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Primary care interventions can reduce alcohol misuse

Saturday May 18, 2013
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The U.S. Preventive Services Task Force has released a final recommendation on screening and behavioral counseling interventions in primary care to reduce alcohol misuse among adolescents and adults.

Primary care professionals should ask all adults ages 18 and older about their drinking habits, according to the task force, and offer counseling to those who drink excessively.

However, although risky and hazardous alcohol use among teens is a significant problem, the task force stated, evidence is insufficient regarding how to identify teens who may be engaging in harmful drinking and whether offering teens brief counseling is effective.

"When people misuse alcohol, there can be serious consequences for themselves, their families and their communities," task force member Sue Curry, PhD, said in a USPSTF news release. "Alcohol misuse is the cause of tens of thousands of deaths per year in the United States — deaths that could have been prevented.

"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."

Alcohol misuse is common, with approximately 30% of the U.S. population engaged in risky use or drinking above recommended limits, according to the news release. It is associated with 85,000 deaths per year, making it the third-leading cause of preventable death in the country.

Alcohol misuse applies to a spectrum of behaviors, as noted in a news release from the Annals of Internal Medicine, which published the USPSTF recommendation. 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 or having alcohol-related legal or social problems. Alcohol dependence 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.

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 also have 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. However, limited evidence suggests brief behavioral counseling interventions generally are ineffective as singular treatments for alcohol abuse or dependence. The task force did not formally evaluate other interventions, such as pharmacotherapy or outpatient treatment programs, for alcohol abuse or dependence. The benefits of specialty treatment are well-established and recommended for people who meet the diagnostic criteria for alcohol dependence, the task force noted.

"Unfortunately, risky and hazardous drinking is also a serious problem among adolescents, but we donít know how to identify teens who may be engaging in risky or hazardous drinking, and we donít know if brief counseling is effective in helping them to stop," Curry said. "We recognize the critical need for more research on what primary care teams can do to help keep teens safe and sober."

While citing the valuable role primary care professionals can play in helping Americans avoid risky drinking, the task force also highlighted the important role of community- and school-based organizations and state and federal agencies in addressing this critical public health issue.

Read the recommendation and supporting data: www.uspreventiveservicestaskforce.org/uspstf/uspsdrin.htm.


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