Alcohol use disorder is one of the most common chronic conditions encountered in primary care. In the United States, 1 in 10 people 12 years and older had alcohol use disorder in 2024. Patients with alcohol use disorder have increased risk for complications and comorbidities in gastrointestinal, cardiovascular, and neurologic systems, as well as anxiety and mood disorders, trauma-related stress disorders, suicide, and unintentional injuries. The US Preventive Services Task Force recommends screening adults with the abbreviated Alcohol Use Disorders Identification Test-Consumption or similar tool. Routine evaluation of patients with alcohol use disorder can include focused physical examination, blood tests, imaging studies to evaluate liver function and fibrosis, and assessment for the likelihood of developing alcohol withdrawal syndrome. Treatment in the primary care setting is effective, and all patients with alcohol use disorder should receive a brief behavioral counseling intervention and treatment or referral for treatment, if indicated. Treatment of co-occurring mental health conditions increases the likelihood of recovery from both conditions. Patients should receive routinely recommended vaccines, including the pneumococcal vaccine in those 19 years or older.
In the United States, 1 in 10 people 12 years and older (27.9 million people) had alcohol use disorder (AUD) in 2024.1 Prevalence of AUD, as well as associated deaths, has increased sharply in recent years, partially due to an increase in incidence during the COVID-19 pandemic.2 In addition to increased risk of liver and pancreatic disease, people with AUD and heavy alcohol consumption have higher morbidity and mortality from cardiovascular causes (eg, hypertension, cardiovascular disease, atrial fibrillation), neurologic conditions (eg, dementia), cancer, nutritional deficiencies, accidents, and suicide. Excess alcohol use is a leading cause of preventable death in the United States, behind tobacco, poor diet and physical inactivity, and illicit drugs.3
Although abstinence from alcohol is the safest approach for most people with AUD, harm reduction strategies that reduce heavy alcohol consumption are also effective. Primary care physicians should be aware of common issues that are caused by, or co-occur with, heavy alcohol use and be able to identify and treat these conditions appropriately.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | Comments |
|---|---|---|
| All adults, including those who are pregnant, should be screened for unhealthy alcohol use in the primary care setting; patients with at-risk or hazardous drinking should receive brief behavioral counseling interventions.4 | B | Systematic review and US Preventive Services Task Force B recommendation |
| Due to compounding risk factors for alcohol-associated liver dis- ease and certain types of cancers, people with AUD should avoid using combustible tobacco.21 | A | Systematic review and US Preventive Services Task Force A recommendation |
| Primary care physicians should screen for and treat co-occurring mental health conditions in people with AUD.36,37 | A | Systematic review, meta-analysis, and Cochrane review |
| People with AUD should be screened for other substance use disorders with the Drug Abuse Screening Test-10 or other validated tool.31,40,41 | C | Cohort studies; meta-analysis showing higher prevalence of other substance use disorders in people with AUD |
| People with AUD should be screened regularly for suicide risk.43,44 | C | Systematic review and meta-analysis with disease-oriented outcomes |
| People with AUD who are 19 years or older should receive pneumococcal vaccination with PCV 15 (Vaxneuvance), PCV 20 (Prevnar 20), or PCV 21 (Capvaxive).56 | C | Consensus guideline |
AUD = alcohol use disorder; PCV = pneumococcal conjugate vaccine.
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.
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