Study Recommends Screening All Patients for Alcohol Abuse

A recent study in the Journal of the American Medical Association recommended that all United States Doctors should be screening patients for alcohol abuse. This recommendation is an update from the previous guidance set forth in 2013 which stated that screening should take place if alcohol misuse was suspected.

Alcohol misuse, according to the previous study, was used to define a wide range of drinking behaviors including risky alcohol use, harmful alcohol use, and alcohol abuse or alcohol addiction.The most recent update to the US Preventive Services Task Force (USPSTF) recommendation on alcohol screenings states that individuals that are suspected of any unhealthy alcohol use should be screened. The study found, “the net benefit of screening and brief behavioral counseling interventions for unhealthy alcohol use in adults, including pregnant women, is moderate.” Evidence from the study is insufficient to determine a balance between the benefits and harms associated with screening and brief counseling for unhealthy alcohol use in adolescents.

Excluding the cost of providing assessment, the recommendations of the USPSTF that all doctors offer risk assessment screening for alcohol use, is based on both benefits and potential harms associated with the service.  Recognizing that clinical decisions often involve considerations versus evidence alone, the USPSTF recommends that clinicians make individual decisions as to screening necessity based on specific patient situations.

What is Considered Unhealthy Alcohol Use?

A standard drink, according to the CDC, “contains 0.6 ounces (14.0 grams or 1.2 tablespoons) of pure alcohol.” This is generally the amount of alcohol that is found in:

• A 12-ounce beer.
• An 8-ounce glass of malt liquor.
• 5 ounces of wine.
• 1.5 ounces or about a shot of 80-proof distilled spirits or liquor such as vodka, whiskey, rum or gin.

According to the American Society of Addiction Medicine (ASAM), hazardous use of alcohol occurs when an individual drinks to a point in which the use of alcohol increases the risk of future negative health consequences. Unfortunately, a worldwide consensus as to what constitutes risky drinking has yet to be reached. However, any alcohol use among pregnant women is considered unhealthy and potentially hazardous.

Consumption of more than 1 drink per day for women, or more than 2 drinks per day for men, is considered potentially unhealthy.  Excessive drinking can lead to dependence and physical withdrawal. Individuals that become addicted to alcohol often require professional alcohol detox to safely overcome the addiction.

Benefits of Physician Counseling for Alcohol Use Disorder

Although more research is necessary before the task force can fully attest as to the benefits of modest physician counseling or potential drawbacks of screening patients for alcohol use disorders, current data suggests that there are zero risks associated with such interventional treatment by physicians.

In fact, the only possible drawbacks found are related to the possible stigma related to drinking habits and differences between doctors in establishing clear guidelines as to what they consider to be “unhealthy habits.” Likewise, patients may feel that the intimacy of the patient-doctor relationship suffers as a result of the alcohol risk assessment, but the potential for this outcome hardly negates the recommendations imposed.

Early detection of alcohol use disorder, or potentially risky alcohol use, especially in pregnant women, leads to reduced unhealthy alcohol use and improved behaviors. As such, the USPSTF has found that brief behavioral counseling interventions in adults that screen positive for risky or unhealthy alcohol use increases the likelihood that alcohol use is reduced. Furthermore, in cases of pregnant women, counseling interventions increase the likelihood that women abstain from alcohol use during pregnancy.