Clinicians Should Provide ‘Drinking Checkup’ to Patients.
The US Preventive Services Task Force (USPSTF) has issued a recommendation for primary care clinicians to screen all adult patients for unhealthy alcohol use, and to provide brief behavioral counseling interventions to patients who drink too much.
But reducing dangerous drinking will also require stronger clinical evidence, more knowledge and resources to support physician practice, and wider social and structural change, two School of Public Health researchers write in an editorial accompanying the USPSTF recommendation in JAMA.
“Patients expect a drinking checkup, and it is time for clinicians, with support, to provide it,” write Angela Bazzi, assistant professor of community health sciences, and Richard Saitz, professor of community health sciences.
The USPSTF has recommended screening all adult patients, including those who are pregnant, for unhealthy alcohol use for many years, but implementation has remained low. Only one in six patients in the US reports having discussed alcohol with their physician, and rates are similarly low in Europe.
Bazzi and Saitz note that research showing benefits from this kind of screening and intervention has been limited to self-reporting by patients, raising doubts about the effectiveness of the strategy. Still, Bazzi and Saitz argue that the USPSTF recommendation is worth following because it may reduce risks and is unlikely to cause harm: “Even small behavior changes could improve population-level health outcomes.”
Bazzi and Saitz highlight several roadblocks that may be preventing primary care providers from screening their patients for alcohol misuse. Physicians receive limited training to identify and manage unhealthy alcohol use, they write, and attitudes that drinking is less of a medical issue than a moral one may also “contribute to physicians’ perceptions that screening and brief counseling are beyond their purview.” Bazzi and Saitz point to the growing understanding of opioid addiction as a disease, and the training medical students are now beginning to receive for addiction screening and treatment, as factors that may change physicians’ perceptions about the larger problem of unhealthy alcohol use and improve their knowledge and confidence around addressing alcohol and other substance use.
Bazzi and Saitz also note that physicians need to recognize the broader social, structural, and cultural contexts when it comes to their patients’ drinking. “Alcohol availability and advertising are ubiquitous, and preparing patients to cope with numerous, daily cues to drink will require strategies that extend beyond brief behavioral counseling,” they write. Even with screenings, counseling, more research, and more skills and training, physicians’ advice about alcohol will be “drowned out” unless this social context changes. That will take limiting the alcohol industry’s influence, they write, and putting out an unequivocal message from the medical community that drinking less is better for health.