Final Recommendation Statement: Unhealthy Alcohol Use in Adolescents and Adults: Screening and Behavioral Counseling Interventions
Abstract
Importance
The USPSTF uses the term “unhealthy alcohol use” to define a spectrum of behaviors, from risky drinking to alcohol use disorder (AUD) (eg, harmful alcohol use, abuse, or dependence) (Table).1 “Risky” or” hazardous” alcohol use means drinking more than the recommended daily, weekly, or per-occasion amounts, resulting in increased risk for health consequences but not meeting criteria for AUD.2 The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines “risky use” as exceeding the recommended limits of 4 drinks per day (56 g/d based on the US standard of 14 g/drink) or 14 drinks per week (196 g/d) for healthy adult men aged 21 to 64 years or 3 drinks per day or 7 drinks per week (42 g/d or 98 g/week) for all adult women of any age and men 65 years or older.2
A standard drink is defined as 12.0 oz of beer (5% alcohol), 5.0 oz of wine (12% alcohol), or 1.5 oz of liquor (40% alcohol).2 The American Society of Addiction Medicine (ASAM) defines “hazardous use” as alcohol use that increases the risk of future negative health consequences.3 The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines the severity of AUD (mild, moderate, or severe) based on the number of criteria met.4 Previous versions of the DSM-5 had separate diagnoses for alcohol abuse and alcohol dependence, but it no longer separates these diagnoses.1 Currently, there is no firm consensus worldwide regarding the definition of risky drinking. In addition, the definition of a standard drink differs by country.1 Any alcohol use is considered unhealthy in pregnant women and adolescents.1 In adolescents, the definition of moderate- or high-risk alcohol use varies by age, based on days of use per year.5
Excessive alcohol use is one of the most common causes of premature mortality in the United States. From 2006 to 2010, an estimated 88,000 alcohol-attributable deaths occurred annually in the United States, caused by both acute conditions (eg, injuries from motor vehicle collisions) and chronic conditions (eg, alcoholic liver disease).1, 6 Alcohol use during pregnancy is also one of the major preventable causes of birth defects and developmental disabilities.7
RPR Commentary
The USPSTF recommends screening for unhealthy alcohol use in primary care settings in adults 18 years or older, including pregnant women, and providing persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce unhealthy alcohol use. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.