Alcohol Misuse Screening: What You Need to Know

Alcohol abuse is a pattern of unhealthy drinking habits that do not meet the medical criteria for alcohol dependence. Screening and counseling can help identify, control and treat alcohol abuse. Medicare Part B covers an annual alcohol misuse evaluation, which can be conducted at primary care facilities to identify patients who use alcohol. Early intervention and follow-up can reduce alcohol consumption and improve health outcomes.

The Substance Abuse and Mental Health Services Administration (SAMHSA) has developed a screening, brief intervention and referral to treatment (SBIRT) program, which is an evidence-based practice used to identify, reduce and prevent problematic use, abuse and dependence on alcohol and illicit drugs. Alcohol screening tests are questionnaires designed to detect an alcohol use disorder (AUD). AUD is a pattern of excessive alcohol consumption that can cause serious problems at work, relationships and health. AUD can be mild, moderate, or severe; severe AUD is sometimes referred to as alcohol abuse or alcoholism.

Using appropriate screening tools will make it possible to better identify patients who abuse alcohol and increase opportunities for appropriate intervention, ultimately helping to reduce the burden of the many conditions associated with excessive alcohol consumption. Patients may be advised to drink less to reduce the risk of dangerous interactions between alcohol and certain medications, and they may also be warned that there is no safe level of alcohol consumption when using these medications. The service code for alcohol screening is G0442 and the code for brief counseling interventions is G0443. Using appropriate screening tools will allow providers to better identify patients with alcohol abuse behaviors so that they can carry out appropriate clinical interventions. A study found that the prevalence of non-dependent heavy drinking was 29.3%, while the prevalence of alcohol dependence was 3.5%.

This indicates that non-dependent heavy drinkers outnumber dependent drinkers by more than eight to one. Providers who reported using CAGE and asked patients about the amount of beverages per occasion and how often they drink could detect patients who abuse alcohol, even if they haven't used a screening tool preferred by the USPSTF. Excessive alcohol consumption is associated with car accidents, violence, and multiple illnesses, including fetal alcohol spectrum disorders. Alcohol screening and brief counseling can sometimes reduce alcohol consumption by 25% in people who drink too much, but only 1 in 6 people have ever talked to their doctor or other health professional about drinking alcohol.

If the patient tests positive for alcohol abuse, but not for alcohol dependence, consider a brief in-person counseling intervention (reimbursed by the new Medicare Code of Procedure G044). Predictive factors for using a preferred screening tool include the physician's specialty, knowledge of the USPSTF recommendation on alcohol consumption (SBI) and how to manage screening questions. In terms of clinical interventions, the National Institute on Alcohol Abuse and Alcoholism (NIAAA)'s brief screening and intervention guide (available online) is a quick two-question assessment tool that will give you a good idea of your patients' level of risk for alcohol-related problems. A meta-analysis of behavioral counseling interventions in primary care to reduce risky adult alcohol consumption identifies brief, multi-contact behavioral interventions (initial session of up to 15 minutes with follow-up) as the most successful in increasing the chances of stopping smoking and improving health outcomes. The Centers for Disease Control and Prevention (CDC) states that there is no known safe amount of alcohol during pregnancy or when trying to get pregnant.

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