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Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
SUMMARIES FOR PATIENTS
Screening and Counseling To Reduce Alcohol Misuse: Recommendations from the United States Preventive Services Task Force
6 April 2004 | Volume 140 Issue 7 | Page I-64
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians.
The summary below is from the full reports titled "Screening and Behavioral Counseling Interventions in Primary Care To Reduce Alcohol Misuse: Recommendation Statement" and "Behavioral Counseling Interventions in Primary Care To Reduce Risky/Harmful Alcohol Use by Adults: A Summary of the Evidence for the U.S. Preventive Services Task Force." They are in the 6 April 2004 issue of Annals of Internal Medicine (volume 140, pages 554-556 and pages 557-568). The first report was written by the U.S. Preventive Services Task Force; the second report was written by E.P. Whitlock, M.R. Polen, C.A. Green, T. Orleans, and J. Klein.
What is the U.S. Preventive Services Task Force?
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).
What is the problem and what is known about it so far?
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.
How did the USPSTF develop these recommendations?
The USPSTF reviewed published research about the benefits and harms of screening and counseling for alcohol misuse.
What did the USPSTF find?
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.
What does the USPSTF suggest that patients and doctors do?
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.
What are the cautions related to these recommendations?
These recommendations may change as new studies become available.
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This article has been cited by other articles:
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 S. Coulton, C. Drummond, D. James, C. Godfrey, J M. Bland, S. Parrott, T. Peters, and the Stepwice Research Team Opportunistic screening for alcohol use disorders in primary care: comparative study BMJ, March 4, 2006; 332(7540): 511 - 517. [Abstract] [Full Text] [PDF]
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 M. M. Desai, R. A. Rosenheck, and T. J. Craig Screening for Alcohol Use Disorders Among Medical Outpatients: The Influence of Individual and Facility Characteristics Am J Psychiatry, August 1, 2005; 162(8): 1521 - 1526. [Abstract] [Full Text] [PDF]
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A. CANAGASABY and D. C. VINSON SCREENING FOR HAZARDOUS OR HARMFUL DRINKING USING ONE OR TWO QUANTITY-FREQUENCY QUESTIONS Alcohol Alcohol., May 1, 2005; 40(3): 208 - 213. [Abstract] [Full Text] [PDF]
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 R W Hingson, R C Zakocs, T Heeren, M R Winter, D Rosenbloom, and W DeJong Effects on alcohol related fatal crashes of a community based initiative to increase substance abuse treatment and reduce alcohol availability Inj. Prev., April 1, 2005; 11(2): 84 - 90. [Abstract] [Full Text] [PDF]
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 R. Saitz Unhealthy Alcohol Use N. Engl. J. Med., February 10, 2005; 352(6): 596 - 607. [Full Text] [PDF]
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 M. A Carter Review: brief multicontact behavioural counselling interventions in primary care reduce risky or harmful alcohol use Evid. Based Nurs., October 1, 2004; 7(4): 108 - 108. [Full Text] [PDF]
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 Other articles noted Evid. Based Med., September 1, 2004; 9(5): e5 - e5. [Full Text] [PDF]
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 USPSTF Recommends Screening and Counseling for Alcohol Misuse Journal Watch (General), April 13, 2004; 2004(413): 3 - 3. [Full Text]
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