O’Connor EA, et al. - Researchers reviewed literature on the efficacy and harms of screening and counseling for unhealthy alcohol use to inform the US Preventive Services Task Force (USPSTF). Findings suggested the availability of screening instruments feasible for use in primary care among adults that can effectively identify people with unhealthy alcohol use. The counseling interventions in those who screen positive were correlated to reductions in unhealthy alcohol use. They did not note any unintended harmful effects of these interventions.

Methods

• Data sources included MEDLINE, PubMed, PsycINFO, and the Cochrane Central Register of Controlled Trials (through October 12, 2017); literature surveillance was conducted through August 1, 2018.
• Study selection included the test accuracy studies and randomized clinical trials of screening and counseling to reduce unhealthy alcohol use.
• Data extraction and synthesis included the independent critical appraisal and data abstraction by two reviewers.
• Using random-effects meta-analyses, the investigators pooled the counseling trials.
• Sensitivity, specificity, drinks per week, exceeding recommended limits, heavy use episodes, abstinence (for pregnant women), and other health, family, social, and legal outcomes comprised the main outcomes and measures.

Results

• A total of 113 studies (N=314,466) were included.
• No studies assessed the benefits and potential adverse effects of screening interventions for unhealthy alcohol use reduction.
• They found that, for adolescents (10 studies; n=171,363), 1 study (n=225) reported a sensitivity of 0.73 and specificity of 0.81 using the AUDIT-C to detect the full spectrum of unhealthy alcohol use.
• For adults (35 studies; n=114,182), sensitivity and specificity between 0.70 and 0.85 were commonly reported by brief screening instruments.
• Two studies of the effects of interventions to reduce unhealthy alcohol use in adolescents (n=588) indicated mixed results: one reported a benefit in high-risk but not moderate-risk drinkers, and the other reported a statistically significant reduction in drinking frequency for boys but not girls. Neither reported health or related outcomes.
• Across all populations (68 studies; n=36,528), they noted the association of counseling interventions with a decrease in drinks per week, the proportion exceeding recommended drinking limits; 15 studies, and the proportion reporting a heavy use episode; 12 studies, and an increase in the proportion of pregnant women reporting abstinence after 6 to 12 months.
• They sparsely reported the health outcomes and generally did not demonstrate group differences in effect.
• There was no evidence to suggest that these interventions could be harmful.