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Task Force Recommends that Primary Care Clinicians Screen and Counsel Adults to Prevent Misuse of Alcohol

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Press Release Date: April 5, 2004

Primary care clinicians should screen all adults and pregnant women for alcohol misuse and refer them for counseling if necessary, according to an updated recommendation issued today from U.S. Preventive Services Task Force. The recommendation is published in the April 6 issue of the Annals of Internal Medicine.

Women who drink more than 7 drinks per week or more than 3 drinks per occasion and men who drink more than 14 drinks per week or more than 4 drinks per occasion are considered to be risky or hazardous drinkers, according to the Task Force. The term alcohol misuse includes risky drinking as well as harmful drinking, which is behavior by individuals who are experiencing physical, social, or psychological harm from alcohol but who do not meet criteria for alcohol dependence as outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.

Alcohol misuse is strongly associated with more than 100,000 preventable deaths per year and is linked to health problems, anxiety and depression, tobacco use, disability, motor vehicle crashes, accidents, injury, social disruption, and violence. Higher levels of alcohol consumption are linked to increased cirrhosis; diseases of the central nervous system; high blood pressure; and cancers of the head and neck, digestive tract, liver, and breast. Excessive alcohol use during pregnancy can cause fetal alcohol syndrome, which can cause growth retardation, facial deformities, and central nervous system dysfunction. In the United States, alcohol abuse costs nearly $185 billion annually.

As many as one-fourth of all patients seen by primary care clinicians in some settings may be risky drinkers, according to studies reviewed by the Task Force. The Task Force noted that several clinical screening tools for alcohol-related problems are currently available for adults and pregnant women and can be found online at the National Institute on Alcohol Abuse and Alcoholism's Web site

The Task Force found that effective counseling sessions for adults identified as risky drinkers should consist of a 15-minute initial session that includes advice to reduce current drinking; feedback about current drinking patterns; explicit goal-setting, usually for moderation; assistance in achieving the goal; and followup through telephone calls, repeat visits, and repeat monitoring. Counseling sessions can be delivered in the primary care setting by one or more members of the health care team, including physicians and other health practitioners, as well as health educators and others trained in alcohol-specific counseling methods. Primary care office-level system supports such as prompts, reminders, step-by-step counseling procedures, and patient education materials are helpful, they noted.

"Effective screening and counseling using state-of-the-science tools during routine primary care visits can reduce the serious toll taken by alcohol misuse," said Task Force chair Ned Calonge, M.D., M.P.H., who is also Chief Medical Officer and State Epidemiologist for the Colorado Department of Public Health and Environment. "However, there is a critical need for more research to determine effective approaches to screen and counsel adolescents."

In a separate finding, the Task Force concluded that there isn't enough rigorous scientific evidence yet to recommend for or against screening and counseling interventions in primary care settings to curb alcohol misuse by adolescents. Although young adults aged 18-25 have the highest rates of binge and heavy drinking, the Task Force found few adequate-quality studies on interventions aimed at adolescents in the primary care setting to reduce alcohol misuse. More research is needed, they noted.

The Task Force, sponsored by the Agency for Healthcare Research and Quality, is the leading independent panel of private-sector experts in prevention and primary care and conducts rigorous, impartial assessments of the scientific evidence for a broad range of preventive services. Its recommendations are considered the gold standard for clinical preventive services. The Task Force based its conclusions on a report from a research team led by Evelyn P. Whitlock, M.D., M.P.H., at AHRQ's Oregon Evidence-based Practice Center, a consortium of clinicians and researchers from Oregon Health & Science University, Kaiser Permanente's Center for Health Research, and the Portland Veterans Affairs Medical Center.

The Task Force grades the strength of the evidence from "A" (strongly recommends), "B" (recommends), "C" (no recommendation for or against), "D" (recommends against) or "I" (insufficient evidence to recommend for or against screening). The Task Force recommends screening and counseling for adults and pregnant women (a "B" recommendation). The Task Force found insufficient evidence to recommend screening and counseling of adolescents (an "I" recommendation).

Once the embargo lifts at 5:00 p.m., EDT, on Monday, April 5, the screening and counseling recommendations for alcohol and materials for clinicians will be available on the AHRQ Web site at Previous Task Force recommendations, summaries of the evidence, easy-to-read fact sheets explaining the recommendations, and related materials are available from the AHRQ Publications Clearinghouse by calling (800) 358-9295 or sending an E-mail to Clinical information also is available from AHRQ's National Guideline Clearinghouse™.

For more information, please contact AHRQ Public Affairs: (301) 427-1399 or (301) 427-1246.


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