Journal of General Internal Medicine

, Volume 27, Issue 2, pp 179–184 | Cite as

Young Adults at Risk for Excess Alcohol Consumption Are Often Not Asked or Counseled About Drinking Alcohol

  • Ralph W. Hingson
  • Timothy Heeren
  • Erika M. Edwards
  • Richard Saitz
Original Research

Abstract

Background

Excessive alcohol consumption is most widespread among young adults. Practice guidelines recommend screening and physician advice, which could help address this common cause of injury and premature death.

Objective

To assess the proportion of persons ages 18–39 who, in the past year, saw a physician and were asked about their drinking and advised what drinking levels pose health risk, and whether this differed by age or whether respondents exceeded low-risk drinking guidelines [daily (>4 drinks for men/>3 for women) or weekly (>14 for men/>7 for women)].

Design

Survey of young adults selected from a national internet panel established using random digit dial telephone techniques.

Participants

Adults age 18–39 who ever drank alcohol, n = 3,409 from the internet panel and n = 612 non-panel telephone respondents.

Main Measures

Respondents were asked whether they saw a doctor in the past year; those who did see a doctor were asked whether a doctor asked about their drinking, advised about safe drinking levels, or counseled to reduce drinking.

Key Results

Of respondents, 67% saw a physician in the past year, but only 14% of those exceeding guidelines were asked and advised about risky drinking patterns. Persons 18–25 were the most likely to exceed guidelines (68% vs. 56%, p < 0.001) but were least often asked about drinking (34% vs. 54%, p < 0.001).

Conclusions

Despite practice guidelines, few young adults are asked and advised by physicians about excessive alcohol consumption. Physicians should routinely ask all adults about their drinking and offer advice about levels that pose health risk, particularly to young adults.

KEY WORDS

alcoholism and addictive behavior communication patient education prevention 

Notes

Acknowledgements

This article is dedicated to Helen Marie Witty, who at age 16 was fatally injured by a young alcohol-impaired driver. Dr. Ralph Hingson had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. This study was supported in part by the National Institute on Alcohol Abuse and Alcoholism Center Grant P60AA13759.

Conflict of Interest

Drs. Ralph Hingson, Tim Heeren, and Erika Edwards have no conflicts of interest to report. Dr. Richard Saitz reports having been a consultant for online alcohol-related screening and brief intervention education projects supported by National Institutes of Health (NIH) grants to Medical Directions and Inflexxion and for NIH grants to the RAND corporation, Kaiser Permanente, the University of Massachusetts, and Brandeis University. Dr. Saitz also has been compensated by Beth Israel Deaconess Hospital and the National Institute on Alcohol Abuse and Alcoholism for serving on data and safety monitoring boards. He is compensated for educational work by the Massachusetts Medical Society, the British Medical Journal Group, and the American Society of Addiction Medicine. He has developed educational materials for Fusion medical education and consulted for Saatchi and Saatchi Healthcare on alcohol dependence treatment. He has or anticipates being compensated as a speaker on alcohol and drug topics by multiple government agencies, academic institutions, and professional societies. He has also provided expert opinion on legal cases involving identification and management of alcohol and drug related problems.

References

  1. 1.
    Saitz R. Clinical practice: unhealthy alcohol use. N Engl J Med. 2005;352(6):596–607.PubMedCrossRefGoogle Scholar
  2. 2.
    Institute of Medicine. Broadening the Base of Treatment for Alcohol Problems: Report of a Study by a Committee of the Institute of Medicine. Washington: National Academy Press; 1990.Google Scholar
  3. 3.
    National Institute on Alcohol Abuse and Alcoholism. Helping Patients Who Drink Too Much: A Clinician’s Guide. updated 2005th ed. Bethesda: U.S. Department of Health and Human Services; 2007. NIH Pub. No. 07–3769.Google Scholar
  4. 4.
    Scientific Affairs Council on, American Medical Association. AMA Guidelines for Physician Involvement in the Care of Substance Abusing Patients. Chicago: American Medical Association; 1979.Google Scholar
  5. 5.
    American Society of Addiction Medicine. Public policy statement on screening for addiction in primary care settings. ASAM News. 1997;17:17–18.Google Scholar
  6. 6.
    U.S. Preventive Services Task Force. Guide to Clinical Preventive Services. 2nd ed. Alexandria: International Medical Publishing; 1998.Google Scholar
  7. 7.
    American Academy of Pediatrics. Policy statement—alcohol use by youth and adolescents: a pediatric concern. Pediatrics. 2010;125(5):1078–1087.CrossRefGoogle Scholar
  8. 8.
    Solberg LI, Maciosek MV, Edwards NM. Primary care intervention to reduce alcohol misuse- ranking its health impact and cost effectiveness. Am J Prev Med. 2008;34(2):143–152.PubMedCrossRefGoogle Scholar
  9. 9.
    Kaner EF, Dickinson HO, Beyer FR, et al. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev. 2007;Issue 2. Art No.: CD004148.Google Scholar
  10. 10.
    Larimer ME, Cronce JM. Identification, prevention, and treatment revisited: individual-focused college drinking prevention strategies 1999–2006. Addict Behav. 2007;32:2439–2468.PubMedCrossRefGoogle Scholar
  11. 11.
    Carey KB, Scott-Sheldon LA, Carey MP, DeMartini KS. Individual-level interventions to reduce college student drinking: a meta-analytic review. Addict Behav. 2007;32:2469–2494.PubMedCrossRefGoogle Scholar
  12. 12.
    Schaus J, Sole M, McCoy T, et al. Screening for high-risk drinking in a college student health center: characterizing students based on quantity, frequency, and harms. J Stud Alcohol Drugs. 2009;12(Supplement):34–44.Google Scholar
  13. 13.
    Fleming MF, Balousek SL, Grossberg PM, et al. Brief physician advice for heavy drinking college students: a randomized controlled trial in college health clinics. J Stud Alcohol.Google Scholar
  14. 14.
    Babor TF, Caetano R, Casswell S, Edwards G, Giesbrecht N, Graham K, Grube JW, Hill L, Holder H, Homel R, Livingston M, Österberg E, Rehm J, Room R, Rossow I. Alcohol: No Ordinary Commodity: Research and Public Policy. 2nd ed. New York: Oxford University Press; 2010.CrossRefGoogle Scholar
  15. 15.
    Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004;291(10):1238–45.PubMedCrossRefGoogle Scholar
  16. 16.
    Midanik L, Chaloupka F, Saitz R, Toomey TL, Fellows JL, Dufour M, Landen M, Brounstein PJ, Stahre MA, Brewer RD, Naimi TS, Miller JW. Alcohol-attributable deaths and years of potential life lost—United States, 2001. MMWR Morb Mortal Wkly Rep. 2004;53(37):866–870. reprinted in JAMA, Dec. 15, 2004;292:2831–32.Google Scholar
  17. 17.
    McKenna MT, Michaud CM, Murray CJ, Marks JS. Assessing the burden of disease in the United States using disability-adjusted life years. Am J Prev Med. 2005;28(5):415–23.PubMedCrossRefGoogle Scholar
  18. 18.
    National Institute on Alcohol Abuse and Alcoholism. Alcohol development and youth: A multi-disciplinary overview. Alcohol Res Health. 2004/2005;28(3):175.Google Scholar
  19. 19.
    Courtney KE, Polich J. Binge drinking in young adults: data, definitions, and determinants. Psychol Bull. 2009;135(1):142–156.PubMedCrossRefGoogle Scholar
  20. 20.
    Roerecke M, Rehm J. Irregular heavy drinking occasions and risk of ischemic heart disease: a systematic review and meta-analysis. Am J Epidemiol. 2010;171(6):633–44.PubMedCrossRefGoogle Scholar
  21. 21.
    World Health Organization. Strategies to Reduce Harmful Use of Alcohol: Draft Global Strategy. Sixty-Third World Health Assembly, Provisional Agenda Item 11.10, March 2010.Google Scholar
  22. 22.
    Rehm J, Mathers C, Popova S, Thavorncharoensap M, Teerawattananon Y, Patra J. Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. Lancet. 2009;73:2223–33.CrossRefGoogle Scholar
  23. 23.
    Office of the U.S. Surgeon General. The Surgeon General's Call to Action to Prevent and Reduce Underage Drinking. Rockville: U.S. Department of Health and Human Services; 2007.Google Scholar
  24. 24.
    Hingson RW, Heeren T, Winter MR. Age at drinking onset and alcohol dependence - age at onset, duration, and severity. Arch Pediatr Adolesc Med. 2006;160(7):739–746.PubMedCrossRefGoogle Scholar
  25. 25.
    Grant BF, Dawson D, Stinson F, Chou S, Dufour M, Pickering R. The 12-month prevalence and trends in DSM-IV alcohol abuse and dependence: United States, 1991–1992 and 2001–2002. Drug Alcohol Depend. 2004;74:223–234.PubMedCrossRefGoogle Scholar
  26. 26.
    Friedmann PD, McCullough D, Chin MH, Saitz R. Screening and intervention for alcohol problems: a national survey of primary care physicians and psychiatrists. J Gen Intern Med. 2000;15(2):84–91.PubMedCrossRefGoogle Scholar
  27. 27.
    D’Amico EJ, Paddock SM, Burnam A, Kung FY. Identification of and guidance for problem drinking by general medical providers: results from a national survey. Med Care. 2005;43(3):229–236.PubMedCrossRefGoogle Scholar
  28. 28.
    National Institute on Alcohol Abuse and Alcoholism. Rethinking Drinking: Alcohol and Your Health. Bethesda: U.S. Department of Health and Human Services; 2009. NIH Pub. No. 09–3770.Google Scholar
  29. 29.
    Shah BU, Barnwell BG, Breller GS. SUDAAN User’s Manual Release 7. Research Triangle Park: Research Triangle Institute; 1996.Google Scholar
  30. 30.
    Heeren T, Edwards EM, Dennis JM, Rodkin JM, Hingson R, Rosenbloom DL. A comparison of results from an alcohol survey of a pre-recruited internet panel and the National Epidemiological Survey on Alcohol and Related Conditions. Alcohol Clin Exp Res. 2008;32(2):222–229.PubMedCrossRefGoogle Scholar
  31. 31.
    Smith PC, Schmidt SM, Allensworth-Davies D, Saitz R. Primary care validation of a single-question alcohol screening test. J Gen Intern Med. 2009;24(7):783–88.PubMedCrossRefGoogle Scholar
  32. 32.
    Taj N, Devera-Sales A, Vinson DC. Screening for problem drinking: does a single question work? J Fam Pract. 1998;46:328–335.PubMedGoogle Scholar
  33. 33.
    National Institute on Alcohol Abuse and Alcoholism. Alcohol Policy Information System. Available at http://www.alcoholpolicy.niaaa.nih.gov/. Accessed August 5, 2011.
  34. 34.
    Frank E, Elon L, Naimi T, Brewer R. Alcohol consumption and alcohol counseling behavior among US medical students: Cohort study. BMJ. 2008;337:1–10.CrossRefGoogle Scholar
  35. 35.
    Bradley KA, Williams EC, Achtmeyer CE, Volpp B, Collins BJ, Kivlahan DR. Implementation of evidence-based alcohol screening in the Veterans Health Administration. Am J Manag Care. 2006;12(10):597–606.PubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine (outside the USA) 2011

Authors and Affiliations

  • Ralph W. Hingson
    • 1
  • Timothy Heeren
    • 2
  • Erika M. Edwards
    • 2
  • Richard Saitz
    • 2
    • 3
  1. 1.Division of Epidemiology and Prevention ResearchNational Institute on Alcohol Abuse and AlcoholismBethesdaUSA
  2. 2.Boston University School of Public HealthBostonUSA
  3. 3.Clinical Addiction Research and Education (CARE) Unit, Section of General Internal MedicineBoston Medical CenterBostonUSA

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