Screening and Counseling To Reduce Alcohol Misuse: Recommendations from the United States Preventive Services Task Force FREE

The U.S. Preventive Services Task Force (USPSTF) is a group of health experts that reviews published research and makes recommendations about preventive health care. The USPSTF and its review of the published research are supported by the Agency for Healthcare Research and Quality (AHRQ).

Alcohol misuse damages health. It can hurt relationships; increase risks for accidents and violence; and cause problems with the liver, brain, and heart. In the United States, a form of alcohol misuse known as “risky” or “harmful” drinking is defined as more than 7 drinks/week or more than 3 drinks/occasion for women and more than 14 drinks/week or more than 4 drinks/occasion for men. This level of drinking does not usually signal abuse or dependence, but it does put people at risk for future problems. Several standard questions can help identify people who have alcohol problems. They include asking about the following: frequency and typical quantity of drinking, frequency of exceeding recommended drinks/occasion, drinking first thing in the morning, feeling guilty about drinking, feeling a need to cut back on drinking, and feeling that others are criticizing you for drinking too much. Brief advice by doctors and other health professionals can help people without alcohol abuse or dependence cut back or stop drinking if they are drinking too much. Yet, many doctors do not routinely ask patients about their drinking habits and do not give patients with excessive drinking or alcohol problems advice about ways to cut back or quit. The USPSTF wanted to see whether research supports including screening and counseling for alcohol misuse in routine primary care visits. Screening means looking for a condition in patients who do not have symptoms or signs of that condition. Screening is different from looking for alcohol problems in patients who have symptoms or signs suggesting alcohol problems, which doctors clearly should do.

The USPSTF reviewed published research about the benefits and harms of screening and counseling for alcohol misuse.

The USPSTF found good evidence that screening adults can accurately identify patients whose alcohol use does not meet criteria for abuse or dependence but is “risky”' or “harmful” and puts them at risk for future alcohol-related health problems. They also found good evidence that brief counseling will reduce alcohol misuse in these types of drinkers over the next 6 to 12 months and maybe even longer. The authors did not identify harms of screening or counseling that would outweigh the potential benefits. The evidence for screening and counseling adolescents was limited.

The USPSTF recommends that doctors screen all adult patients in primary care settings for alcohol misuse and provide counseling for identified risky or harmful drinkers. Referral for specialist treatment may be appropriate for those with alcohol abuse or dependence.

These recommendations may change as new studies become available.