Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse

Is there direct evidence that the combination of screening and behavioral counseling interventions for alcohol misuse lead to reduced morbidity and/or mortality?

Is there evidence to support specific screening modalities for alcohol misuse? In the general adult population? In adolescents? In pregnant women? In racial/ethnic minority populations? In seniors?

What are adverse effects associated with alcohol use screening and screening-related assessment?

Do behavioral counseling interventions reduce alcohol misuse in the targeted subgroup (general adult population, pregnant women, adolescents, racial/ethnic minority groups, seniors)? Is there evidence to support specific behavioral counseling approaches or modalities?

What health care system influences are present in effective screening and behavioral counseling interventions for alcohol misuse?

Are there other positive outcomes from behavioral counseling interventions to reduce alcohol misuse?

What are the adverse effects or harms associated with behavioral counseling interventions for alcohol misuse?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

Comparisons include, but are not limited to:

screening modalities for alcohol misuse

behavioral counseling interventions

combination of behavioral counseling with medication

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

General United States adult population

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

Adolescents: Persons under the legal drinking age of 21

Pregnant women

Seniors: Persons aged 65 and older

Racial/ethnic minorities: Native Americans, Latinos, African-Americans

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Benefits include, but are not limited to:

Intermediate health outcomes such as lower risk alcohol use; and,

Health outcomes such as sobriety; reduction in all-cause mortality, alcohol-related deaths, morbidity related to alcohol misuse, alcohol-related trauma, alcohol-related traffic incidents, reduction in sick days.

Describe any health-related risks, side effects, or harms that you are concerned about.

Adverse effects of screening for alcohol misuse such as anxiety and labeling

Adverse effects of counseling interventions

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Pregnancy, including preterm birth
• Substance abuse

AHRQ Priority Populations

• Low income groups
• Minority groups
• Women
• Elderly

Federal Health Care Program

• Medicaid
• Medicare

Importance

Describe why this topic is important.

Alcohol misuse is a major global public health issue. In the United States, alcohol misuse contributes to numerous health and social problems. According to the CDC, “excessive alcohol use is the third leading life-style related cause of death in the United States.” In 2008, the CDC estimated that there are approximately 79,000 deaths annually attributable to excessive alcohol use in the United States. The estimated cost of alcohol misuse in 1998 was $184.6 billion. In established market economies, alcohol use has a relatively greater effect on disability-adjusted life years (15.6% of all years lost due to disability) compared with mortality (5.1% of potential life years lost). Persons who misuse, abuse, or are dependent on alcohol have elevated risks for a host of health problems, including chronic diseases and injuries. For example, higher levels of alcohol consumption have been linked to increased risk of liver cirrhosis, diseases of the central nervous system, hypertension, and cancers of the head and neck, digestive tract, liver, and breast and increased injuries. Consumption of alcohol also increases the risk of violence and escalation of aggressive behavior; violence-related trauma is strongly linked to alcohol use.

Special risks are associated with alcohol use by pregnant women. Among pregnant women, for example, moderate drinking has been linked to an increased risk of spontaneous abortion. Additionally, heavy maternal alcohol consumption during pregnancy can lead to a range of physical and cognitive birth defects, including fetal alcohol syndrome (FAS), a serious developmental disorder with characteristic facial abnormalities, growth retardation, and reductions in general intellectual functioning and academic skills, cognitive and motor functioning, and social functioning.

In recent years, increased attention has been focused on the problem of underage and adolescent alcohol use. The 2007 Surgeon General’s Call to Action to Prevent and Reduce Unde

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

The U.S. Preventive Services Task Force released its current recommendation on alcohol misuse screening and behavioral counseling interventions in primary care in 2004. Its goal is to update each topic every 5 years in accordance with the National Guidelines Clearinghouse protocols.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

There is insufficient evidence evaluating the effectiveness of screening and behavioral counseling in primary care settings to prevent or reduce alcohol misuse by adolescents.

Clinicians may be uncertain how to adopt effective interventions as a regular part of routine health care. Further, there are limited data to separate out the essential elements of efficacious interventions.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

The U.S. Preventive Services Task Force will use this report to update its recommendation on Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse.

Describe the timeframe in which an answer to your question is needed.

The U.S. Preventive Services Task Force would like to update its recommendation on screening and behavioral counseling interventions in primary care to reduce alcohol misues as soon as possible. Its current recommendation is over 5 years old.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

The review should include Native Americans, Latinos, African-Americans.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

The U.S. Preventive Services Task Force will use this report to update its recommendation on Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse.

Are you making a suggestion as an individual or on behalf of an organization?

Organization

Please tell us how you heard about the Effective Health Care Program

AHRQ supports the U.S. Preventive Services Task Force