Advise about Risky Alcohol Use

Most adults who drink at risky levels and were asked about their alcohol use during checkups were not advised to drink less, according to a new Centers for Disease Control and Prevention (CDC) study. The study looked at alcohol screening and brief counseling practices among healthcare providers in 17 states and the District of Columbia. Alcohol screening and brief counseling is an approach based on the best available scientific evidence that can help adults who drink alcohol at risky levels to reduce the amount that they drink.

In the United States, risky alcohol use resulted in more than $249 billion in economic costs in 2010 and over 88,000 deaths every year from 2006-2010. Risky alcohol use includes binge drinking, heavy drinking, and any use by pregnant women or those under age 21. Binge drinking is drinking five or more drinks on a single occasion for men or four or more drinks on a single occasion for women. Heavy drinking (also considered high weekly or daily consumption) is drinking 15 or more drinks per week for men or eight or more drinks per week for women.

Risky alcohol use increases the risk for developing long-standing diseases (such as heart disease and breast cancer), as well as injuries and violence (such as motor vehicle crashes, suicide, and homicide). Any alcohol use by pregnant women increases the risk for miscarriage, stillbirth, and a range of lifelong disorders in their babies known as fetal alcohol spectrum disorders (FASDs).  

Alcohol Screening and Brief Counseling

Similar to screenings for blood pressure or tobacco use, alcohol screening and brief counseling is an effective clinical preventive service that is supported by decades of research. It is recommended by the US Preventive Services Task Force and medical organizations, such as the American Academy of Family Physicians, the American Medical Association, the American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics. In 2014, CDC published a guide to help primary medical care practices incorporate alcohol screening and brief counseling into routine clinic visits.

Recent Findings

CDC researchers found the following among U.S. adults who reported having a checkup in the past two years:

• Among all adults
  • About 3 in 4 reported being asked about their alcohol use (in person or on a form);
  • However, only 1 in 3 were asked in a way to help identify risky drinking patterns.
• Among binge drinkers asked about their alcohol use
  • Only 1 in 3 reported being advised by a provider about the harms of their alcohol use; and
  • Only 1 in 6 reported being advised to reduce or quit drinking.

These findings indicate that routine alcohol screening and brief counseling, as recommended, is not yet a standard part of primary medical care. This is despite evidence that it works, is cost-effective (good value for the amount of money that it costs), and is recommended for all adults during routine clinic visits with their primary healthcare providers. Continued efforts are needed to increase adoption of alcohol screening and brief counseling by healthcare providers to reduce risky alcohol use among adults.

About this Study

• The study, Screening for Excessive Alcohol Use and Brief Counseling of Adults — 17 States and the District of Columbia, 2014, was published in the March 31, 2017 issue of CDC’s Morbidity and Mortality Weekly Report (MMWR).
• The data for the study were collected from 17 states and the District of Columbia (DC) from the 2014 Behavioral Risk Factor Surveillance System (BRFSS).
• BRFSS is a state-based telephone survey of U.S. adults aged 18 and over. Information is collected on a variety of health conditions, health practices, and risk behaviors including alcohol use.

Resources for Health Professionals

• Planning and Implementing Screening and Brief Intervention for Risky Alcohol Use: A Step-by-Step Guide for Primary Care Practices
  This guide provides steps and resources to help primary medical care practices plan and implement alcohol screening and brief counseling.
• Alcohol Screening, Brief Intervention, and Referral to Treatment: Demonstration Videos
  Oregon Health and Science University’s family medicine program offers videos with demonstrations of conducting alcohol screening and brief counseling.

More Information

• CDC’s Alcohol and Public Health Website
• CDC Feature: Alcohol Screening and Brief Intervention
• CDC’s Fetal Alcohol Spectrum Disorders Website
• Fetal Alcohol Spectrum Disorders Prevention Program: American College of Obstetricians and Gynecologists (ACOG)
• National Organization on Fetal Alcohol Syndrome (NOFAS)
• Alcohol Misuse: Screening and Behavioral Counseling Interventions in Primary Care
  Summary of Recommendations and Evidence: U.S. Preventive Services Task Force