Hazardous and Harmful Alcohol Consumption in Primary Care

Abstract

Increasing emphasis has been placed on the detection and treatment of hazardous and harmful drinking disorders, particularly among patients who are seen in primary care settings. In this review, we summarize the epidemiology and health-related effects of hazardous and harmful drinking and discuss current methods for their detection and treatment. Hazardous drinking is defined as a quantity or pattern of alcohol consumption that places patients at risk for adverse health events, while harmful drinking is defined as alcohol consumption that results in adverse events (e.g., physical or psychological harm). Prevalence estimates range from 4% to 29% for hazardous drinking and from less than 1% to 10% for harmful drinking. Data from several recent large prospective studies suggest that alcohol consumption in quantities consistent with hazardous or harmful drinking may increase risk for adverse health events, such as hemorrhagic stroke and breast cancer. Existing screening instruments, such as the Michigan Alcoholism Screening Test (MAST) or the CAGE questionnaire, while excellent for detecting alcohol abuse or dependence, should not be used alone to screen for hazardous and harmful drinking. The Alcohol Use Disorders Identification Test (AUDIT) is currently the only instrument specifically designed to identify hazardous and harmful drinking. Treatment of these disorders in the form of brief interventions can be successfully accomplished in primary care settings, as demonstrated by a number of well-conducted randomized trials. Given its proven efficacy in the primary care setting, we recommend routine application of this treatment approach.

The Systematic Development and Pilot Randomized Evaluation of Counselling for Alcohol Problems, a Lay Counselor‐Delivered Psychological Treatment for Harmful Drinking in Primary Care in India: The PREMIUM Study

“…AUD range from hazardous drinking, to harmful drinking and ultimately to alcohol dependence (Reid et al., 1999). The World Health Organization (WHO)'s (mhGAP‐Mental Health Gap Action Programme) guidelines advocate the use of brief advice for hazardous drinking and motivational interviewing (MI)‐based brief psychological treatments (PTs) for harmful drinking (World Health Organization, 2010).…”

The CAGE Questionnaire for Alcohol Misuse: A Review of Reliability and Validity Studies

“…For example, there may be adverse drug-alcohol interactions when alcohol reaches a certain level 6 . Detection of alcohol misuse can also make available information that can be important in clinical research studies, particularly in analysis of effect of behavior and in studies of geneenvironment interactions 7 .…”

“…In an early stage of alcohol misuse, a simple intervention, such as a brief counseling session delivered by a primary care physician, has proven to be an effective treatment 5,6 . A number of screening instruments have been used to detect alcohol misuse [8][9][10] .…”

“…A number of screening instruments have been used to detect alcohol misuse [8][9][10] . The CAGE questionnaire is a brief and popular screening instrument used in clinical practice 6 . Other common instruments include the Alcohol Use Disorders Identification Test (AUDIT), and Michigan Alco-hol Screening Test (MAST) 6 .…”

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