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Screen all adults for unhealthy alcohol use, says USPSTF

Based on its review of the evidence, the USPSTF Primary Care Clinics recommended adults 18 and older, including pregnant women,…

Based on its review of the evidence, the USPSTF Primary Care Clinics recommended adults 18 and older, including pregnant women, for unhealthy alcohol use. If patients are in hazardous or dangerous beverages, clinics should give them short behavioral counseling measures to reduce unhealthy alcohol use. This is a “B” recommendation. (www.uspreventiveservicestaskforce.org)

“In this final recommendation, the Working Group calls on clinics to screen all adults and advise those who drink beyond recommended limits,” said USPSTF member Carol Mangione, MD, MSPH, in a press release . (www.uspreventiveservicestaskforce.org) “We found that screening and short counseling in primary care can help reduce unhealthy alcohol use. Pregnant women are particularly important because alcohol use during pregnancy can lead to birth defects and developmental problems.” [1

9659003] The commission committee members said that current evidence is insufficient to assess the balance between benefits and damage to screening and provide behavioral counseling measures in primary care settings for patients aged 12-17 – an “I” statement.

“We continue to require more research and encourage primary care clinics to use their judgment when they decide what to tighten teens,” said USPSTF Chair Sue Curry, Ph.D., in the release.

The Working Group defined unhealthy alcohol use as drinking beyond limits recommended by the National Institute on Alcohol Abuse and Alcoholism (NIAAA): (www.niaaa.nih.gov)

  • for men, no more than four drinks per day and no more than 14 drinks per week and
  • for women, no more than three drinks a day and no more than seven drinks a week.

Screening means that doctors ask patients a series of questions about how often they drink and other patterns of drinking. If patients are in hazardous or dangerous beverages, doctors should provide short behavioral counseling measures to reduce unhealthy alcohol consumption, says the working group. These short interventions typically include discussing how the patient’s weight of weight is compared to recommended limits and ways to reduce drinking.

Patients who appear to have a more severe alcohol deficiency (AUD) can be referred to more extensive treatment.

This final recommendation recommendation complies with the USPSTF Draft Recommendation from June and its final recommendation from 2013, (www.uspreventiveservicestaskforce.org) which AAFP supported at the time.

In its recommendation in 2013, the working group used the term “alcohol abuse” was used to define a wide range of drinking behaviors (eg hazardous or dangerous alcohol use, harmful alcohol use and alcohol abuse or addiction). However, in the current final recommendation, USPSTF uses the American Society of Addiction Medicine term “unhealthy use” which is defined as any use of alcohol that increases the risk of health consequences or has already led to health impact, including an AUD diagnosis.

Final recommendation details

USPSTF ordered a systematic proof of assessment to update its 2013 recommendation on this kind of screening. The review examined the effectiveness of screening to reduce unhealthy alcohol use, morbidity, mortality or risky behavior and improve health, social or legal results.

The task committee also evaluated the accuracy of different screening methods, the effectiveness of counseling measures to reduce unhealthy alcohol use, and improve patient performance and the injuries of screening and behavioral counseling.

In the case of screening tools, the USPSTF determined that one to three object screening instruments are most accurate for assessing unhealthy alcohol use in adults. Such instruments include the abbreviated test for alcohol consumption test consumption and the NIAAA recommended simple alcohol profile. The working group discounted the use of the well-known CAGE (Cut Down, Annoyed, Guilty, Eye-Opener) tool because it only detects alcohol dependence and not the entire spectrum of unhealthy alcohol use.

Screening tools are available for specific populations, including for pregnant women, the task committee noted, and any positive screen should be followed up with more in-depth assessment to confirm unhealthy alcohol use and determine the next step.

USPSTF also found that behavioral counseling measures for unhealthy alcohol use varied in their specific components, administration, length and number of interactions. Almost all bets included four or fewer sessions, with a median of a session. Most interventions consisted of two hours of contact time or less with a median contact time of 30 minutes.

Reply to public comment

The draft of this recommendation release was published for public comment on the USPSTF website from June 5 to July 2.

Some commentators said they were concerned about the lack of discussion about specific populations.

In response, USPSTF responded to the language of alcohol consumption injuries in adolescents to the clinical considerations (www .uspreventiveservicestaskforce.org) the section and the injuries of alcohol use during pregnancy to the discussion (section 19459004)

.

Others commented on clarifying which screening tools were discussed so that the working group created a subcategory “Useful Resources” in the “Clinical Considerations” section with references to further explaining the tools.

Up Next

AAFP Commission The Public and Science Health Commission plans to review the USPSTF’s final recommendation and evidence assessment and determine the Academy’s attitude to the recommendation.

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] Familydoctor.org: Alkoholmissbruk (familydoctor.org)

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