Are American Adults Receiving Recommended Alcohol Screening at Primary Care Visits?

The US Preventive Services Task Force (USPSTF) recommends screening all adults for unhealthy alcohol use during primary care visits. Investigators used nationally representative survey data (N=19,213 primary care visits) to estimate the percentage of visits in which a validated alcohol screening questionnaire was administered, and whether practitioners documented providing counseling or education on alcohol use (or referral for these services). Investigators also examined patient and visit characteristics that predicted alcohol screening receipt.

• Alcohol screening with a validated questionnaire was documented in 2.6% of visits.
• Patients’ sex, race/ethnicity, age group, or length of appointment time were not associated with screening receipt.
• Receiving care from one’s assigned primary care physician, being a new patient to the practice, or having chronic medical conditions were associated with screening receipt.
• Alcohol counseling or referral was documented in 0.8% of visits.

Comments: Investigators note that more than three-quarters of adult participants in other national surveys report that a medical professional had asked them about alcohol consumption recently; however, the USPSTF recommends screening with structured validated questionnaires, which occurred with very low frequency in this national study. The Alcohol Use Disorders Identification Test (AUDIT), AUDIT-C, and the NIAAA Single Alcohol Screening Question are straightforward to use and screen for the full spectrum of unhealthy alcohol use (risky drinking and alcohol use disorders). Because brief interventions (i.e., 10-15 minutes of focused counseling on reducing alcohol use) lead to clinically meaningful reductions in alcohol consumption, higher rates of screening and counseling or referral could substantially reduce alcohol-related morbidity and mortality.

Aaron D. Fox, MD

Reference: Chatterton B, Agnoli A, Schwarz EB, Fenton JJ. Alcohol screening during US primary care visits, 2014–2016. J Gen Intern Med. 2022;37(15):3848–3852.