Adult Binge Drinkers Underrecognized in Clinical Settings

Diana Phillips

March 30, 2017

Most adult binge drinkers are not being asked about alcohol use by their physicians, nor are they being counseled about the risks of excess drinking or advised to reduce their drinking, new research shows.

The findings, published in the March 31 issue of the Morbidity and Mortality Weekly Report, indicate that physicians still do not routinely offer alcohol misuse screening and brief intervention (ASBI), despite its established efficacy.

To estimate the prevalence of US adults who reported receiving elements of ASBI, researchers from the Centers for Disease Control and Prevention analyzed data from 17 states and the District of Columbia collected in the 2014 Behavioral Risk Factor Surveillance System.

"Overall, 77.7% of persons reported being asked about alcohol use in person or by form, 68.8% reported being asked how much they drink, and 32.9% reported being asked about binge drinking," the authors report.

However, among adults who self-reported binge drinking, defined as four or more drinks for women and five drinks for men "on an occasion," eight or more drinks for women and 15 or more for men during the course of a week, and any drinking by pregnant women or individuals younger than 21 years, only one third (37.2%) reported being asked at least one alcohol use screening-related question and being advised about the harms of excessive drinking. Moreover, only one (18.1%) of six reported being asked about alcohol use and advised to reduce or quit drinking.

Of binge drinkers who were asked about their alcohol use, men were more likely than women to be counseled regarding harmful drinking (22.6% vs 11.4%). Similarly, people with disabilities were more likely than those without to receive such counseling (46.9% vs 35.5%).

The US Preventive Services Task Force recommends that clinicians screen adults aged 18 years or older for alcohol misuse and provide those who screen positive for hazardous drinking with brief behavioral counseling interventions to reduce alcohol misuse. Under the Affordable Care Act, most health plans are obliged to cover the service, the authors write.

"While most adults reported being asked about alcohol use during a check-up, only one in three reported being asked about binge-level consumption, even though screening for binge-level consumption is recommended," the authors report. "Without proper screening and assessment, health professionals will not know which patients could benefit from a brief intervention, treatment (which might include pharmacotherapy), or a referral to treatment for alcohol dependence."

In a study presented last year at the American Association of Geriatric Psychiatry and reported by Medscape Medical News, older binge drinking adults might be especially vulnerable to this screening and advisory oversight.

The penetration in clinical settings of ASBI, which has been shown to reduce excessive alcohol use and could have "a significant population-level benefit" if used routinely in primary care, might be greater if integrated into systems-level changes, the authors explain. Among the possibilities, they suggest the following:

  • including ASBI in electronic health records, with appropriate prompts and screening tools;

  • including ASBI measures in physician/provider performance metrics; and

  • implementing ASBI in conjunction with multiple patient, professional and organizational, and community-level strategies.

"If ASBI was provided as recommended in all appropriate medical settings, and coupled with recommended, evidence-based community interventions, preventable morbidity and mortality associated with excessive alcohol use might be reduced," according to the report.

The authors have disclosed no relevant financial relationships.

Morb Mortal Wkly Rep. 2017;66:313-319. Full text

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