HealthDay News — The U.S. Preventive Services Task Force (USPSTF) is now recommending primary care providers screen all adults aged 18 years and older for alcohol misuse, and further recommends providing brief counseling interventions for those who engage in risky or hazardous behavior.
“Alcohol misuse is the cause of tens of thousands of deaths per year in the United States — deaths that could have been prevented,” Task Force member Sue Curry, PhD, said in a press release. “The good news is that primary care professionals can identify adults who engage in risky or hazardous drinking, and through brief counseling, help them drink more responsibly.”
The USPSTF Recommendation Statement, published online in the Annals of Internal Medicine, outlines three tools clinicians can use to screen for alcohol misuse in primary care:
- The Alcohol Use and Disorders Idenfitication Test (AUDIT)
- The abbreviated AUDIT-Consumption (AUDIT-C)
- Single question screening — for example, asking a patient,“How many times in the past year have you had four [for women and all persons older than 65 years] or five [for men] drinks in a day?”
None of these three screening instruments require more than a few minutes to complete, according to USPSTF. The AUDIT consists of 10 questions and takes about 2 to 5 minutes to complete, whereas the AUDIT-C comprises three questions that can be answered in 1 to 2 minutes. The single-question screening method consists of one question that takes no more than 1 to 2 minutes to complete.
If alcohol misuse is identified, the USPSTF recommends clinicians utilize four behavioral counseling interventions, which vary by structure, content and duration:
- Very brief single contact of 5 minutes or fewer duration
- Brief single contact of 6 to 15 minute duration
- Brief multicontact, with each contact consisting of 6 to 15 minute duration
- Extended multicontact, consisting of one or more contacts 15 minutes or longer in duration
“Brief multicontact behavioral counseling seems to have the best evidence of effectiveness,” the panel wrote. “Very brief behavioral counseling has limited effect.”
The revised 2013 USPSTF recommendation replaces a 2004 recommendation. It clarifies the USPSTF definition of “alcohol misuse” to include “the full spectrum of unhealthy drinking behaviors, from risky drinking to alcohol dependence.” The earlier recommendation limited the definition to “risky, hazardous or harmful drinking.”
The 2013 Recommendation Statement is classified as a Grade B recommendation, as there is insufficient evidence to assess the benefits vs. risks of alcohol misuse screening or the optimal intervals for screening.