At a time when the cost of the Affordable Care Act is only now being realized and most academics are offering ways services can be cut to keep budgets manageable, the United States Preventive Services Task Force (USPSTF)is going the other way and recommending more health care - that clinicians screen all adults 18 and over, including pregnant women, for alcohol misuse.
Clinicians should provide brief behavioral counseling interventions to patients engaged in risky or hazardous drinking. Alcohol misuse is the third leading cause of preventable death in the United States after tobacco use and being overweight, resulting in more than 85,000 deaths a year.
"Alcohol misuse" is the term used to define a spectrum of behaviors. Harmful alcohol use is a pattern of drinking that causes physical or mental damage. Alcohol abuse is drinking that leads to failure to meet responsibilities, use of alcohol in physically hazardous situations, and/or having alcohol-related legal or social problems.
Alcohol dependence (alcoholism) includes physical cravings and withdrawal symptoms, frequent consumption of alcohol in larger amounts over longer periods than intended, and a need for markedly increased amounts of alcohol to achieve intoxication.
About 25 percent of the U.S. population admits to alcohol misuse, with most engaging in what is considered risky or hazardous drinking, or drinking more than is recommended during a given time period. Adequate evidence suggests behavioral counseling interventions reduce weekly alcohol consumption and promote long-term compliance with recommended drinking limits among patients engaging in risky or hazardous drinking.
These interventions have also been shown to reduce binge drinking, which is characterized as heavy per-occasion alcohol use. The most effective interventions were brief (10 to 15 minutes per contact) multicontact interventions delivered by primary care physicians with some additional support from a nurse or health educator. Limited evidence suggests that brief behavioral counseling interventions are generally ineffective as singular treatments for alcohol abuse or dependence.
The Task Force did not formally evaluate other interventions (pharmacotherapy or outpatient treatment programs) for alcohol abuse or dependence, but the benefits of specialty treatment are well established and recommended for persons meeting the diagnostic criteria for alcohol dependence. These recommendations differ from the 2004 statement in that the USPSTF has clarified the definition of alcohol misuse to include the full spectrum of drinking habits from risky to dependent.
The Task Force emphasizes that evidence on the effectiveness of brief behavioral counseling interventions in the primary care setting remains largely restricted to persons engaging in risky or hazardous drinking. Evidence is lacking to recommend an optimal screening interval. The Task Force also found insufficient evidence to make recommendations for screening or behavioral interventions for adolescents.