Putting Prevention into Practice

An Evidence-Based Approach

Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse


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Am Fam Physician. 2014 Jun 15;89(12):971-972.

  Related U.S. Preventive Services Task Force Recommendation Statement: Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse: Recommendation Statement.

Case Study

A 22-year-old man presents for a routine physical examination. While you are taking his history, he states that he “goes out drinking” every weekend with his friends.

Case Study Questions

  1. According to the U.S. Preventive Services Task Force (USPSTF), which of the following tools are considered instruments of choice for screening for alcohol misuse in the primary care setting?

    • A. The Alcohol Use Disorders Identification Test (AUDIT).

    • B. The abbreviated AUDIT-Consumption (AUDIT-C).

    • C. Single-question screening.

    • D. The Cut-Down, Annoyed, Guilty, and Eye-Opener (CAGE) questionnaire.

  2. Based on recommendations from the USPSTF, which one of the following statements about screening for alcohol misuse is correct?

    • A. There is high certainty that screening for alcohol misuse has substantial net benefit.

    • B. Adolescents should be screened for alcohol misuse.

    • C. Adults should be screened for alcohol misuse and, if they engage in risky or hazardous drinking, they should receive brief behavioral counseling interventions.

    • D. The recommendations for screening apply to persons actively seeking treatment for alcohol misuse.

  3. After screening this patient, you determine that he engages in hazardous drinking. According to the USPSTF, which level of behavioral counseling has the best evidence of effectiveness and should be recommended for this patient?

    • A. Very brief single contact (five minutes or less).

    • B. Brief single contact (six to 15 minutes).

    • C. Brief multicontact (each contact is six to 15 minutes).

    • D. Extended multicontact (each contact is longer than 15 minutes).

Answers

1. The correct answers are A, B, and C. The USPSTF considers three tools as the instruments of choice for screening for alcohol misuse in the primary care setting: the full version of AUDIT, the abbreviated AUDIT-C, and single-question screening (such as asking, “How many times in the past year have you had five [for men] or four [for women and all adults older than 65 years] or more drinks in a day?”). Although the CAGE questionnaire has been used in primary care settings as a screening tool for alcohol disorders, it has comparatively poor sensitivity for identifying risky or hazardous drinking, particularly in older adults and pregnant women.

2. The correct answer is C. The USPSTF recommends that clinicians screen adults 18 years or older for alcohol misuse and provide persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce alcohol misuse. The USPSTF concludes with moderate certainty that there is a moderate net benefit for this recommendation. The USPSTF also concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening and behavioral counseling interventions in primary care settings to reduce alcohol misuse in adolescents. These recommendations do not apply to persons actively seeking evaluation or treatment for alcohol misuse.

3. The correct answer is C. The USPSTF found that counseling interventions in the primary care setting can positively affect unhealthy drinking behaviors in adults engaging in risky or hazardous drinking. This is achieved by reducing weekly alcohol consumption and increasing long-term adherence to recommended drinking limits. Brief multicontact behavioral counseling for alcohol misuse seems to have the best evidence of effectiveness; very brief behavioral counseling has limited effect.

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The views expressed in this work are those of the authors, and do not reflect the official policy or position of the Uniformed Services University of the Health Sciences, the Department of Defense, or the U.S. government.

SOURCES

U.S. Preventive Services Task Force. Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013;159(3):210–218.

Jonas DE, Garbutt JC, Amick HR, 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. 2012;157(9):645–654.

The case study and answers to the following questions are based on the recommendations of the U.S. Preventive Services Task Force (USPSTF), an independent panel of experts in primary care and prevention that systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services. More detailed information on this subject is available in the USPSTF Recommendation Statement and the evidence report on the USPSTF website (http://www.uspreventiveservicestaskforce.org). The practice recommendations in this activity are available at http://www.uspreventiveservicestaskforce.org/uspstf/uspsdrin.htm

A collection of Putting Prevention into Practice quizzes published in AFP is available at http://www.aafp.org/afp/ppip.



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