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Seniors are Least Likely to Discuss Alcohol Use with Health Care Provider but Few Adults Do

Alcohol screening and counseling is an effective but underused health service but most doctors do not raise the subject with patients: CDC reports

Drinking too much alcohol has many more health risks than most people realize. Alcohol screening and brief counseling can help people set realistic goals for themselves and achieve those goals. Health care workers can provide this service to more patients and involve communities to help people avoid dangerous levels of drinking.

Tom Frieden, MD, MPH - Director of the Centers for Disease Control and Prevention

Jan. 8, 2014 - Only one in six adults - and only one in four binge drinkers - say a health professional has ever discussed alcohol use with them and senior citizens are the least likely to have ever had such a discussion, according to a new Vital Signs report from the Centers for Disease Control and Prevention.

Even among adults who binge drink 10 or more times a month, only one in three have ever had a health professional talk with them about alcohol use.

Binge drinking is defined as consuming four or more drinks for women and five or more drinks for men within 2-3 hours. Talking with a patient about their alcohol use is an important first step in screening and counseling, which has been proven effective in helping people who drink too much to drink less.

A drink is defined as five ounces of wine, 12 ounces of beer, or 1.5 ounces of 80-proof distilled spirits or liquor. At least 38 million adults in the United States drink too much. Most are not alcoholics.

Drinking too much causes about 88,000 deaths in the United States each year, and was responsible for about $224 billion in economic costs in 2006. It can also lead to many health and social problems, including heart disease, breast cancer, sexually transmitted diseases, fetal alcohol spectrum disorders, motor-vehicle crashes, and violence.

Alcohol screening and brief counseling can reduce the amount of alcohol consumed on an occasion by 25 percent among those who drink too much. It is recommended for all adults, including pregnant women.

As with blood pressure, cholesterol and breast cancer screening, and flu vaccination, it has also been shown to improve health and save money. Through the Affordable Care Act, alcohol screening and brief counseling can be covered by most health insurance plans without copay.

Seniors Least Likely to Talk with Doctor

Weighted prevalence of discussing alcohol use with a doctor or other health professional among U.S. adults by age group and gender.
Behavioral Risk Factor Surveillance System, 44 states and the District of Columbia, August 1–December 31, 2011

Group

Number

Talked with about alcohol use

Ever

Past year

%

%

Age (yrs)

18–24

6,529

27.9

15.9

25–34

15,411

17.1

7.8

35–44

21,333

14.6

6.5

45–64

68,414

14.6

6.7

≥65

53,525

9.3

4.2

Total

166,753

15.7

7.6

Gender

Men

64,836

19.0

9.2

Women

101,917

12.5

6.0

“Drinking too much alcohol has many more health risks than most people realize,” said CDC Director Tom Frieden, M.D., M.P.H. “Alcohol screening and brief counseling can help people set realistic goals for themselves and achieve those goals. Health care workers can provide this service to more patients and involve communities to help people avoid dangerous levels of drinking.”

 

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Health professionals who conduct alcohol screening and brief counseling use a set of questions to screen all patients to determine how much they drink and assess problems associated with drinking. This allows them to counsel those who drink too much about the health dangers, and to refer those who need specialized treatment for alcohol dependence.

CDC used 2011 Behavioral Risk Factor Surveillance System data to analyze self-reports of ever being “talked with by a health provider” about alcohol use among U.S. adults aged 18 and older from 44 states and the District of Columbia.

No state or district had more than one in four adults report that a health professional talked with them about their drinking, and only 17 percent of pregnant women reported this. Drinking during pregnancy can seriously harm the developing fetus.

Through the Affordable Care Act, more Americans will have access to health coverage and to no-cost preventive services like alcohol misuse screening and counseling. Visit Healthcare.gov or call 1-800-318-2596 (TTY/TDD 1-855-889-4325) to learn more. Open enrollment in the Marketplace began October 1 and ends March 31, 2014. For those enrolled by Dec. 15, 2013, coverage starts as early as Jan. 1, 2014.

For more information about CDC’s efforts in alcohol and public health, visit http://www.cdc.gov/alcohol/

The National Institute on Alcohol Abuse and Alcoholism has developed materials designed to help health care professionals conduct fast, evidence-based alcohol screening and brief interventions for adults 18+: http://www.niaaa.nih.gov/publications/clinical-guides-and-manuals/helping-patients-who-drink-too-much-clinicians-guide.

Vital Signs is a CDC report that appears on the first Tuesday of the month as part of the CDC journal Morbidity and Mortality Weekly Report, or MMWR. The report provides the latest data and information on key health indicators. These are cancer prevention, obesity, tobacco use, motor vehicle passenger safety, prescription drug overdose, HIV/AIDS, alcohol use, health care–associated infections, cardiovascular health, teen pregnancy, food safety and viral hepatitis.

Binge Drinking

Weighted prevalence of ever discussing alcohol use with a doctor or other health professional among U.S. adult binge drinkers, by binge drinking frequency in the past month — Behavioral Risk Factor Surveillance System, 44 states and the District of Columbia, 2011

The figure above shows the weighted prevalence of ever discussing alcohol use with a doctor or other health professional among U.S. adult binge drinkers, by binge drinking frequency in the past month for 44 states and the District of Columbia during 2011. Prevalence among binge drinkers (25.4%) was approximately twice that of non-binge drinkers (13.5%), and increased significantly with the number of binge drinking episodes, ranging from 23.6% (95% confidence interval [CI]: 19.4-28.4) among those reporting one to two episodes to 34.9% (95% CI: 29.7-40.4) among those reporting ≥10 episodes during the past 30 days.

What Health Care Providers Need to Do

·         The key steps in alcohol screening and brief counseling include

1.    Ask patients about their drinking

2.    Talk with patients in plain language about what they think is good and not so good about their drinking

3.    Provide options: ask if patient wants to stop drinking, cut down, seek help, or continue with their present drinking pattern and come up with a plan.

4.    Close on good terms regardless of patient response

·         Screening and counseling should occur in many places including primary care practices, obstetrics/gynecology practices, emergency departments and trauma centers

·         Making sure it happens in routine medical practices includes five steps:

1.    Make sure staff understands that most patients who drink too much need brief counseling but may not need specialized alcoholic treatment.

2.    Involve and build support with others in the medical practice, using current guidelines.

3.    Develop a plan with them to make it part of standard service.

4.    Train staff on how to screen and provide brief counseling.

5.    Pilot test the plan to see if it works and change it as needed.

 

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