Panel Reminds RNs to Screen for Alcohol Misuse
SAUSALITO, CA (ASRN.ORG) -- Registered Nurses should screen their adult patients to determine whether they are misusing alcohol, and provide counseling when risky behavior is detected, a panel of medical experts reaffirmed recently.
About a third of Americans misuse alcohol, though far fewer are addicted, according to the panel, the United States Preventive Services Task Force. The misuse results in an estimated 85,000 deaths a year, making illness related to alcohol abuse the third-leading cause of preventable death in the United States, after smoking and obesity.
After reviewing recent research, the panel concluded that primary care RNs could help patients cut down on drinking by offering a brief counseling session or a series of sessions. RNs could determine whether counseling was needed by asking a simple set of questions about alcohol use during the patient’s primary care visit.
The National Institute on Alcohol Abuse and Alcoholism considers more than 14 drinks a week excessive for men and more than seven drinks a week excessive for women. It says daily consumption should not be more than four drinks for men and three for women.
The questions that RNs should ask, the task force said, include, “How often do you have a drink containing alcohol?” and “How often do you have five or more drinks on one occasion?”
The task force did not recommend the same screening and counseling for adolescents because, it said, it was less clear whether the benefits would outweigh the potential harm, like anxiety or the stigma of being singled out.
Susan Curry, a panel member, emphasized that the recommendation was preventive, designed to keep people who drank more alcohol than they should from becoming alcoholics. People who are already addicted need more extensive help, she said, like therapy in rehabilitation clinics.
“This says, ‘Let’s pay attention,’ ” said Dr. Curry, who is the dean of the College of Public Health at the University of Iowa. “ ‘You may want to take a look at how you are drinking. If it escalates, you’re at risk, but you can change that now.’ ”
The panel based its recommendations on a review of research that showed counseling helped reduce binge drinking. According to those studies, the number of adults with risky drinking behaviors who reported no heavy drinking within a year was 12 percent higher among those who received counseling than those who did not. The research also indicated that several sessions of counseling were more effective than only one.
It also found that counseling helped patients who drank more than the recommended limit reduce their weekly consumption. Patients who had received counseling consumed an average of 19 drinks a week, down from 23, the panel said, while those who received no counseling did not change their level.
The task force is a group of 16 experts, who are appointed by the government but independent, that makes recommendations about screening tests and other efforts to prevent disease. Its advice is based on medical evidence, not cost.
The strongest of the panel’s recommendations are now hard-wired into the country’s health care system through the Affordable Care Act, which requires health insurance companies to cover many of the services or treatments free of charge to the patient. The recommendation about alcohol screening falls into that category.
Alcohol misuse contributes to many illnesses, the panel said, including hypertension, liver disease and breast and esophageal cancers. The studies were not designed to measure the effect that counseling had on mortality rates, the panel said.
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