Expect a ‘drinking checkup’ during your next doctor’s visit

You can expect a “drinking checkup” when you visit the doctor. All adults, including pregnant women, should be screened for unhealthy alcohol use by their primary care physicians, the United States Preventive Services Task Force advises. For those patients who drink above the recommended limits, doctors should provide brief counseling to help them reduce their drinking, according to the new task force statement published Tuesday in the medical journal JAMA.

As far as teens, the independent panel of medical experts came up empty. The task force said it did not find enough evidence to make a recommendation for or against alcohol screening and counseling for those under the age of 18. The panel is calling for more research.

Unhealthy alcohol use means drinking beyond the recommended limits. No more than four drinks in a single day and 14 drinks in a week is the line drawn for men age 21 to 64, according to National Institute on Alcohol Abuse and Alcoholism. For women and older men, the institute advises no more than three drinks in one day and no more than seven drinks in a week. There is no safe level of alcohol for pregnant women, according to the institute.

The negative consequences of too much alcohol include illness, injury, and death — unhealthy alcohol use ranks as the third leading preventable cause of death in the US according to the task force. When pregnant women drink, birth defects and developmental problems in their children may follow.

Too many doctors don’t speak up about alcohol

The new recommendation is a simple update of the task force’s long-standing position. Since 1996, the task force has recommended doctors screen and briefly counsel adults for unhealthy drinking and before that, in 1989, it recommended physicians ask their patients to describe how they use alcohol.

“Yet implementation of screening and brief intervention still remains quite low,” Angela Bazzi and Dr. Richard Saitz, both of Boston University School of Public Health, wrote in an editorial published with the new guidelines in JAMA. “For example, in the United States, 1 in 6 patients reports having discussed alcohol with their physician; rates in Europe are similarly low.”

Bazzi and Saitz note that the World Health Organization supports screening and brief counseling for unhealthy drinking in adults, while the American Academy of Pediatrics does so for youth.

Even small steps are beneficial

The lack of discussion in doctors’ offices continues despite high prevalence of unhealthy drinking, “evidence for screening and brief intervention efficacy, substantial government funding, practice guidelines, and quality measures and incentives,” wrote the editorial authors.

Behavioral counseling interventions include in-person or web-based sessions that are usually short, for example, just one to four sessions,two hours or less of total contact time, according to the task force.

In studies, patients who have been advised to cut back on alcohol often report that they have done so to please the researchers, while reviews find no effects on objective measures of alcohol consumption (their blood levels) or the rates of injuries, alcohol-related illnesses and hospitalizations, according to Bazzi and Saitz. Still, “even small behavior changes” could improve health, they wrote.

“The societal context must change,” wrote Bazzi and Staitz. They added that less use of alcohol, “is better for health.”