'Screen Every Adult for Unhealthy Alcohol Use, USPSTF Says'

 

• Unhealthy alcohol use is a leading cause of death and serious illness among U.S. adults.
• In new draft guidance, the USPSTF reaffirmed that all adults should be screened for unhealthy alcohol use, and recommended brief behavioral counseling interventions when appropriate.
• The task force found insufficient evidence to make the same recommendation in adolescents.

In updated draft guidance, the U.S. Preventive Services Task Force (USPSTF) said that all adults should be screened for unhealthy alcohol use in primary care settings, recommendationsopens in a new tab or window that align with those from 2018.

For adults who screen positive for "risky or hazardous drinking," the task force recommended brief behavioral counseling interventions -- a grade Bopens in a new tab or window recommendation, based on moderate net benefit.

"Unhealthy alcohol use is really a major cause of death and serious illness in this country, and we can reduce that risk by asking adults about their drinking and providing brief counseling," James Stevermer, MD, MSPH, a member of the USPSTF, told MedPage Today.

HHS and the Department of Agriculture define moderate drinking as no more than two drinks per day for men and no more than one drink per day for women. Unhealthy alcohol use reflects "a spectrum of behavior from risky drinking to alcohol use disorder," the task force noted.

Unhealthy alcohol use is a leading cause of preventable death in adults.

In recent years, alcohol-related organ complications,opens in a new tab or window including pancreatitis and liver diseaseopens in a new tab or window, have grown, particularly among young adults and teenagers. Rates of alcohol-induced liver disease-related hospitalizations and liver transplantsopens in a new tab or window have also surged over the last two decades, with a concerning rise among younger adults, especially women.

According to an analysis from the Lancet Commission, at least 60% of liver cancersopens in a new tab or window globally could be prevented with control of certain risk factors, with alcohol use responsible for roughly 20%.

The USPSTF made no recommendations for or against screening and counseling among adolescents ages 12 to 17, pointing to insufficient evidence of benefits versus harms (I statement). Specifically, there was inadequate evidence that screening instruments can detect unhealthy alcohol use, and that counseling interventions were tied to reduced alcohol use.

As a family physician in rural Missouri, Stevermer said, "I have plenty to do when I see patients, and I want to spend my time where there's evidence that it's beneficial."

As new research emerges, Stevermer said he hopes the task force will be able to make a different recommendation for adolescents in its next review.

"In the absence of evidence, healthcare professionals should use their judgment when determining whether or not to screen their teen patients," task force member John Ruiz, PhD, said in a statement.

While alcohol-related deaths are typically due to the "health effects of chronic excessive use" (heart disease, cancer, and liver disease), alcohol-related injuries also represent a "significant cause of loss of life," especially among young adults, the task force said.

The USPSTF called for more studies on the effectiveness of interventions to reduce unhealthy alcohol use in adolescents and adults, and on the accuracy of the U.S. Alcohol Use Disorders Identification Test (USAUDIT) and the USAUDIT-Consumption.

The recommendations for adults, including pregnant persons, were based on the following criteria:

• Adequate evidence that current screening instruments can detect unhealthy alcohol use
• Convincing evidence that the recommended interventions are linked to reduced unhealthy alcohol use and epidemiological evidence that such reductions lower the risk of mortality and morbidity
• Adequate evidence that the harms of interventions are "no greater than small"
• Inadequate evidence regarding the harms of screening

The recommendations do not apply to adults previously diagnosed with unhealthy alcohol use or those who seek evaluation or treatment for such use.

The USPSTF warned that consuming alcohol while pregnant can lead to fetal alcohol spectrum disorders and other adverse birth outcomes, and that starting to drink alcohol at younger ages as the brain is still developing "may contribute to an increased risk of unhealthy alcohol use."

The task force's evidence reviewopens in a new tab or window highlighted 79 trials, involving more than 40,000 participants. In pooled analyses, those participating in interventions to reduce unhealthy alcohol use reduced alcohol consumption by an average of 1.6 drinks per week more than those in control groups.

The USPSTF also reviewed 13 studies of 12 screening instruments used among adolescents, and noted adequate evidence for detecting alcohol use disorder, but the screening tools for unhealthy alcohol use were "limited in quantity with lower sensitivity and specificity measures."

Across four U.S.-based trials in adolescents that assessed the benefits of counseling to reduce unhealthy alcohol use in the primary care setting, three did not demonstrate statistical significance.

The American Academy of Pediatrics recommends universal screening for substance use,opens in a new tab or window including alcohol useopens in a new tab or window, among adolescents as part of routine healthcare.

The recommendations will be open for public commentopens in a new tab or window until Sept. 2.

https://www.medpagetoday.com/primarycare/preventivecare/116829