Screening For Alcohol Abuse During Physical Checkup Recommended

In an effort to address the risk of alcohol abuse, experts now recommend a comprehensive screening for any signs and symptoms of all American adults during their physician checkup for physical examination. 

"The U.S. Preventive Services Task Force (USPSTF) recommends that clinicians screen adults aged 18 years or older for alcohol misuse and provide persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce alcohol misuse," the USPTF said.

More than half of adults 18 years of age and over are current regular drinkers (at least 12 drinks in the past year), according to the statistics from the Centers for Disease Control and Infection (CDC, Atlanta). However, of all the American adults (ages 18 and over), 43.1 percent of men and 28.8 percent of women were binge drinkers –– consumed at least four/five (women/men) drinks within 2 hours at least once, in the past year –– according to the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) data. Alcohol abuse is the third leading cause of preventable death in the U.S.

"Alcohol misuse" is defined as "a spectrum of behaviors, including risky or hazardous alcohol use (for example, harmful alcohol use and alcohol abuse or dependence)," according to USPSTF.

"Risky or hazardous alcohol use means drinking more than the recommended daily, weekly, or per-occasion amounts resulting in increased risk for health consequences."

"Consuming more than 4 drinks on any day or 14 drinks per week for men, or more than 3 drinks on any day or 7 drinks per week for women (as well as any level of consumption under certain circumstances)," is deemed risky by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the U.S. Department of Agriculture.

"Alcohol abuse" (defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) is drinking that has the consequence of recurrent failure by an individual in major home, work, or school responsibilities; usage of alcohol in physically hazardous situations (such as while operating heavy machinery); or alcohol-related legal or social problems.

USPSTF says that alcohol misuse includes "the full spectrum of unhealthy drinking behaviors, from risky drinking to alcohol dependence, rather than limiting its meaning to just risky, hazardous, or harmful drinking (as screening will detect a broad range of unhealthy drinking behaviors). The USPSTF emphasizes, however, that evidence regarding the effectiveness of brief behavioral counseling interventions in the primary care setting remains largely restricted to persons engaging in risky or hazardous drinking."

It is plausible therefore, that the government-backed advisory panel USPSTF reviewed the existing data to determine if rigorous screening helped identify and intervene in more cases of potential alcohol abuse.

The task force members analyzed results from trials involving randomly assigned adults, adolescents, and pregnant women to different screening and behavior counseling strategies for alcohol misuse between 1985 and 2011. They also looked into systematic reviews of the impact of alcohol screenings that were published between 2006 and 2011. The task force found that "counseling interventions in the primary care setting can positively affect unhealthy drinking behaviors in adults engaging in risky or hazardous drinking. Positive outcomes include reducing weekly alcohol consumption and long-term adherence to recommended drinking limits."

Currently, most pediatricians and family caregivers admit to providing alcohol prevention services to adolescents, but not to most adults on a regular basis. Lack of time or familiarity with the screening tools or even the requisite training or skills, may be to blame.

However, the task force recommends screening of all adults ages 18 and older, including women who are pregnant, in order to identify more people who have problems with alcohol. The existing data, according to the panel, supported the benefits of finding these high risk people and providing them with proper treatment or counseling to prevent more serious alcohol abuse.

"Although pregnant women are included, this recommendation is related to decreasing risky or hazardous drinking, not to complete abstinence, which is recommended for all pregnant women. These recommendations do not apply to persons who are actively seeking evaluation or treatment for alcohol misuse."

The Alcohol Use Disorders Identification Test (AUDIT) is the most widely studied for detecting alcohol misuse in primary care settings, with exquisite sensitivity and specificity for detecting the full spectrum of alcohol misuse across multiple populations. Comprising 10 questions and requiring approximately two to five minutes to administer, AUDIT is very effective. Single-question screening across the alcohol-misuse spectrum requires less than one minute to administer.

Expanded testing is expected to help decrease the  prevalence of dangerous drinking behaviors and associated harms, and consistent testing practices for abnormal drinking behaviors protects those who abuse alcohol as well as their associates. The overall benefit of screening adults, including younger adults, for alcohol misuse and providing brief behavioral counseling interventions for those engaged in risky or hazardous drinking is moderate, according to the task force experts.

Brief counseling interventions in adults with screening-detected risky or hazardous drinking have a positive impact on binge drinking, high average weekly intake of alcohol, and consumption above recommended intake limits.However, the evidence is insufficient to assess the balance of benefits and harms of screening and behavioral counseling for alcohol misuse in adloescents. The experts also failed to review the evidence on interventions for alcohol dependence, including 12-step programs (such as Alcoholics Anonymous), intensive outpatient or inpatient treatment programs, and pharmacotherapy.

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