Blog | Thursday, January 9, 2014

QD: News Every Day--Doctors should increase alcohol counseling among their panels

Only 1 in 6 adults, including binge drinkers, reported ever discussing alcohol consumption with a health professional, and only one-third of those who binged 10 or more times a month ever reported doing so, the CDC reported.

Excessive alcohol led to 88,000 deaths annually from 2006 to 2010, and $224 billion in economic costs in 2006 alone. Among other public health efforts, the U.S. Preventive Services Task Force has recommended alcohol screening and brief intervention for adults to address the problem.

To analyze whether physicians and other providers were following through, the CDC analyzed Behavioral Risk Factor Surveillance System data from a question added to surveys in 44 states and the District of Columbia from Aug. 1 to Dec. 31, 2011, about patient-reported communication with a health professional about alcohol among nearly 167,000 adults.

Results appeared online Jan. 7 at MMWR.

The prevalence of ever discussing alcohol use with a health professional was 15.7% overall, 17.4% among current drinkers and 25.4% among binge drinkers. It was most prevalent among those aged 18 to 24 years (27.9%). However, only 13.4% of binge drinkers reported discussing alcohol use with a health professional in the past year, and only 34.9% of those who reported binge drinking 10 or more times in the past month had ever discussed alcohol with a health professional.

Health care professionals reported lack of time, training, and self-efficacy; discomfort discussing the topic; perceived difficulty working with substance use patients; skepticism of treatment effectiveness; patient resistance; and lack of insurance coverage. Aspects of the Affordable Care Act provider reimbursement for screening, as does Medicare and some private insurance.

“A key aspect of routinizing alcohol screening and counseling as standard practice in medical practice includes ensuring that staff comprehend that most patients who drink too much will only require brief counseling, not specialized treatment,” the authors wrote. “Support from key staff members and stakeholders, including the development and testing of an implementation plan, and training on the use of guidelines, is also needed. Finally, the use of a variety of health professionals (e.g., doctors, nurses, clinical social workers) to screen all patients, including women who are or could be pregnant (should be advised not to drink at all), and intervene with those who screen positive for drinking too much through the use of approved guidelines, can also address provider concerns, particularly about time and efficacy.”