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USPSTF Recommends Screening and Counseling for Alcohol Misuse

The third U.S. Preventive Services Task Force (USPSTF) has been releasing new and updated guidelines during the past 3 years (guidelines homepage; Journal Watch May 15 2001; and Journal Watch Apr 13 2004).

USPSTF 3 concludes each of its guidelines with a recommendation, graded as follows:

A -- The intervention is strongly recommended.

B -- The intervention is recommended.

C -- The USPSTF makes no recommendation for or against the intervention.

D -- The intervention is not routinely recommended.

I -- Evidence is insufficient to recommend for or against the intervention.

The USPSTF recommends screening and behavioral counseling to reduce alcohol misuse by adults, including elders and pregnant women, in primary care settings. The recommendations focus on identification and management of people who drink amounts that increase risk for future consequences (>2 standard drinks daily or >4 per occasion for men; >1 daily or >3 per occasion for women) and of people who drink amounts that cause harm but who do not meet criteria for alcohol dependence. Recommendation: B

The task force identified evidence that screening with validated questionnaires -- such as the Alcohol Use Disorders Identification Test (AUDIT), the CAGE questionnaire, and others -- can identify alcohol misuse that places patients at risk for morbidity and mortality. They recommend that clinicians choose the most appropriate test for the target population (e.g., the 5-item TWEAK for pregnant women). The USPSTF identified 12 controlled trials that involved brief interventions that were delivered by primary care physicians. Interventions included feedback and advice about drinking and setting goals, and many included follow-up contacts. Interventions led to decreased drinking (i.e., drinks per week decreased by 13%-34%; the proportion of people who drank moderate amounts [vs. risky or hazardous amounts] increased by 10%-19%). In three studies with long-term outcome data, one group found decreased hospitalization and a trend toward lower mortality rates, another found significantly fewer alcohol-related deaths, and a third found no differences in morbidity and mortality rates among intervention recipients than among controls.

For adolescents, data were sparse. The USPSTF concluded that the evidence was insufficient to recommend for or against screening and counseling of adolescents. Recommendation: I

Comment: Notably, the task force now recommends alcohol screening and intervention despite limited data on long-term morbidity and mortality rates. In this case, the benefits of screening and intervention (assuming that less drinking will decrease morbidity rates) appear to outweigh any potential harms. At the time of publication, the full text of the recommendation statement and the evidence statement was available free of charge.

— Richard Saitz, MD, MPH, FACP, FASAM

Published in Journal Watch General Medicine April 13, 2004

Citation(s):

U.S. Preventive Services Task Force. Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: Recommendation statement. Ann Intern Med 2004 Apr 6; 140:554-6.

• Original article (Subscription may be required)
• Medline abstract (Free)

Whitlock EP et al. Behavioral counseling interventions in primary care to reduce risky/harmful alcohol use by adults: A summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2004 Apr 6; 140:557-68.

• Original article (Subscription may be required)
• Medline abstract (Free)