Alcohol misuse is strongly associated with long-term health problems, disability, death, accident, injury, social disruption, and violence. In the United States, more than 140,000 people (approximately 97,000 men and 43,000 women) die each year from excessive alcohol use, making it the fourth-leading preventable cause of death following tobacco, poor diet and physical inactivity, and illegal drugs. Every day 32 people are killed (1 every 45 minutes) from a motor vehicle accident involving an alcohol-impaired driver.
Primary care physicians are often the only medical professionals that an at-risk drinker will encounter, placing them in a prime position to help prevent premature morbidity and mortality from alcohol use. Incorporating annual screening for alcohol misuse into primary care practices will aid in detecting risky or hazardous alcohol use before the onset of abuse, dependency, physical and social injury.
AFMC developed the Arkansas Substance Abuse Resource Guide to help you identify resources available in your county.
Strategies for Success
Manage patients’ high-risk alcohol use and alcohol abuse disorder
- Keep accurate records to include history and physical examination.
- Screen for alcohol misuse annually (single question screening).
- Utilize formal screening tools such as Audit, Audit-C, CRAFFT and NIAAA to identify risky/hazardous drinking and alcohol use disorder (AUD).
- Provide brief intervention counseling to patients identified with high-risk alcohol use and AUD (15 to 30-minute counseling or 30-minute or more counseling).
- Direct and coordinate consults and referrals with other care providers and treatment centers as needed.
- Provide follow-up care.
- Commend and encourage patients who are successful in efforts to reduce or stop alcohol consumption.
- Continue to support patients who are not successful in efforts to reduce or stop alcohol consumption.
Know the facts about alcohol.
- The primary care physician may be the only physician that a high-risk drinker will encounter.
- Each year about 95,000 deaths are attributed to alcohol consumption.
- Excessive alcohol use can increase a person’s risk of stroke, liver cirrhosis, alcoholic hepatitis, cancer and other serious health conditions.
- Excessive alcohol use can also lead to risk-taking behavior, including driving while impaired. The Centers for Disease Control and Prevention reports that 32 people in the United States die in motor vehicle crashes that involve an alcohol-impaired driver daily.
- In many cases counseling for alcohol-related disorders can be accomplished in an outpatient clinical environment.
- Medications for select patients can be of help for the treatment of alcohol-related disorders.
- High-risk drinking is identified by:
- Men under 65 years of age: Consuming more than four “standard” drinks per day or 14 drinks per week
- Men over 65 years of age: Consuming more than three “standard” drinks per day or seven drinks per week
- Women (all): Consuming more than three “standard” drinks per day or seven drinks per week
- Binge Drinking as identified by the National Institute on Alcohol Abuse and Alcoholism (NIAAA):
- A pattern of drinking that raises the blood alcohol concentration (BAC) to 0.08 g/dl which usually occurs when women consume four drinks and men consume five drinks within a 2-hour period
- Binge Drinking as identified by the Substance Abuse and Mental Health Services Administration (SAMHSA):
- Five or more alcoholic drinks for males and four or more alcoholic drinks for females on the same occasion (i.e., at the same time or within a couple of hours of each other) on at least one day in the past month
- Heavy Alcohol Use as identified by SAMHSA:
- Binge drinking on five or more days in the past month
Improve office systems.
- Using an electronic medical record (EMR) when screening for high-risk alcohol will assist in the identification and management of patients with AUD.
- Patients with high-risk alcohol use and AUD benefit from a medical home in which the primary care provider directs care and coordinates consults with other care providers as needed.
- Provide staff education – defining high-risk alcohol use and AUD.
- Provide staff education – parameters for men and women to identify high-risk drinking.
- Educate non-physician staff on screening as part of an office visit intake.
- Utilize facility locator for treatment centers and community outreach.
Educate patient and family about levels of alcohol use and AUD.
- Keep accurate records to include history and physical examination.
- What counts as a drink?
- How many drinks are in common containers?
- What’s your drinking pattern?
- Times to avoid alcohol: planning to drive a vehicle or operate machinery, taking medications that interact with alcohol, managing a medical condition that may worsen with alcohol consumption, pregnant or trying to become pregnant.
- Can you “hold your liquor?” Answering yes may put you at greater risk.
- What’s “heavy” or “at-risk” drinking?
- What’s the harm?
- Injuries associated with drinking
- Health problems
- Birth defects
- Alcohol use disorders
- Assist patients with a written plan for change.
- Assist patients with a plan for change by utilizing technology.
- Complete a change plan on the Rethinking Drinking website; email it to a personal account for weekly reviews
- Store goals and strategies in mobile device
- Set up automated reminders
- Create motivating passwords
- Involve patients with strategies for decreasing alcohol consumption.
- Keep track – utilize drinking tracker
- Count and measure
- Set goals
- Pace and space
- Include food
- Find alternatives
- Avoid triggers
- Plan to handle urges
- Plan to say, “No thanks”
Web Resources
Provider Resources
- S. J. Curry et al., “Screening and Behavioral Counseling Interventions to Reduce Unhealthy Alcohol Use in Adolescents and Adults: US Preventive Services Task Force Recommendation Statement,” JAMA - J. Am. Med. Assoc., vol. 320, no. 18, pp. 1899–1909, 2018.
- Substance Abuse and Mental Health Services Administration (SAMHSA). 2019 National Survey on Drug Use and Health (NSDUH). Table 2.1B—Tobacco Product and Alcohol Use in Lifetime, Past Year, and Past Month among Persons Aged 12 or Older, by Age Group: Percentages, 2018 and 2019. Available at: www.samhsa.gov Accessed 03/15/2023.
- SAMHSA. 2019 National Survey on Drug Use and Health (NSDUH). Table 5.4A—Alcohol Use Disorder in Past Year among Persons Aged 12 or Older, by Age Group and Demographic Characteristics: Numbers in Thousands, 2018 and 2019. Available at: www.samhsa.gov. Accessed 03/15/2023.
AAFP
Agency for Healthcare Research and Quality
Arkansas Office of Drug Abuse and Prevention
- PreventionworksAR.org
- Tools
CDC – Centers for Disease Control and Prevention
- Alcohol use and health
- Deaths from Excessive Alcohol Use in the United States
- Motor Vehicle Safety – Impaired Driving
NCQA – National Committee for Quality Assurance
NIH – National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Other resources
Patient Resources
- Arkansas Alcoholics Anonymous (AA)
Hotline: (501) 664-7303 - Arkansas Regional Service Committee of Narcotics Anonymous
Toll Free: (888) 501-1607 - Arkansas Area Al-Anon / Alateen
- Celebrate Recovery Groups (Faith-based)
Reviewed and revised March 2023