A government task force issued updated draft recommendations last Monday advising primary care doctors to screen for misuse of alcohol and to provide short bursts of counseling to those who engage in “risky drinking.” That’s based on how often and how much they imbibe and whether they regularly binge on four or more drinks at a time, if they’re a woman, or five or more if they’re a man.
Those new recommendations drew little notice because they haven’t changed significantly from guidelines issued eight years ago.
But that’s a shame considering that few of the estimated 30 percent of Americans who qualify as problem drinkers — which puts them at higher risk of becoming full-blown alcoholics — get the proper screening and treatment, according to Susan Curry, dean of the University of Iowa’s College of Public Health. She served on the US Preventive Services Task Force that issued the updated recommendation.
The screening involves a simple questionnaire that a primary care physician can administer if patients reveal during a routine physical that they’re drinking beyond moderation.
While many risky drinkers don’t need or want to go to a support group such as Alcoholics Anonymous, brief behavioral counseling sessions in a doctor’s office are effective at reducing alcohol consumption — both in terms of frequency of binges and amount consumed — for at least six months to a year, according to results from 23 clinical trials on which the latest recommendations were based.
“These sessions can be conducted in person or over the phone,” said Curry. “We’re talking about two or three sessions lasting 5 to 15 minutes each. It’s broadly feasible that doctors can do this.” Yet, she added, very few do.
Massachusetts General Hospital internist Dr. Leigh Simmons told me she’s been screening her patients for alcohol misuse for years and referring risky drinkers to the hospital’s addiction clinic, where social workers can conduct brief counseling sessions.
“That’s convenient for our physicians, but it’s much more difficult for physicians who don’t know how to do counseling in their practice or where to make a referral,” Simmons pointed out, “especially if the patient doesn’t have insurance coverage for mental health treatments.”
While many of the task force’s screening recommendations for other health problems involve ordering blood tests or X-rays and referring patients to specialists for abnormal results, a number similarly involve questioning and counseling patients, and these can siphon a considerable amount of a physician’s time.
A Duke University study estimated that if primary care physicians followed all of the task force recommendations for preventive care, they’d need to add 7.4 hours to their work day.
“We have to pick and choose which of these recommendations to follow,” said Simmons, “and carefully select those that will be of the highest value.” She said she doesn’t make time, for example, for discussions involving tatoos, which she doesn’t think are a major health concern.
But taking the time to screen for alcohol abuse or a smoking habit, Simmons said, should be a major priority for primary care physicians, because evidence is strong that providing a little advice and support can help patients change their habits.
Some doctors may have a hard time “carrying the ball over the finish line to help patients,” said Simmons, but they shouldn’t use this as an excuse because they have all had at least some training on screening for and treating addictions during medical school and residency. And they can take advantage of continuing medical education programs offered by the National Institute on Alcohol Abuse and Alcoholism and others on how to administer basic behavioral treatments.
CapeCodBear: Doctors receive one hour of education on alcoholism in medical school and one-half day during internship. The only alcohol experience they get during residency is when they rotate on the addiction ward or treat a drunk with another condition.
jds1282: Adding in alcohol screening and 5 to 15 minutes of potential counseling seems like an impossible request for doctors already struggling to fit their appointment slots, no?