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

Abstract

IMPORTANCE Unhealthy alcohol use is common, increasing, and a leading cause of premature mortality. OBJECTIVE To review literature on the effectiveness and harms of screening and counseling for unhealthy alcohol use to inform the US Preventive Services Task Force. DATA SOURCES MEDLINE, PubMed, PsycINFO, and the Cochrane Central Register of Controlled Trials through October 12, 2017; literature surveillance through August 1, 2018.STUDY SELECTION Test accuracy studies and randomized clinical trials of screening and counseling to reduce unhealthy alcohol use.DATA EXTRACTION AND SYNTHESIS Independent critical appraisal and data abstraction by 2 reviewers. Counseling trials were pooled using random-effects meta-analyses.MAIN OUTCOMES AND MEASURES Sensitivity, specificity, drinks per week, exceeding recommended limits, heavy use episodes, abstinence (for pregnant women), and other health, family, social, and legal outcomes. RESULTSOne hundred thirteen studies (N = 314 466) were included. No studies examined benefits or harms of screening programs to reduce unhealthy alcohol use. For adolescents (10 studies [n = 171 363]), 1 study (n = 225) reported a sensitivity of 0.73 (95% CI, 0.60 to 0.83) and specificity of 0.81 (95% CI, 0.74 to 0.86) using the AUDIT-C (Alcohol Use Disorders Identification Test-Consumption) to detect the full spectrum of unhealthy alcohol use. For adults (35 studies [n = 114 182]), brief screening instruments commonly reported sensitivity and specificity between 0.70 and 0.85. Two trials of the effects of interventions to reduce unhealthy alcohol use in adolescents (n = 588) found mixed results: one reported a benefit in high-risk but not moderate-risk drinkers, and the other reported a statistically significant reduction in drinking frequency for boys but not girls; neither reported health or related outcomes. Across all populations (68 studies [n = 36 528]), counseling interventions were associated with a decrease in drinks per week (weighted mean difference, −1.6 [95% CI, −2.2 to −1.0]; 32 studies [37 effects; n = 15 974]), the proportion exceeding recommended drinking limits (odds ratio [OR], 0.60 [95% CI, 0.53 to 0.67]; 15 studies [16 effects; n = 9760]), and the proportion reporting a heavy use episode (OR, 0.67 [95% CI, 0.58 to 0.77]; 12 studies [14 effects; n = 8108]), and an increase in the proportion of pregnant women reporting abstinence (OR, 2.26 [95% CI, 1.43 to 3.56]; 5 studies [n = 796]) after 6 to 12 months. Health outcomes were sparsely reported and generally did not demonstrate group differences in effect. There was no evidence that these interventions could be harmful.CONCLUSIONS AND RELEVANCE Among adults, screening instruments feasible for use in primary care are available that can effectively identify people with unhealthy alcohol use, and counseling interventions in those who screen positive are associated with reductions in unhealthy alcohol use. There was no evidence that these interventions have unintended harmful effects.Additionally, for the outcome drinks per week, whic...

Screening for Unhealthy Alcohol Use

“…In this issue of JAMA , the US Preventive Services Task Force (USPSTF) presents a recommendation statement 1 and an accompanying evidence review 2 on screening and behavioral counseling interventions for unhealthy alcohol use. “Un healthy alcohol use” refers to a spectrum from use of alcohol that increases the risk for health consequences (ie, risky or hazardous drinking) to the diagnosis of alcohol use disorder (AUD).…”

A Call to Standardize Definitions, Data Collection, and Outcome Assessment to Improve Care in Alcohol‐Related Liver Disease

“…Simple, effective screening for AUD can be achieved with the single question assessing how many times over the past year patients exceeded daily drinking recommendations (four and three drinks for men and women, respectively), with one or more occurrences being positive . The Alcohol Use Disorders Identification Test can be used when more specificity is needed . The DSM‐V recommends that providers specify the severity of AUD as mild (presence of two to three symptoms), moderate (presence of four to five symptoms), or severe (presence of six or more symptoms) and document the presence of remission, categorized as early (>3 months but <12 months) or sustained (>12 months) .…”

“…Treatments range from “brief interventions” to daily medications with or without other behavioral therapies . A recent systematic review found that interventions reduce drinks per week, drinking beyond recommend limits, and heavy‐use episodes and increase abstinence . Approved medications for AUD include acamprosate, disulfiram, and naltrexone .…”

“…A recent systematic review found that interventions reduce drinks per week, drinking beyond recommend limits, and heavy‐use episodes and increase abstinence . Approved medications for AUD include acamprosate, disulfiram, and naltrexone . Newer behavioral therapies involve counseling interventions or specific strategies delivered in person at office visits or electronically as well as more traditional therapies such as Alcoholics Anonymous and rehabilitation facilities .…”

“…Approved medications for AUD include acamprosate, disulfiram, and naltrexone . Newer behavioral therapies involve counseling interventions or specific strategies delivered in person at office visits or electronically as well as more traditional therapies such as Alcoholics Anonymous and rehabilitation facilities . The literature assessing transplantation for ALD generally fails to report concurrent treatment of AUD, but given the data supporting the efficacy of medication and behavioral treatment, it is imperative to treat the underlying AUD and assess its impact on ALD study outcomes, particularly relapse.…”