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Cited by 249Substance Abuse Treatment and OutcomesAlcohol Consumption and Health EffectsSmoking Behavior and Cessation

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Screening and Behavioral Counseling Interventions to Reduce Unhealthy Alcohol Use in Adolescents and Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

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O’Connor, Elizabeth A., Perdue, Leslie A., Senger, Caitlyn A., Rushkin, Megan, Patnode, Carrie D., Bean, Sarah I., Jonas, Daniel E.·2018·JAMA
DOI 10.1001/jama.2018.12086PMC PMC13585200
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Abstract

Importance: Unhealthy alcohol use is common, increasing, and a leading cause of premature mortality. Objective: To review literature on the effectiveness and harms of screening and counseling for unhealthy alcohol use to inform the US Preventive Services Task Force. Data Sources: MEDLINE, PubMed, PsycINFO, and the Cochrane Central Register of Controlled Trials through October 12, 2017; literature surveillance through August 1, 2018. Study Selection: Test accuracy studies and randomized clinical trials of screening and counseling to reduce unhealthy alcohol use. Data Extraction and Synthesis: Independent critical appraisal and data abstraction by 2 reviewers. Counseling trials were pooled using random-effects meta-analyses. Main Outcomes and Measures: Sensitivity, specificity, drinks per week, exceeding recommended limits, heavy use episodes, abstinence (for pregnant women), and other health, family, social, and legal outcomes. Results: One hundred thirteen studies (N = 314 466) were included. No studies examined benefits or harms of screening programs to reduce unhealthy alcohol use. For adolescents (10 studies [n = 171 363]), 1 study (n = 225) reported a sensitivity of 0.73 (95% CI, 0.60 to 0.83) and specificity of 0.81 (95% CI, 0.74 to 0.86) using the AUDIT-C (Alcohol Use Disorders Identification Test-Consumption) to detect the full spectrum of unhealthy alcohol use. For adults (35 studies [n = 114 182]), brief screening instruments commonly reported sensitivity and specificity between 0.70 and 0.85. Two trials of the effects of interventions to reduce unhealthy alcohol use in adolescents (n = 588) found mixed results: one reported a benefit in high-risk but not moderate-risk drinkers, and the other reported a statistically significant reduction in drinking frequency for boys but not girls; neither reported health or related outcomes. Across all populations (68 studies [n = 36 528]), counseling interventions were associated with a decrease in drinks per week (weighted mean difference, -1.6 [95% CI, -2.2 to -1.0]; 32 studies [37 effects; n = 15 974]), the proportion exceeding recommended drinking limits (odds ratio [OR], 0.60 [95% CI, 0.53 to 0.67]; 15 studies [16 effects; n = 9760]), and the proportion reporting a heavy use episode (OR, 0.67 [95% CI, 0.58 to 0.77]; 12 studies [14 effects; n = 8108]), and an increase in the proportion of pregnant women reporting abstinence (OR, 2.26 [95% CI, 1.43 to 3.56]; 5 studies [n = 796]) after 6 to 12 months. Health outcomes were sparsely reported and generally did not demonstrate group differences in effect. There was no evidence that these interventions could be harmful. Conclusions and Relevance: Among adults, screening instruments feasible for use in primary care are available that can effectively identify people with unhealthy alcohol use, and counseling interventions in those who screen positive are associated with reductions in unhealthy alcohol use. There was no evidence that these interventions have unintended harmful effects.

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  1. Northrup, 2010, Effective measurement of problematic drinking for college students: reducing differential item functioning across gender and race., Diss Abstr Int B Sci Eng, 70, 4492
  2. U.S. Preventive Services Task Force, 2015, U.S. Preventive Services Task Force Procedure Manual

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Metadata

Authors
O’Connor, E. A., Perdue, L. A., Senger, C. A., Rushkin, M., Patnode, C. D., Bean, S. I., & Jonas, D. E.
Affiliations
  • Kaiser Permanente (US)
  • University of North Carolina at Chapel Hill (US)
Corresponding author
O’Connor, Elizabeth A.
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2018-11-13
Volume
320
Issue
18
Pages
1910
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2018.12086
PMC
PMC13585200
OpenAlex
W2901360762
Cited by
249
References
201
Citations by year
2026: 29 · 2025: 27 · 2024: 30 · 2023: 40 · 2022: 32 · 2021: 34 · 2020: 40 · 2019: 11 · 2018: 6
FWCI
3.25
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion)
Topics
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Smoking Behavior and Cessation
Keywords
unhealthy alcohol use, alcohol screening, behavioral counseling, adolescents, adults, AUDIT-C, screening sensitivity and specificity, brief intervention, abstinence, pregnant women, alcohol-related harm, USPSTF recommendations, sex differences in drinking, high-risk drinkers, alcohol-related violence
MeSH terms
Health Risk Behaviors, Adolescent, Adult, Alcohol Drinking, Behavior Therapy, Counseling, Female, Humans, Male, Mass Screening, Patient Education as Topic, Alcohol-Related Disorders

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