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Addressing Alcohol Use: Practice Manual

Author/s: 
Gonzalez, Sandra, Grubb, John, Kowalchuk, Alicia, Sidani, Mohamad, Spooner, Kiara, Zoorob, Roger

Risky alcohol use, defined as any level of alcohol consumption which increases the risk of harm to oneself or others, is both a substance use disorder and medical issue. Recognized as one of the leading preventable causes of death, risky alcohol use leads to over 88,000 deaths each year in the United States. Among adults in the U.S., approximately 58% of men and 46% of women report drinking in the last 30 days. National estimates also indicate that greater than 50% of the alcohol consumed by adults is during binge drinking, the most common pattern of excessive or risky alcohol use. More specifically, in the U.S., approximately 23% of adult men report binge drinking five times per month, while 11% of adult women report binge drinking three times per month. Furthermore, research indicates that more than one in two women of childbearing age drink alcohol. Among those that drink alcohol, 18% engage in binge drinking.

Family physicians and other primary care providers are in an ideal position to facilitate the prevention of morbidity and mortality associated with risky alcohol use. Many professional organizations recognize the importance of screening and behavioral counseling interventions to reduce alcohol misuse, including the American Academy of Family Physicians (AAFP), American College of Obstetricians and Gynecologists (AGOG), and the U.S. Preventive Services Task Force (USPSTF).

Alcohol screening and brief intervention (SBI) is a USPSTF grade B recommendation that includes:

• Screening all adult primary care patients for risky alcohol use, at least yearly, using an evidence-based screening tool.

• Providing a brief behavioral intervention to patients screening positive for risky alcohol use, to help them make healthier choices around their drinking (e.g., to reduce alcohol use or quit drinking).

This practice manual provides a systems-change approach for implementing alcohol SBI into your practice.

Keywords 
alcohol alcohol abuse binge drinking

Effectiveness of brief alcohol interventions in primary care populations

Author/s: 
Kaner, EFS, Beyer, FR, Muirhead, C, Campbell, F, Pienaar, ED, Bertholet, N, Daeppen, JB, Saunders, JB, Burnand, B

Background

Excessive drinking is a significant cause of mortality, morbidity and social problems in many countries. Brief interventions aim to reduce alcohol consumption and related harm in hazardous and harmful drinkers who are not actively seeking help for alcohol problems. Interventions usually take the form of a conversation with a primary care provider and may include feedback on the person’s alcohol use, information about potential harms and benefits of reducing intake, and advice on how to reduce consumption. Discussion informs the development of a personal plan to help reduce consumption. Brief interventions can also include behaviour change or motivationally-focused counselling.

This is an update of a Cochrane Review published in 2007.

Keywords 
alcohol use interventions therapy

Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Author/s: 
GBD 2016 Alcohol Collaborators

Background

Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older.

Methods

Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health.

Findings

Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2·2% (95% uncertainty interval [UI] 1·5–3·0) of age-standardised female deaths and 6·8% (5·8–8·0) of age-standardised male deaths. Among the population aged 15–49 years, alcohol use was the leading risk factor globally in 2016, with 3·8% (95% UI 3·2–4·3) of female deaths and 12·2% (10·8–13·6) of male deaths attributable to alcohol use. For the population aged 15–49 years, female attributable DALYs were 2·3% (95% UI 2·0–2·6) and male attributable DALYs were 8·9% (7·8–9·9). The three leading causes of attributable deaths in this age group were tuberculosis (1·4% [95% UI 1·0–1·7] of total deaths), road injuries (1·2% [0·7–1·9]), and self-harm (1·1% [0·6–1·5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27·1% (95% UI 21·2–33·3) of total alcohol-attributable female deaths and 18·9% (15·3–22·6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0·0–0·8) standard drinks per week.

Interpretation

Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption.

Funding

Bill & Melinda Gates Foundation.

Keywords 
alcohol use risk-relations
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