Should primary care clinicians screen adolescents and adults, including pregnant women, for unhealthy alcohol use?

In this updated 2018 review, the US Preventive Services Task Force (USPSTF) concludes there is sufficient evidence to recommend screening for unhealthy alcohol use in adults, including pregnant women, 18 years or older (B recommendation). The USPSTF concludes that there is insufficient evidence to recommend screening for alcohol use in adolescents aged 12 to 17 years (I statement). These recommendations are essentially unchanged from the 2013 USPSTF recommendations. (LOE = 2c)

US Preventive Services Task Force. Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults. US Preventive Services Task Force recommendation statement. JAMA 2018;320(18):1899-1909.  [PMID:30422199]

Practice guideline

Government

Population-based

In this 2018 update, the task force found no studies that directly examined the benefits or harms of screening programs to reduce unhealthy alcohol use in adolescents and adults, including pregnant women. The task force did, however, find adequate evidence that brief behavioral counseling in adults who screen positive for unhealthy alcohol use reduces alcohol use. No evidence supports screening or brief behavioral counseling in adolescents for reducing alcohol use. The task force also concludes that there is small to no risk of harm from screening and brief behavioral counseling interventions in adults and pregnant women. There is no evidence to suggest that patients of different race/ethnicity, sex, or socioeconomic status are more or less likely to benefit from interventions. The US Surgeon General and Centers for Disease Control and Prevention recommend routine screening for unhealthy alcohol use in adults. The American Academy of Pediatrics recommends screening for alcohol use in all adolescents. The American College of Obstetricians and Gynecologists and the World Health Organization recommend screening all women for unhealthy alcohol use before pregnancy and in their first trimester, and offering brief counseling to all pregnant women who do use alcohol.