alcohol use

Evaluating and Treating Alcohol Use in Older Adult Patients

Nathan Hinkle — Tue, 04 Aug 2026 20:36:31 +0000

Date Added:

August 4, 2026

Journal/Publication:

Canadian Family Physician/Le Medecin De Famille Canadien

Publisher:

College of Family Physicians of Canada

Publication Date:

July 29, 2026

Issue:

7-8

Volume:

Pages:

466-468

URL:

Evaluating and treating alcohol use in older adult patients

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.46747/cfp.720708466

Keywords

alcohol use

older adults

cardiovascular disease

MeSH

alcohol drinking

frailty

aged

RPR Commentary: A review of the recognition, assessment, and treatment of older patients who regularly drink alcohol-containing beverages. James W. Mold, MD, MPH

Free full text

View

Clinical question
How do I evaluate and treat alcohol use in older
adult patients?
Bottom line
Although older adults generally drink less alcohol than
their younger counterparts,1 the consequences of use
are more severe. Older adults are more susceptible to
alcohol-related toxicity due to physiologic changes.2
The health impacts of heavy alcohol intake include
increased risks of cardiovascular disease, stroke, liver
disease, cancer, and mortality.3 Acute and chronic
alcohol use contributes to geriatric syndromes, such as
cognitive impairment, falls, frailty, and malnutrition.4

Author/s:

Frank, Chris, Molnar, Rummell, Sonja, Chan, Peter

Alcohol-Related Liver Disease A Review

Nathan Hinkle — Wed, 08 Jul 2026 17:54:03 +0000

Date Added:

July 8, 2026

Journal/Publication:

JAMA

Publisher:

The American Medical Association

Publication Date:

July 6, 2026

Pages:

E1-E13

URL:

Alcohol-Related Liver Disease A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

doi: 10.1001/jama.2026.7636

Keywords

Alcohol-related liver disease

ALD

alcohol use

MeSH

Liver Transplantation

Gastrointestinal Hemorrhage

alcohol drinking

RPR Commentary: A review of current knowledge about alcohol-related liver disease. James W. Mold, MD, MPH

Free full text

View

Abstract
Importance: Alcohol-related liver disease (ALD) is the leading cause of liver-related morbidity and mortality, and the most common indication for liver transplant in Europe and the US. In the US, ALD-related mortality increased from 6.7 deaths per 100 000 people in 1999 to 12.5 deaths per 100 000 people in 2022.

Observations: ALD can develop with long-term daily alcohol consumption of more than 20 g per day for women (1.4 standard drinks/d) and more than 30 g per day for men (2.1 standard drinks/d), with 1 standard drink containing 14 g of ethanol, equivalent to approximately 12 oz of beer, 5 oz of wine, or 1.5 oz of distilled spirits. ALD encompasses reversible steatosis; steatohepatitis, which can cause alcohol-associated hepatitis; and fibrosis, which can cause cirrhosis, portal hypertension, hepatic decompensation, and hepatocellular carcinoma. Risk factors for ALD progression include increased quantity and duration of alcohol use, female sex, older age, obesity, type 2 diabetes, metabolic syndrome, smoking, viral hepatitis, and specific genetic variants. Most patients with ALD (90%) are asymptomatic or have nonspecific symptoms, such as fatigue. Alcohol-associated hepatitis often causes fever, anorexia, nausea, vomiting, abdominal pain, and jaundice. Individuals with decompensated cirrhosis typically have ascites, variceal bleeding, jaundice, and/or hepatic encephalopathy. Noninvasive liver fibrosis tests, such as the Fibrosis-4 score (which includes alanine transaminase, aspartate aminotransferase, platelet count, and age), and more specific second-line tests, including liver stiffness measurement (vibration-controlled transient elastography) and blood-based fibrosis markers such as the enhanced liver fibrosis test and N-terminal propeptide of type III collagen, provide early diagnosis of ALD and assess liver fibrosis severity, which is the strongest predictor of liver-related outcomes. Alcohol cessation interventions such as motivational enhancement therapy, cognitive behavioral therapy, and pharmacologic therapy (eg, baclofen, naltrexone) are recommended to prevent disease progression. Because alcohol consumption is often underreported, screening tools, such as the Alcohol Use Disorders Identification Test, and sensitive biomarkers of recent alcohol intake (eg, blood phosphatidylethanol) may improve clinical accuracy. Sustained abstinence from alcohol is the primary treatment for ALD. Among patients with alcohol-related cirrhosis, alcohol abstinence over a median follow-up of 36 months was associated with reduced risk of liver-related mortality (adjusted hazard ratio, 0.43 [95% CI, 0.26-0.70]) and all-cause mortality (adjusted hazard ratio, 0.45 [95% CI, 0.30-0.67]). Liver transplant evaluation should be considered for patients with severe alcohol-associated hepatitis or decompensated cirrhosis.

Conclusions and Relevance: People with chronic daily heavy alcohol consumption should be assessed for ALD with noninvasive testing. The primary treatment goal is alcohol cessation. Patients with severe alcohol-associated hepatitis or decompensated cirrhosis should be considered for liver transplant.

Author/s:

Aleksander Krag, Frederik Aberg, Jessica Mellinger, Brian P. Lee, Mads Israelsen

Screening for Alcohol Use and Brief Counseling of Adults — 13 States and the District of Columbia, 2017

John Bayhi — Sat, 14 Mar 2020 20:31:53 +0000

Date Added:

March 14, 2020

Journal/Publication:

MMWR Morbidity and Mortality Weekly Report

Publisher:

Centers for Disease Control and Prevention

Publication Date:

March 13, 2020

Issue:

Volume:

Pages:

265-270

URL:

Screening for Alcohol Use and Brief Counseling of Adults — 13 States and the District of Columbia, 2017

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.15585/mmwr.mm6910a3

Keywords

alcohol use

screening and brief intervention

alcohol SBI

binge drinking

PMID (1):

32163383

MeSH

Behavioral Risk Factor Surveillance System

Fetal Alcohol Spectrum Disorders

Public Health Practice

health personnel

Evidence-Based Medicine

insurance coverage

Telephone

Centers for Disease Control and Prevention

U.S.

Longitudinal Studies

The CDC recommends screening all adults for binge drinking with a single question and recommending reduction to those who screen positive. James W. Mold, MD, MPH

Free full text

View

What is already known about this topic?

Binge drinking increases the risk for adverse health conditions and death. Alcohol screening and brief intervention (SBI), recommended by the U.S. Preventive Services Task Force (USPSTF) for all adults in primary care, is effective in reducing binge drinking.

What is added by this report?

In 2017, 81% of survey respondents were asked by their health care provider about alcohol consumption and 38% about binge drinking at a checkup in the past 2 years. Among those asked about alcohol use and who reported current binge drinking, 80% received no advice to reduce their drinking.

What are the implications for public health practice?

Implementation of alcohol SBI as recommended by USPSTF, coupled with population-level evidence-based interventions, can reduce binge drinking among U.S. adults.

Author/s:

McKnight-Eily, LR, Okoro, CA, Turay, K, Acero, C, Hungerford, D

Effectiveness of brief alcohol interventions in primary care populations

Tracy Ashby — Mon, 12 Nov 2018 06:00:00 +0000

Date Added:

November 12, 2018

Journal/Publication:

Cochrane Database of Systematic Reviews

Publisher:

John Wiley & Sons, Inc.

Publication Date:

February 24, 2018

Issue:

URL:

Effectiveness of brief alcohol interventions in primary care populations

Type:

Meta-analyses, Reviews, and Guidelines, Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1002/14651858

Keywords

MeSH

motivational interviewing

cognitive therapy

Screening and brief interventions for unhealthy levels of alcohol use in primary care settings are effective for reducing alcohol intake. A number of screening instruments are available. Evidence-based brief interventions have generally included: feedback on the screening outcome plus structured advice about potential risks of heavy drinking and ways to reduce consumption. Effective feedback and advice has taken several forms including: FRAMES, motivational interviewing, Motivational Enhancement Therapy (MET), Brief Negotiated Interview (BNI), and/or Cognitive Behavioral Therapy (CBT). Some have been backed up by diaries or exercises for the patient to complete at home, and follow-up telephone calls.

Free full text

Background

Excessive drinking is a significant cause of mortality, morbidity and social problems in many countries. Brief interventions aim to reduce alcohol consumption and related harm in hazardous and harmful drinkers who are not actively seeking help for alcohol problems. Interventions usually take the form of a conversation with a primary care provider and may include feedback on the person’s alcohol use, information about potential harms and benefits of reducing intake, and advice on how to reduce consumption. Discussion informs the development of a personal plan to help reduce consumption. Brief interventions can also include behaviour change or motivationally-focused counselling.

This is an update of a Cochrane Review published in 2007.

Author/s:

Kaner, EFS, Beyer, FR, Muirhead, C, Campbell, F, Pienaar, ED, Bertholet, N, Daeppen, JB, Saunders, JB, Burnand, B

Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Tracy Ashby — Sat, 25 Aug 2018 05:00:00 +0000

Date Added:

August 25, 2018

Journal/Publication:

The Lancet

Publisher:

Elsevier

Publication Date:

August 23, 2018

URL:

Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/S0140-6736(18)31310-2

Keywords

MeSH

quality-adjusted life years

prevalence

This systematic review suggests that there may be no safe level of alcohol intake. Any small cardiovascular benefit appears to be outweighed by adverse effects on other systems.

Free full text

View

Background

Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older.

Methods

Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health.

Findings

Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2·2% (95% uncertainty interval [UI] 1·5–3·0) of age-standardised female deaths and 6·8% (5·8–8·0) of age-standardised male deaths. Among the population aged 15–49 years, alcohol use was the leading risk factor globally in 2016, with 3·8% (95% UI 3·2–4·3) of female deaths and 12·2% (10·8–13·6) of male deaths attributable to alcohol use. For the population aged 15–49 years, female attributable DALYs were 2·3% (95% UI 2·0–2·6) and male attributable DALYs were 8·9% (7·8–9·9). The three leading causes of attributable deaths in this age group were tuberculosis (1·4% [95% UI 1·0–1·7] of total deaths), road injuries (1·2% [0·7–1·9]), and self-harm (1·1% [0·6–1·5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27·1% (95% UI 21·2–33·3) of total alcohol-attributable female deaths and 18·9% (15·3–22·6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0·0–0·8) standard drinks per week.

Interpretation

Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption.

Funding

Bill & Melinda Gates Foundation.

Author/s:

GBD 2016 Alcohol Collaborators

SBIRT: Screening, Brief Intervention, and Referral to Treatment

Tracy Ashby — Thu, 11 Jan 2018 06:00:00 +0000

Date Added:

October 18, 2018

URL:

SBIRT: Screening, Brief Intervention, and Referral to Treatment

Type:

Clinical Decision Aids, Practice Management Research Results

Format:

Article

Keywords

MeSH

health risk behaviors

substance-related disorders

SBIRT is the approach developed by mental health authorities for incorporating alcohol and drug misuse screening, brief interventions, and referral into primary care practice.

Free full text

View

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based practice used to identify, reduce, and prevent problematic use, abuse, and dependence on alcohol and illicit drugs. The SBIRT model was incited by an Institute of Medicine recommendation that called for community-based screening for health risk behaviors, including substance use.

Author/s:

SAMHSA-HRSA Center for Integrated Health Solutions