Putting Prevention into Practice

An Evidence-Based Approach

Screening and Behavioral Counseling Intervention to Reduce Unhealthy Alcohol Use in Adolescents and Adults


Am Fam Physician. 2019 Jun 15;99(12):771-772.

Related U.S. Preventive Services Task Force: Screening and Behavioral Counseling Interventions to Reduce Unhealthy Alcohol Use in Adolescents and Adults: Recommendation Statement

Related editorial: Identification of and Treatment for Unhealthy Alcohol Use in Primary Care Settings

Author disclosure: No relevant financial affiliations.

Case Study

A 20-year-old male with a history of exercise-induced asthma presents to your office for his yearly physical. He is a student at the local university and is on the university fencing team. When asked about his classwork, he expresses that college is going okay but can be stressful sometimes, noting that he occasionally misses classes in the morning because he is tired. He states that he spends time with friends to relieve stress, occasionally going to parties.

Case Study Questions

1. Based on the U.S. Preventive Services Task Force (USPSTF) recommendation statement, which one of the following is the initial screening test of choice for alcohol use in this patient?

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

  • B. AUDIT–Consumption (AUDIT-C).

  • C. No screening.

  • D. Cut down, Annoyed, Guilty, Eye-Opener (CAGE) tool.

  • E. USAUDIT-C (based on U.S. standards).

2. According to the USPSTF, which of the following tools are common components of effective brief behavioral counseling interventions?

  • A. General feedback.

  • B. Personalized normative feedback sessions.

  • C. Drinking diaries.

  • D. Web-based interventions.

3. The patient's 15-year-old brother presents to your office a week later for a sports team physical examination. What is the USPSTF recommendation for this younger patient?

  • A. Screen for unhealthy alcohol use with a one- to three-item screening instrument.

  • B. Do not screen for unhealthy alcohol use.

  • C. There is insufficient evidence to recommend for or against screening for unhealthy alcohol use.

  • D. Screen for unhealthy alcohol use with a comprehensive, 10-item screening instrument.


1. The correct answer is B. The USPSTF recommends screening for unhealthy alcohol use in primary care settings in adults 18 years or older and providing patients who are engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce unhealthy alcohol use. The USPSTF found that one- to three-item screening instruments have the best accuracy for assessing

Author disclosure: No relevant financial affiliations.

The views expressed in this work are those of the authors and do not reflect the official policy or position of MedStar Georgetown University Hospital or the U.S. government.


1. Curry SJ, Krist AH, Owens DK, et al. Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: US Preventive Services Task Force recommendation statement. JAMA. 2018;320(18):1899–1909.

2. 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;320(18):1910–1928.

This PPIP quiz is based on the recommendations of the USPSTF. More information is available in the USPSTF Recommendation Statement and supporting documents on the USPSTF website (https://www.uspreventiveservicestaskforce.org). The practice recommendations in this activity are available at https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/unhealthy-alcohol-use-in-adolescents-and-adults-screening-and-behavioral-counseling-interventions.

This series is coordinated by Kenny Lin, MD, MPH, Deputy Editor.

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



Copyright © 2019 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

CME Quiz

More in Pubmed


Mar 15, 2020

Access the latest issue of American Family Physician

Read the Issue

Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article