Alcohol misuse is common in the U.S., where approximately 21 percent of adults report risky or hazardous drinking and nearly 4 percent are alcoholic. Now, the U.S. Preventive Services Task Force (USPSTF) recommends that primary care doctors screen adults aged 18 years or older for alcohol misuse and provide behavioral counseling interventions for identified alcohol abusers.

"Alcohol abuse" is drinking that leads an individual to recurrently fail in major home, work, or school responsibilities, use alcohol in physically hazardous situations, or have alcohol-related legal or social problems. Alcoholism, or alcohol dependence, includes physical cravings and withdrawal symptoms, frequent drinking in larger amounts than intended over longer periods, and a need for markedly increased amounts to achieve intoxication. Both definitions correspond with those found in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.

To arrive at its recommendation, the USPSTF conducted 23 randomized, controlled trials where the effects of behavioral counseling interventions were compared to usual adult care without intervention after a primary care physician had screened and detected alcohol misuse. The interventions were either brief or brief multi-contact behavioral counseling sessions provided directly by the physician for the most part.

The studies showed that the interventions reduced binge drinking, which is defined as drinking so much within about two hours that blood alcohol concentration levels reach 0.08 g/dL, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA). This usually occurs when men consume five or more drinks and women consume four or more drinks within two hours. Intervention also reduced the total number of drinks per week consumed by adults who are risky or hazardous drinkers.

At the 12 month follow-up mark, adults who received interventions had reduced their average weekly consumption of alcohol from a baseline of 23 drinks to approximately 19 drinks per week.

In younger, often college-aged adults, three trials provided evidence that intervention reduces the frequency of heavy drinking episodes by about one day per month (average baseline, six to seven heavy drinking days per month) at six months of follow-up. Among the younger adults, limited data showed that average consumption decreased from a baseline of about 15 drinks to 13 drinks per week at six months of follow-up.

The NIAAA recommends that healthy adult men aged 65 years or younger have no more than four drinks per day and no more than 14 drinks per week, and healthy adult women and all adults older than 65 years have no more than three drinks per day and no more than seven drinks per week. The NIAAA also recommends lower levels of consumption or abstinence for adults who receive medications that interact with alcohol, have a health condition exacerbated by alcohol, or are pregnant.

Alcohol misuse contributes to a wide range of health conditions, such as hypertension, gastritis, liver disease and cirrhosis, pancreatitis, certain types of cancer, cognitive impairment, anxiety, and depression. Along with its contribution to a wide range of health conditions, alcohol misuse has also been implicated in falls, drownings, fires, motor vehicle crashes, homicide, and suicide.

In its current guidelines, the USPSTF emphasizes that evidence on the effectiveness of interventions remains largely restricted to persons engaging in risky drinking and does not extend to the full spectrum of unhealthy drinking behaviors. The current statement updates its 2004 guidelines. Recommendations made by the USPSTF, an independent panel of medical experts, are independent of the U.S. government.