Doctors should ask patients about alcohol misuse, panel says

Primary care doctors should ask adults how much and how often they drink alcohol and counsel those with risky and dangerous drinking habits, a government-backed panel said today.

Based on a review of studies conducted since 1985, the U.S. Preventive Services Task Force (USPSTF) determined there is good enough evidence both that screening can accurately detect alcohol misuse and that counseling can reduce heavy drinking in people age 18 and older.

Screening "takes hardly any time at all, and it works pretty well," said Dr. Michael LeFevre, co-vice chair of the Task Force and a family medicine doctor at the University of Missouri School of Medicine in Columbia.

"From my point of view as a family physician, the shorter and easier the better," he said.

Risky drinking is defined by the National Institute on Alcohol Abuse and Alcoholism as more than four drinks in a single day or 14 drinks per week for men and more than three drinks in a day or seven in a week for women. Research suggests about one third of U.S. adults misuse alcohol.

Asking men the last time they had five drinks in one sitting, and women the last time they had four, is a good start, according to LeFevre.

"If they can name a time, that means we should be talking to them more about what their alcohol consumption looks like," he said.

If that time was for the patient's birthday, and the only time in years the patient had binge drank, it's probably not a big deal. But if that happens on a regular basis, he said, that would point toward alcohol misuse.

The review behind the new recommendations included 23 trials that randomly assigned risky drinkers to behavioral counseling or normal care.

Overall, counseling interventions led to a 12 percent absolute increase in the proportion of people who reported no heavy drinking episodes one year later, and an average reduction in weekly drinks from 23 to 19.

Brief counseling sessions, the USPSTF noted, are more likely to help people who have a few too many drinks on occasion than those who abuse or are dependent on alcohol. People with a serious drinking problem may need more specialty treatment, according to the Task Force, which published its recommendations Monday in the Annals of Internal Medicine.

"A brief intervention as applied by, say, a primary care physician in practice is probably not going to be adequate intervention for people on the alcohol dependence end of the spectrum," LeFevre said.

The USPSTF said there weren't enough data for it to weigh the possible benefits and harms of asking younger teenagers about their alcohol use.

"The Task Force felt that it would be inappropriate to assume that what we have learned about the best ways to screen and manage adults (is) in fact applicable to adolescents," LeFevre said.

However, he added, that's not a recommendation against asking teens about their alcohol use - it's just a call for more studies to figure out the most effective way to do that.

Dr. Sharon Levy said she hoped doctors didn't choose not to talk to teens about alcohol based on the new recommendations.

"We recognize that there's not a lot of data, but we also recognize that alcohol use is one of the most significant contributors to (illness) and mortality in adolescents," said Levy, director of the Adolescent Substance Abuse Program at Children's Hospital Boston.

"There's no question that alcohol use is a serious problem for this age group," she said.

Levy, who wasn't involved in drafting the new guidelines, co-authored a statement from the American Academy of Pediatrics recommending that doctors screen adolescents for drug and alcohol use.

She said the type of brief interventions recommended for adults who drink too much are also "developmentally appropriate" for teens.

"They work with adults and they seem really adaptable," Levy said.