The AAFP has updated its recommendations regarding screening and behavioral counseling interventions in primary care to reduce alcohol misuse.
The Academy now recommends that family physicians and other health professionals screen all adults 18 and older for alcohol misuse and provide individuals engaged in risky or hazardous drinking with brief behavioral counseling to reduce alcohol misuse. The recommendation also states that, although the Academy recognizes the avoidance of alcohol products by adolescents aged 12-17 years is desirable, the effectiveness of physician advice and counseling in this area is uncertain.
According to Alan Schwartzstein, M.D., of Oregon, Wis., chair of the AAFP Commission on Health of the Public and Science, the AAFP recommendation mirrors that of the U.S. Preventive Services Task Force(www.uspreventiveservicestaskforce.org) (USPSTF) with regard to adults, but differs where adolescents are concerned.
A May 13 statement from the USPSTF states that current evidence remains 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.
"For us as an Academy, we wanted to go on record that we recognize that adolescents should not use alcohol products, which is a little stronger than saying 'avoid risky behaviors,'" Schwartzstein said. "But we also agree with the USPSTF that the effectiveness of a physician's counseling advice is uncertain."
As a family physician, Schwartzstein said he finds a way to talk to teenagers at various age levels about risky behaviors, even though they are a more difficult population to talk to directly. "I often approach it from the perspective that there are going to be some opportunities during the teen years for risky behaviors," he said. "I explain that they'll get peer pressure to engage in some of those over the next five or six years, and they should carefully assess whether these things are good for them or not. If alcohol happens to come up, I'll get into that more specifically."
Schwartzstein also said that although the AAFP and USPSTF recommendations apply to pregnant women, they are related to decreasing risky or hazardous drinking and not to complete abstinence, which is recommended for pregnant women. The recommendations also do not apply to individuals who are actively seeking evaluation or treatment for alcohol misuse.
"We (at the AAFP) don't want pregnant women to drink at all," said Schwartzstein. "We didn't want to indirectly suggest that pregnant women could drink in moderation. So the recommendation applies to pregnant women, but in a different manner."
Risky or hazardous alcohol use is defined by the USPSTF as "drinking more than the recommended daily, weekly or per-occasion amounts, resulting in increased risk for health consequences." The USPSTF said it found adequate evidence that numerous screening instruments can detect alcohol misuse in adults with acceptable sensitivity and specificity.