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screening for alcohol abuse

Indications: - screening & behavioral counseling recommended by USPSTF for all adults, including pregnant women [7,12] - evidence is insufficient to recommend screening for adolescents [7,12] - American Academy of Pediatricians recommends screening every adolescent for alcohol use during office visits [10] Epidemiology: - only 16% of U.S. adults have discussed alcohol use with their health care providers [8] - only 1 in 3 adults asked about binge drinking at checkups [11] Procedure: 1) screening begins with quantifying alcohol use - at risk drinking - men > 14 drink/week or > 4 drinks/occasion - women > 7 drink/week or > 7 drinks/occasion - increased use within recommended guidelines does not constitute positive screen even if spouse expresses concern 2) CAGE questions (score > 1 is positive) 3) 2 question screen a) Have you ever had a drinking problem? b) When was your last drink? (+ response is within last 24 h) 4) Alcohol Use Disorders Identification Test (AUDIT) - score >=4 for men & >= 3 for women is positive 5) Michigan Alcoholism Screening Test (MAST) 6) single-question screening for alcohol abuse (SASQ) - When was the last time you had more than X drinks in 1 day? X= 4 for women, 5 for men [3] Validated questionnaire more sensitive & more specific than blood alcohol Positive screen identifies candidates for further evaluation Management: - brief counseling indicated for those who screen positive Notes: - web-based screening with brief intervention minimally effective in reducing alcohol intake in University students [9]

Related

alcohol abuse (includes alcohol use disorder, risky alcohol use) alcoholism (includes binge drinking) screening tool for Tobacco, Alcohol & other Drugs

Specific

Alcohol Screening & Brief Intervention for Youth Alcohol Use Disorders Identification Test (AUDIT) CAGE questions Michigan Alcoholism Screenin Test (MAST)

General

screening

References

  1. Journal Watch 25(14):116, 2005 Canagasaby A, Vinson DC. Screening for hazardous or harmful drinking using one or two quantity-frequency questions. Alcohol Alcohol. 2005 May-Jun;40(3):208-13. Epub 2005 Mar 29. PMID: 15797883
  2. Coulton S et al, Opportunistic screening for alcohol use in primary care: Comparative study. BMJ 2006; 332:511 PMID: 16488896
  3. Smith PC et al. Primary care validation of a single-question alcohol screening test. J Gen Intern Med 2009 Jul; 24:783. PMID: 19247718
  4. Medical Knowledge Self Assessment Program (MKSAP) 14, American College of Physicians, Philadelphia 2006 - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  5. US Preventive Services Task Force Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse: U.S. Preventive Services Task Force Recommendation Statement DRAFT http://www.uspreventiveservicestaskforce.org/draftrec.htm - Jonas DE et al Behavioral Counseling After Screening for Alcohol Misuse in Primary Care: A Systematic Review and Meta-analysis for the U.S. Preventive Services Task Force Ann Intern Med. 25 September 2012
  6. Vinson DC et al Clinician Suspicion of an Alcohol Problem: An Observational Study From the AAFP National Research Network. Annals of Family Medicine. Jan/Feb 11(1) 2013 PMID: 23319506 http://www.annfammed.org/content/11/1/53.full
  7. Moyer VA. Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2013 May 14; PMID: 23698791 http://annals.org/article.aspx?articleid=1686100 - U.S. Preventive Services Task Force (USPSTF). Draft Recommendation Statement June 2018 Unhealthy Alcohol Use in Adolescents and Adults: Screening and Behavioral Counseling Interventions. https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/unhealthy-alcohol-use-in-adolescents-and-adults-screening-and-behavioral-counseling-interventions - Draft Evidence Review 2018 Draft Evidence Review for Unhealthy Alcohol Use in Adolescents and Adults: Screening and Behavioral Counseling Interventions. https://www.uspreventiveservicestaskforce.org/Page/Document/draft-evidence-review/unhealthy-alcohol-use-in-adolescents-and-adults-screening-and-behavioral-counseling-interventions
  8. Centers for Disease Control and Prevention (CDC) Vital Signs: Communication Between Health Professionals and Their Patients About Alcohol Use - 44 States and the District of Columbia, 2011. MMWR. Jan 7, 2014 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm63e0107a1.htm
  9. Kypri K et al. Web-based alcohol screening and brief intervention for university students. JAMA 2014 Mar 26; 311:1218. PMID: 24668103 http://jama.jamanetwork.com/article.aspx?articleid=1849990 - Naimi TS and Cole TB. Electronic alcohol screening and brief interventions. expectations and reality. JAMA 2014 Mar 26; 311:1207 PMID: 24668101 http://jama.jamanetwork.com/article.aspx?articleid=1849965
  10. Siqueira L, Smith VC Binge Drinking Pediatrics. August 31, 2015 PMID: 26324872 http://pediatrics.aappublications.org/content/early/2015/08/26/peds.2015-2337
  11. McKnight-Eily LR, Okoro CA, Mejia R, et al. Screening for Excessive Alcohol Use and Brief Counseling of Adults - 17 States and the District of Columbia, 2014. MMWR Morb Mortal Wkly Rep 2017;66:313-3019 https://www.cdc.gov/mmwr/volumes/66/wr/mm6612a1.htm
  12. US Preventive Services Task Force. Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: US Preventive Services Task Force Recommendation Statement. JAMA 2018 Nov 13; 320:1899. PMID: 30422199 https://jamanetwork.com/journals/jama/fullarticle/2714537 - O'Connor EA, Perdue LA, Senger CA et al. Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: Updated evidence report and systematic review for the US Preventive Services Task Force. JAMA 2018 Nov 13; 320:1910. PMID: 30422198 https://jamanetwork.com/journals/jama/fullarticle/2714536 - Bazzi A, Saitz R. Screening for unhealthy alcohol use. JAMA 2018 Nov 13; 320:1869 PMID: 30422181 https://jamanetwork.com/journals/jama/fullarticle/2714514