Prevention of Substance Abuse: Alcohol

Substance abuse is a major public health problem in the United States, The lifetime prevalence of alcohol abuse if approximately 18% whereas the lifetime prevalence of alcohol dependence is near 13%. Rates appear to be higher in men, whites, and younger and unmarried individuals. Approximately two-thirds of high school seniors are regular users of alcohol. Alcohol dependence often coexists with other disorders as well as with mood, anxiety, and personality disorders. Underdiagnosis and treatment of alcohol abuse is substantial, both because of patient denail and lack of detection of clinical clues. Treatment rates for alcohol dependence have slightly declined over the last several years.Only a quarter of alcohol dependent patients have ever been treated.

  As with cigarette use, clinicians identification and counseling about alcoholism may improve the chances of recovery.About 10% of all adults seen in medical practices are problem drinkers. An estimated 15-30% of hospitalized patients have problems with alcohol abuse of dependence, but the connection between patients' presenting complaints and their alcohol abuse is often missed. The CAGE test is both sensitive and specific for chronic alcoholism.However it is less sensitive in detecting heavy or binge drinking in elderly patients and has been criticized  for being less applicable to minority groups or to women. Others recommend asking three questions: (1) How many days per week do you drink (frequency)? (2) On a day when you drink, how many drinks do you have in one day (quantity)? (3) On how many occasions in the last month did you drink more than five drinks (binge drinking)? The alcohol use Disorder Identification Test (AUDIT) consists of questions on the quantity and frequency of alcohol consumption, on alcohol dependence symptoms, and on alcohol-related problems. The AUDIT questionnaire is a cost-effective and efficient diagnostic tool for routine screening of alcohol use disorders in primary care settings. Choice of therapy remains controversial. However, use of screening procedures and brief intervention methods can produce a 10-30% reduction in long-term alcohol use and alcohol-related problems. However, brief advice and counseling without regular follow-up and reinforcement cannot sustain significant long-term reductions in unhealthy drinking behaviors.