CDC Finds Most Problem Drinkers Aren't Asked the Right Questions by Doctors

US health officials recommended more than a decade ago that doctors screen adults to spot those with a drinking problem. But while doctors may ask general questions about alcohol use, binge drinkers report they aren’t being pinned down on how much they consume.

That’s what CDC reported Thursday in a survey of 17 states and the District of Columbia. The findings, gleaned from responses reported in 2014 the Behavioral Risk Factor Surveillance System, found that while 77% of respondents said they’d been ask by a doctor or on a form about alcohol, only 32.9% said they’d been asked about binge-level consumption—defined as 5 drinks for men and 4 drinks for women at 1 sitting.

Among those who are binge drinkers, only 37.2% said they were asked about alcohol use, and warned about the dangers of drinking too much. Of this group, only 18.1% said they’d been advised to drink less or quit.

“While most adults reported being asked about alcohol use during a checkup, only 1 in 3 reported being asked about binge-level consumption, even though screening for binge-level consumption is recommended” the CDC report states. “Without proper screening and assessment, health professionals will not know which patients could benefit from a brief intervention, treatment (which might include pharmacotherapy), or a referral to treatment for alcohol dependence.”

According to the CDC report, the research involved a specific 5-part questionnaire—called the Alcohol Survey and Behavioral Intervention—which was designed to pinpoint heavy drinkers following a 2004 recommendation from the US Preventive Services Task Force. That recommendation called for all adults 18 and older to be screened for alcohol abuse.

This intervention calls for doctors to specifically counsel those who report high levels of alcohol use, and evidence shows that when the conversations occur, they can be effective. But based on the CDC results, it appears patients might report alcohol use on a form but never be asked about it. The latest results show things haven’t improved since a similar survey based on 2011 data, even though the costs associated with alcohol abuse are rising.

While this report cited 2010 data that pegged the cost of alcohol abuse at $249 billion a year, resulting in at least 88,000 deaths from 2006 to 2010, other evidence suggests that risky alcohol use is a problem occurring alongside the nation’s opioid epidemic. In a recent follow-up to their groundbreaking 2015 study on the “deaths of despair,” which include deaths from alcohol, drugs, and suicide, Princeton economists Anne Case, PhD, and Angus Deaton, PhD, found rising rates of drug, alcohol, and suicide mortality among whites with a high school education or less.

In addition, the economists found that this pattern stood out in the United States and was not seen in wealthier European countries, where access to healthcare is more certain.

The CDC report says about 3.5% of US adults have been dependent on alcohol in the past year; 10.2% of those who drink in excess are considered dependent on alcohol. A 2015 study from the National Institutes of Health found that while men still drink more than women, that gap is narrowing with more women consuming alcohol.

The CDC report did find that binge drinkers were more likely to be advised to cut back drinking if they were male (22.6%) than female (11.4%), if they were Native American or Alaskan Native (33%), and if they had less than a high school education (31.3%).

Reference

McKnight-Eily LR, Okoro CA, Mejia R, et al. Screening for alcohol use and brief counseling of adults—17 states and the District of Columbia, 2014. MMWR Morb Mortal Wkly Rep. 2017;66:313-319. doi: http://dx.doi.org/10.15585/mmwr.mm6612a1.