How Screening for Misuse of the Deadliest Drug - Alcohol - Saves Lives

It may surprise some people, but by statistics, alcohol is by far the deadliest drug. Alcohol is responsible for 88,000 preventable deaths annually in the United States.1 Many of these are related to chronic diseases caused by alcohol use, such as liver disease and heart disease. Additionally, close to 30% of all fatal motor vehicle accidents (more than 10,000 per year) occur as a result of alcohol-impaired drivers.2 That means that one person dies from an alcohol-impaired driving incident every 50 minutes.  It should also be noted that 48% of all perpetrators of homicide drank alcohol directly before the murder,3 and 40% of all victims of homicide were under the influence of alcohol.4  Alcohol use is similarly correlated with other violent crimes including robbery, intimate partner violence, and sexual assault. It can become a crippling addiction, responsible for the destruction of many relationships, careers, and families. 

Given its devastating impact on both physical and mental health, alcohol use disorder (AUD) is a very important clinical consideration for medical providers. Disordered use of alcohol is very common, but is under-diagnosed and under-treated.5  The United States Preventive Services Task Force (USPSTF) has recommended screening all adults over the age of 18, including pregnant women, for alcohol use disorder.6 This is conducted by use of screening questionnaires.

The USPSTF recommends initial screening by either 1-item or 3-item screening instruments. These questionnaires ask people to quantify their alcohol use both by frequency and by number of drinks consumed. For the purposes of the screening questions, the amount of alcohol equal to “one drink“ is different depending on the type of alcohol consumed. “One drink“is equivalent to 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of hard liquor (80 proof).

The 1-item screening is called the “Single Alcohol Screening Question” (SASQ).  That question is “how many times in the past year have you had X or more drinks in a day?“ (For women, X = 4 drinks, while for men, X = 5 drinks).  If the answer to this question is anything above zero (one or more incidents), this counts as a positive test. The 3-item questionnaire most commonly used is called the AUDIT-C (link provided). 

If either of these initial screening questionnaires is positive, it is then recommended that more detailed surveys are conducted. A very commonly-used, detailed survey is the AUDIT (link provided).  This provides a more in-depth assessment as to the extent and categorization of unhealthy alcohol use. The HHS department defines “binge drinking” as five or more drinks for men and four or more for women within about 2 hours, and “heavy drinking” as more than 14 drinks a week for men and more than 7 drinks a week for women.7 These are risky patterns of alcohol use, and can lead to more serious conditions such as physical and psychological alcohol dependence. 

The goal of screening is to identify unhealthy alcohol use as early as possible. Once identified, it is then necessary to provide brief behavioral counseling interventions for those who engage in risky or problematic drinking. The interventions have proven effective at reduction of unhealthy alcohol use. Behavioral therapy can be an effective countermeasure against unhealthy alcohol use, as can establishment of support systems.6 There are also pharmacologic treatments available to assist with alcohol cravings and binging tendencies. In the event of more serious alcohol-related problems such as dependence, mitigating measures against withdrawal symptoms may be indicated.  All of the above treatment interventions should only be undertaken under the supervision of a physician.

As with so many issues, the first step towards improvement is recognition that there is a problem. That’s why screening it’s so important. For those who struggle with alcohol, sometimes it’s difficult and intimidating to take the first step... but if you recognize a problem with your own alcohol use, please do yourself a favor and take that first step towards getting help. If you are worried about a loved one who suffers from unsafe alcohol use, don’t hesitate; speak up! Encourage them to get the help they need now, because alcohol use has a tendency to become a downward spiral. It can cause untold amounts of suffering and despair. Everyone needs help from time to time, and there is help out there! Take action today.

 

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