Alcohol screening is recommended for all adult patients. Screening is not aimed just at alcohol dependent individuals, but also at the far larger population of patients with alcohol misuse who can benefit from brief primary care counseling. About 20% of Veterans Administration (VA) primary care patients screen positive for alcohol misuse, which ranges from drinking above recommended limits without problems (risky drinking) to severe alcohol use disorders (alcohol dependence). For veterans using the VA healthcare system, alcohol misuse is associated with psychosocial, legal, or employment problems and personal suffering, as well as with adverse health outcomes. The VA requires screening for alcohol misuse (including risky and harmful drinking, alcohol abuse and alcohol dependence) first because alcohol misuse is associated with increased morbidity and mortality. Medical problems due to alcohol dependence include alcohol withdrawal syndrome, hepatitis, cirrhosis, pancreatitis, thiamine deficiency, neuropathy, and cardiomyopathy. Secondly, VA requires screening for alcohol misuse because the brief counseling triggered as a result of screening has been shown to decrease drinking and improve health outcomes. In 2006, the National Commission for Prevention Priorities sponsored by the Centers for Disease Control and the Agency for Healthcare Research and Quality identified brief alcohol counseling as one of the top ten national prevention priorities based on clinically preventable burden of disease and cost-effectiveness. Alcohol dependence represents only one end of the spectrum of alcohol misuse and many drinkers who are not alcohol dependent have medical or social problems attributable to alcohol. Further, other asymptomatic drinkers are at risk for future problems due to chronic, heavy alcohol use or episodic heavy drinking. Because patients who drink above recommended limits (without alcohol dependence) far outnumber patient with alcohol dependence, the non-dependent drinkers account for the majority of alcohol-related morbidity and mortality in the general population. There is a dose-response relationship between average daily alcohol consumption and elevations in blood pressure and risk of cirrhosis, hemorrhagic stroke, trauma and cancers of the oropharynx, larynx, esophagus, and liver.
Recommended Drinking Limits: Based on the accumulated epidemiological evidence, individuals who drink above the following levels are at increased risk for adverse consequences of drinking:
- 14 drinks/week typically for men, 7 drinks/week typically for women, or
- 4 drinks on an occasion for men, 3 drinks on an occasion for women.
