Alcohol misuse is strongly associated with long-term health problems, disability, death, accident, injury, social disruption, and violence. In the United States, more than 178,000 people (approximately 120,000 men and 58,000 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. 37 people in the United States are killed every day in crashes involving an alcohol-impaired driver—this is one death every 39 minutes.
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.
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.
- Excessive alcohol use is responsible for approximately 95,000 deaths annually in the United States.
- Excessive alcohol can increase a person's risk of liver disease, cancer, cardiovascular issues, neurologic damage, immune system disfunction, and other conditions.
- Excessive alcohol use can also lead to risk-taking behavior, including driving while impaired. The Centers for Disease Control and Prevention (CDC) reports that 37 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 4 “standard” drinks per day or 14 drinks per week
- Men over 65 years of age: Consuming more than 3 “standard” drinks per day or seven drinks per week
- Women (all): Consuming more than 3 “standard” drinks per day or 7 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 CDC, is 4 or more drinks for women and 5 or more drinks for men on one occasion.
- Heavy drinking is defined by the CDC as 8 or more drinks for women and 15 or more drinks for men in a week.
- Binge Drinking as identified by the Substance Abuse and Mental Health Services Administration (SAMHSA):
- Five or more alcoholic drinks for men and four or more alcoholic drinks for women 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
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
AAFP — American Academy of Family Physicians
Arkansas Department of Health
Arkansas Department of Human Services
Arkansas Office of Drug Abuse and Prevention
CDC – Centers for Disease Control and Prevention
NIH – National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Prevention Arkansas
SAMHSA — Substance Abuse and Mental Health Services Administration
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
Reviewed and revised April 2026
