Doctors Rarely Tell Binge Drinkers to Cut Back: Alcohol Screening in 13 States, 2017

Visual abstract from the CDC report.

Summary

• Binge drinking raises the risk of illness and death. Alcohol screening and brief intervention (SBI) — recommended by the U.S. Preventive Services Task Force for all adults in primary care — reduces it.
• In 2017, 81% of adults surveyed had been asked about alcohol at a checkup in the past 2 years, but only 38% about binge drinking. Of those asked about alcohol who binge drank, 80% got no advice to cut back.
• SBI as recommended, plus population-level measures, can reduce binge drinking.

Why it matters

From 2006 to 2010, binge drinking contributed to about 49,000 deaths a year from acute causes such as injuries and violence, and it raises the risk of chronic diseases like breast cancer and of fetal alcohol spectrum disorders. The Task Force recommended alcohol SBI in 2004, 2013 and 2018. Binge drinking means four or more drinks for women or five or more for men on one occasion — typically bringing blood alcohol to 0.08 g/dL within about 2 hours.

The survey

The Behavioral Risk Factor Surveillance System, a state telephone survey, ran an optional alcohol SBI module in 13 states (Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Kansas, Nebraska, Nevada, New Hampshire, Tennessee and Wisconsin) and D.C. in 2017. Adults with a checkup in the past 2 years were asked whether they'd been asked if they drink, how much, and whether they'd had five (men) or four (women) or more drinks on an occasion; whether they'd been told what drinking is harmful; and whether they'd been advised to cut down or quit.

What was found

Being asked about binge drinking was more common among men (40.1% vs 36.0%), people without a high school diploma (46.2%), lower-income people, Hispanic adults, and people who actually binge drank (47.3% vs 36.1%).

Among people who binge drank and had been screened:

• only 41.7% were told about the harms of drinking too much;
• only 20.1% were advised to reduce or quit.

Advice to cut down was more common among men (24.1%), people with a disability (28.2%), people without a high school diploma (38.2%), people below the poverty line (37.5%), the uninsured (36.2%) and Hispanic adults (28.5%, vs 16.8% of White adults) — perhaps reflecting more contact with health systems, or systems like the VA and federally qualified health centers that build SBI in.

Screening isn't enough — counseling is the point

Screening alone doesn't reduce binge drinking. Brief counseling — feedback on the screening result, a conversation about the risks, and a plan to cut down if the patient wants one — is what works. People with dependence should be referred to treatment (the Substance Abuse and Mental Health Services Administration runs a treatment locator). A 2018 Task Force review found counseling cut drinking by an average of 1.6 drinks a week, the odds of exceeding limits by 40% and heavy episodes by 33% at 6–12 months, and helped pregnant women stay abstinent.

Help on the way: a new 2018 health-plan quality measure — Unhealthy Alcohol Use Screening and Follow-Up — and federal support for training and partnerships could spread SBI.

Guidance: the Dietary Guidelines for Americans, 2015–2020 say adults of legal age who drink should do so in moderation — up to one drink a day for women, two for men — and some people shouldn't drink at all, including pregnant women or those who might be, and people with certain conditions or medicines.

Limits: answers were self-reported; results come from 14 sites, not the whole country; it's unknown whether people told their doctors they binge drank; and the median response rate was only 43.8%.

The bottom line: SBI isn't being used as recommended. Done properly, and paired with community measures such as higher alcohol taxes and limits on alcohol outlet density, it could reduce alcohol-related illness and death.

Sources

Based on Lela R. McKnight-Eily, Catherine A. Okoro, Khadija Turay, Cristian Acero and Dan Hungerford, "Screening for Alcohol Use and Brief Counseling of Adults — 13 States and the District of Columbia, 2017," MMWR, Centers for Disease Control and Prevention; a work of the United States government in the public domain.