programs) for alcohol abuse or dependence, but the benefits of specialty treatment are well established and recommended for persons meeting the diagnostic criteria for alcohol dependence.

The Task Force emphasized that evidence on the effectiveness of brief behavioral counseling interventions in the primary care setting remains largely restricted to persons engaging in risky or hazardous drinking. Evidence is lacking to recommend an optimal screening interval. The Task Force also found insufficient evidence to make recommendations for screening or behavioral interventions for adolescents.

The Task Force considers three tools the instruments of choice for screening for alcohol misuse in the primary care setting: the Alcohol Use Disorders Identification Test (AUDIT), the abbreviated AUDIT-Consumption (AUDIT-C), and single-question screening (for example, the National Institute on Alcohol Abuse and Alcoholism recommends asking, “How many times in the past year have you had 5 [for men] or 4 [for women and all adults older than 65 years] or more drinks in a day?”).