USPSTF: Screen adults for unhealthy alcohol use

The U.S. Preventive Services Task Force recently issued final recommendations that stated adults older than 18 years, including pregnant women, should be screened for unhealthy alcohol use in primary care settings. In addition, those found to participate in hazardous or risky drinking should be offered brief behavioral counseling interventions to reduce unhealthy alcohol use.

The USPSTF also stated that there is insufficient evidence on screening teenagers aged 12 to 17 years for alcohol use in primary care settings.

Both statements were recently published in JAMA.

“Unhealthy alcohol use ... is common, increasing, and a leading cause of premature mortality,” Elizabeth A. O’Connor, PhD, Kaiser Permanente Research Affiliates Evidence-based Practice Center, and colleagues wrote.

According to researchers, unhealthy alcohol use includes exceeding recommended limits, use that negatively affects health, and alcohol use disorder. Data show 26% of adults and 4.9% of teenagers engaged in binge drinking (five or more drinks on one occasion) in 2016.

O’Connor and colleagues added that WHO and the American College of Obstetricians and Gynecologists recommend screening all women for unhealthy alcohol use before pregnancy and in their first trimester with a validated tool. These groups also recommend offering a brief intervention to all pregnant women who use alcohol.

“Screening and counseling to reduce unhealthy alcohol use may prevent deleterious health effects and help prevent progression to more severe forms of unhealthy use,” the researchers added.

Carol Mangione

In a previous interview with Healio Family Medicine, task force member Carol Mangione, MD, MSPH, provided tips for medical professionals on broaching the subject of alcohol use with their patients.

“Clinicians should take time to ask their patients questions about how often they drink and other drinking patterns, such as the typical amount of drinks they have in one sitting. These questions take a few minutes to answer and asking even a single question is effective at detecting unhealthy alcohol use,” she said.

“If a clinician finds that a patient is drinking more than they should, they should conduct a brief primary care counseling intervention such as two 10- to 15-minute clinician discussions and a follow-up phone call. .... [or] refer the patient to brief counseling and evaluate whether any other steps should be taken,” Mangione also said.

In a related editorial to the most recent USPSTF statements, Angela Bazzi, PhD and Richard Saitz, MD, MPH, both of Boston University’s School of Public Health, said the USPSTF recommendations, particularly those involving teenagers, have room for improvement, and suggested looking to another health crisis for some of the answers.

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“Stronger clinical trial evidence, including interventions to prevent youth from initiating drinking, and studies finding effects on clinical outcomes, will be needed to support broader and more definitive recommendations. The opioid epidemic and establishment of addiction medicine as a medical specialty will likely help improve physician training, but more will be needed to implement universal screening,” they wrote.

“Physicians need skills, interdisciplinary colleagues, and systems (eg, electronic records and decision support) to facilitate screening and counseling, as well as resources to care for patients identified as having [alcohol use disorder] in general health settings,” Bazzi and Saitz added. – by Janel Miller

References:

Bazzi A, Saitz, R. JAMA. 2018:Published online ahead of print.

O’Connor EA, et al. JAMA. 2018;doi:10.1001/jama.2018.12086.

USPSTF. JAMA. 2018;doi:10.1001/jama.2018.16789.

Disclosures: Please see the studies for the authors’ relevant financial disclosures.