In an assessment of evidence pertaining to the unhealthy use of alcohol in adolescents and adults, the US Preventive Services Task Force (USPSTF) recommends screening for unhealthy alcohol use in primary care settings in patients ≥18 years of age, including pregnant women. The USPSTF also recommends that adult patients be provided with behavioral counseling interventions to reduce the unhealthy use of alcohol (Grade B recommendation).
This recommendation replaces the 2013 recommendation in which the task force used the term “alcohol misuse.” The term “unhealthy alcohol use” expressed in the updated guidelines describes a wider spectrum of behaviors from risky drinking to alcohol use disorder. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), “risky use” is defined as exceeding the recommended limits of 4 drinks per day (56 g/d) or 14 drinks per week (196 g/d) for a healthy adult man aged 21 to 64 years or 3 drinks per day or 7 drinks per week for adult women of any age and men aged ≥65 years.
The task force found adequate evidence to support the assessment of unhealthy alcohol use in primary care. Numerous brief screening instruments can detect unhealthy alcohol use with acceptable sensitivity and specificity; these include the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and the NIAAA-recommended Single Alcohol Screening Question (SASQ).
The USPSTF found reductions in both the odds of exceeding recommended drinking limits and heavy use episodes at 6- to 12-month follow-up when adults who screened positive for unhealthy alcohol use were enrolled in brief behavioral counseling interventions. In pregnant woman, behavioral counseling interventions increased the likelihood that they would not consume alcohol during their pregnancy. However, the USPSTF did not find adequate evidence to support screening or brief behavioral counseling interventions for unhealthy alcohol use in adolescents.
The task force found small to no harms associated with screening and behavioral counseling interventions in adults and pregnant women. This rating is based on the minimal harms of the screening instruments, the noninvasive intervention questions, and the absence of any reported harms in the evidence reviewed. The USPSTF found inadequate evidence to assess the harms of screening and interventions for alcohol use in adolescents.
“The USPSTF concludes with moderate certainty that screening and brief behavioral counseling interventions for unhealthy alcohol use in the primary care setting in adults 18 years or older, including pregnant women, is of moderate net benefit,” the members of the task force wrote. “The USPSTF concludes that the evidence is insufficient to determine the benefits and harms of screening for unhealthy alcohol use in the primary care setting in adolescents aged 12 to 17 years.”
US Preventive Services Task Force; Curry SJ, Krist AH, Owens DK, et al. Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: US Preventive Services Task Force recommendation statement. JAMA. 2018;320(18):1899-1909.