Blog | Friday, February 1, 2013

QD: News Every Day--Alcohol screening, counseling a mixed bag for primary care

More than a third of internists screening for alcohol misuse and abuse find that 10% or more of those screened turn up positive, a poll found.

ACP Internist asked its audience "If you screen for alcohol misuse or abuse in your practice, what percentage of patients who are screened have signs of alcohol misuse or abuse?"

Respondents answered:
Don't screen at all: 9.7%
Less than 5%: 18.3%
5% - 7%: 15%
8% - 10%: 20.5%
More than 10%: 36.5%

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reported that 8.5% of U.S. adults met the criteria for an alcohol use disorder. (2% met the criteria for a drug use disorder and 1.1% met the criteria for both.)

But about 30% of the U.S. population misuse alcohol, with most engaging in what is considered risky drinking, according to a report from the U.S. Preventive Services Task Force (USPSTF) published in the Annals of Internal Medicine.

Generally, primary care physicians had 27% sensitivity when it came to clinical suspicion of either hazardous or harmful drinking, but their screens had 98% sensitivity, according to a report in Annals of Family Medicine.

ACP Internist reported in January that internists have to wade through a mixed bag of messages when discussing alcohol with their patients.

That article reported benefits seem limited to the cardiovascular system in people over age 50 if they do not exceed the recommended number of servings per week. Risks include development of breast cancer in women, particularly those who consume more than a few servings a week.

Heavy drinking imposes significant risks for osteoporosis, many types of cancer, liver disease, hypertension, atrial fibrillation, stroke and multiple social and behavioral problems. Late-night drinking has its own mythology about potential impairment of a good night's sleep.

The key is to find out where patients are on that continuum. Complications to that process include what defines a serving, whether it's the volume of a pour or the high alcohol content of some drinks, or the belief that some components of wine may lead to longevity.

And, the definitions of what is use, misuse and abuse also have to be spelled out, as does the role of binge drinking.

And don't think that abstainers don't have their own set of problems, according to a study that found nondrinkers were associated with weak networks of friends, loneliness and a higher likelihood of not yet having had a sexual debut, and then at age 28, a higher prevalence of anxiety and depression symptoms.