Hazardous drinking and alcohol-related disorders are a widespread public health problem in the United States. In , the number of alcoholic liver disease-related deaths was 14, and the number of alcohol-induced deaths, excluding accidents and homicides, was 23, Risky or harmful drinking that goes unrecognized can further complicate the assessment and treatment of other medical and psychiatric conditions. Currently, an estimated 50 percent of adults 18 years of age and older are regular drinkers. An estimated 6 percent of older adults are considered to be heavy users of alcohol. It is generally accepted that less severe alcohol problems e.
Consequently, primary care physicians may sometimes provide the only care that people with alcohol abuse or dependence receive. Given that alcohol-related problems can cause significant morbidity and mortality, early identification and secondary prevention of alcohol problems by using screening and brief interventions in primary care have been increasingly advocated.
Evidence exists for the effectiveness of screening for early identification of alcohol-related disorders and interventions for alcohol problems in medical settings. These programs may not be appropriate for problem drinkers who have risky or harmful alcohol use but do not meet the DSM-IV-TR criteria for abuse or dependence. Even if patients accept a referral and complete a rehabilitation program, about one-third will not respond to treatment. The American Society of Addiction Medicine recommends that the services of primary care physicians and other primary health care providers include, at a minimum, the provision of these four elements of care 32 :.
Commonly used screening tools to identify alcohol misuse include but are not limited to the following:. Behavioral interventions and patient education are often used for patients who have less severe alcohol use i. There is ongoing debate about what exactly constitutes a brief intervention. In , the U. The original systematic review conducted by the Oregon Evidence-based Practice Center covered the literature through February and addressed nonpregnant adults, pregnant women, and adolescents in primary care settings.
The results of this systematic review, which were published in , were used as the basis for the USPSTF recommendations discussed above. Lastly, guidelines approach the subject of brief alcohol interventions differently; there does not appear to be one standardized approach for the practice of brief intervention. The main objective for this report is to conduct a systematic review of the effectiveness of screening followed by behavioral counseling, with or without referral, for alcohol misuse in primary care settings. We will update the evidence review produced for the USPSTF in with some revisions and expansions to the scope of the review.
What is the direct evidence that screening for alcohol misuse followed by a behavioral counseling intervention, with or without referral, leads to reduced morbidity e. What adverse effects are associated with screening for alcohol misuse and screening-related assessment? What adverse effects are associated with behavioral counseling interventions, with or without referral, for people with alcohol misuse as identified by screening?
How do behavioral counseling interventions, with or without referral, compare with one another and with usual care for reducing morbidity e. To what extent do health care—system influences promote or hinder effective screening and interventions for alcohol misuse? Alcohol misuse includes risky or hazardous drinking, harmful drinking, alcohol abuse, and alcohol dependence.
Office-based screening for alcohol misuse followed by behavioral counseling interventions intended primarily to reduce alcohol intake e. Studies using office-based screening for alcohol misuse with one of the following instruments will be eligible for inclusion:. Outcome assessment at least 6 months after randomization or from receipt of the intervention for nonrandomized controlled trials.
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We feel that the results should not be used to make decisions. Preventive Services Task Force. We will systematically search, review, and analyze the scientific evidence for each KQ. The steps that we will take to accomplish the literature review are described below. To identify articles relevant to each KQ, we will begin with a focused MEDLINE search on alcohol misuse by using a variety of terms, medical subject headings MeSH , and major headings and limiting the search to English-language and human-only studies.
Relevant terms are listed in Table 2. We will conduct quality checks to ensure that the known studies i. If they are not, we will revise and rerun our searches. We will not simply conduct one search starting from where the systematic review on alcohol misuse left off. Rather, since our review has some differences in scope described above on page 5 , we will search the literature published in and later. This search date was selected based on the earliest publication date found in previous systematic reviews which was and expert opinion about when the earliest literature on this topic was published.
Potential sources of gray literature include ClinicalTrials. We will review our search strategy with the Technical Expert Panel TEP and supplement it as needed according to their recommendations. In addition, to attempt to avoid retrieval bias, we will manually search the reference lists of landmark studies and background articles on this topic to look for any relevant citations that might have been missed by electronic searches.
We will also conduct an updated literature search of the same databases searched initially concurrent with the peer review process. Any literature suggested by peer reviewers or from the public will be investigated and, if appropriate, incorporated into the final review.
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Appropriateness will be determined by the same methods described above. Studies marked for possible inclusion by either reviewer will undergo a full-text review. For studies without adequate information to determine inclusion or exclusion, we will retrieve the full text and then make the determination. Each full-text article will be independently reviewed by two trained members of the team for inclusion or exclusion based on the eligibility criteria described above.
If both reviewers agree that a study does not meet the eligibility criteria, the study will be excluded. If the reviewers disagree, conflicts will be resolved by discussion and consensus or by consulting a third member of the review team. As described above, all results will be tracked in an EndNote database. We will record the reason why each excluded full-text publication did not satisfy the eligibility criteria so that we can later compile a comprehensive list of such studies.
For studies that meet our inclusion criteria, we will abstract important information into evidence tables. We will design data abstraction forms to gather pertinent information from each article, including characteristics of study populations, settings, interventions, comparators, study designs, methods, and results. Trained reviewers will extract the relevant data from each included article into the evidence tables. All data abstractions will be reviewed for completeness and accuracy by a second member of the team.
To assess the quality internal validity of studies, we will use predefined criteria based on those developed by the USPSTF ratings: good, fair, poor and the University of York Centre for Reviews and Dissemination. If observational studies are included for KQ 6, we will perform quality assessments by using the criteria outlined by Deeks and colleagues. Two independent reviewers will assign quality ratings for each study. Disagreements between the two reviewers will be resolved by discussion and consensus or by consulting a third member of the team. We will give a good quality rating to studies that meet all criteria.
Fair quality ratings will be given to studies that presumably fulfill all quality criteria but do not report their methods sufficiently to answer all of our questions. We will give a poor quality rating to studies that have a fatal flaw defined as a methodological shortcoming that leads to a very high risk of bias in one or more categories and will exclude them from our analyses. If we find three or more similar studies for a comparison of interest, we will consider quantitative analysis i.
In order to determine whether quantitative analyses are appropriate, we will assess the clinical and methodological heterogeneity of the studies under consideration following established guidance. We will not plan to combine studies that enrolled only pregnant women or adolescents with those that enrolled all adults.
When quantitative analyses are not appropriate e. We anticipate that much of the data found in this review will be synthesized qualitatively. Planned stratifications or categories for subgroup analyses include geographic location of studies United States vs. We will grade the strength of evidence based on the guidance established for the Evidence-based Practice Center Program. It also considers other optional domains that may be relevant for some scenarios, such as a dose-response association, plausible confounding that would decrease the observed effect, strength of association magnitude of effect , and publication bias.
Table 3 describes the grades of evidence that can be assigned. Grades reflect the strength of the body of evidence to answer KQs on the comparative effectiveness, efficacy, and harms of the interventions included in this review. Grades do not refer to the general efficacy or effectiveness of interventions.
Two reviewers will assess each domain for each key outcome, and differences will be resolved by consensus. We will grade the strength of evidence for the outcomes deemed to be of greatest importance to decisionmakers and those most commonly reported in the literature. We expect these to include intermediate outcome measures of alcohol use, health outcomes, and mortality.
We will assess applicability of the evidence following guidance from the Methods Guide for Effectiveness and Comparative Effectiveness Reviews. Some factors identified a priori that may limit the applicability of evidence include the following: age of enrolled populations; sex of enrolled populations e. Further description of contextual questions from the U. To do so, we will rely on previously published reviews and expert input.
We will also address the issue of whether there is known evidence of efficacy of pharmacotherapy for patients with dependence identified by screening in the primary care setting as opposed to treatment seekers or those identified by other methods or for subjects treated in primary care settings. The following two paragraphs are from Section 3.
Contextual questions are not key questions associated with the analytic framework; however, they represent issues in an updated review for which the USPSTF needs a valid but not necessarily systematic summary of current research in order to provide the context for its vote and recommendation statement. Contextual questions may elicit a range of different types of information, including: 1 updated information for a key question that is not being systematically updated; 2 contextual information on natural history, current practice, prevalence and risk groups, or other aspects of the service for which it is strongly believed there will not be information, but which are part of the Task Force's considerations e.
Contextual questions are not necessarily addressed systematically; however, the approach taken may meet criteria for a systematic review. Comprehensive literature searches are not generally undertaken specifically to answer these questions. Information for contextual questions can be gathered in a variety of ways: 1 through targeted literature searches, 2 from authoritative surveys or reviews, 3 from expert input, and 4 opportunistically, while reviewing comprehensive literature searches for key questions.
Contextual questions are not listed as separate questions in the methods section of the report and are not reported in the results section. The information resulting from non-systematic review should be included as part of the introduction or in the discussion section, and related as appropriate to the results of the systematic review. Risky or hazardous drinkers are at risk from consumption that exceeds daily, weekly, or per occasion thresholds. Harmful use is defined by the ICD as a pattern of drinking that is already causing damage to health.
Alcohol abuse is a maladaptive pattern of use leading to clinically significant impairment or distress that meets at least one of the following criteria: use results in failure to fulfill occupational or social obligations due to drinking; use occurs in physically hazardous situations or leads to recurrent legal problems; use continues despite persistent social or interpersonal problems.
Alcohol dependence is a maladaptive pattern of use leading to clinically significant impairment or distress that meets at least three of the following criteria: tolerance; withdrawal; a great deal of time spent obtaining alcohol, using it, or recovering from its effects; important activities given up or reduced because of alcohol; drinking more or longer than intended; persistent desire or unsuccessful efforts to cut down or control alcohol use; use continued despite knowledge of having a psychological problem caused or exacerbated by alcohol.
In addition, for Comparative Effectiveness reviews, the key questions were posted for public comment from December 14, through January 11, and finalized by the EPC after review of the comments. Based on public and TEP input, we excluded pharmacotherapy. Pharmacotherapy for alcohol dependence in the primary care setting was considered for possible addition to this update. Key Informants are the end users of research, including patients and caregivers, practicing clinicians, relevant professional and consumer organizations, purchasers of health care, and others with experience in making health care decisions.
Within the EPC program, the Key Informant role is to provide input into identifying the Key Questions for research that will inform healthcare decisions. The EPC solicits input from Key Informants when developing questions for systematic review or when identifying high priority research gaps and needed new research. Key Informants are not involved in analyzing the evidence or writing the report and have not reviewed the report, except as given the opportunity to do so through the peer or public review mechanism.
Because of their role as end-users, individuals are invited to serve as Key Informants and those who present with potential conflicts may be retained. Technical Experts comprise a multi-disciplinary group of clinical, content, and methodological experts who provide input in defining populations, interventions, comparisons, or outcomes as well as identifying particular studies or databases to search.
They are selected to provide broad expertise and perspectives specific to the topic under development. Divergent and conflicted opinions are common and perceived as health scientific discourse that results in a thoughtful, relevant systematic review. Technical Experts provide information to the EPC to identify literature search strategies and recommend approaches to specific issues as requested by the EPC.
Technical Experts do not do analysis of any kind nor contribute to the writing of the report and have not reviewed the report, except as given the opportunity to do so through the peer or public review mechanism. Because of their unique clinical or content expertise, individuals are invited to serve as Technical Experts and those who present with potential conflicts may be retained. Peer reviewers are invited to provide written comments on the draft report based on their clinical, content, or methodological expertise.
Peer review comments on the preliminary draft of the report are considered by the EPC in preparation of the final draft of the report. Peer reviewers do not participate in writing or editing of the final report or other products. The synthesis of the scientific literature presented in the final report does not necessarily represent the views of individual reviewers. The dispositions of the peer review comments are documented and will, for CERs and Technical briefs, be published three months after the publication of the Evidence report.
Peer reviewers who disclose potential business or professional conflicts of interest may submit comments on draft reports through the public comment mechanism. Search Effective Health Care website Submit search. According to the National Institute on Alcohol Abuse and Alcoholism NIAAA , men may be at risk for alcohol-related problems if their alcohol consumption exceeds 14 standard drinks per week or 4 drinks per day; and women may be at risk if they have more than 7 standard drinks per week or 3 drinks per occasion.
Routine screening for the presence of alcohol, nicotine, or other drug use problems in patients, as well as screening for risk factors for development of alcohol, nicotine, and other drug dependence. Appropriate intervention by the primary care provider. Ongoing general medical care services to persons who manifest alcohol, nicotine, or other drug problems, including dependence.
Screening-related assessment: confirming screening results and distinguishing patients suitable for brief interventions from those needing specialty care referral In , the USPSTF also recommended the following 19 : Screening and behavioral counseling interventions to reduce alcohol misuse by adults, including pregnant women, in primary care settings. Grade: B Recommendation Evidence is insufficient to recommend for or against screening and behavioral counseling interventions to prevent or reduce alcohol misuse by adolescents in primary care settings.
Grade: I Statement The original systematic review conducted by the Oregon Evidence-based Practice Center covered the literature through February and addressed nonpregnant adults, pregnant women, and adolescents in primary care settings. We expanded the eligible settings from traditional primary care to also include settings with primary care-like relationships e.
We added additional outcomes of interest to our populations, interventions, comparators, outcomes, timing, and settings PICOTS and analytic framework. The Key Questions Question 1 What is the direct evidence that screening for alcohol misuse followed by a behavioral counseling intervention, with or without referral, leads to reduced morbidity e. Question 2 How do specific screening modalities compare with one another for detecting alcohol misuse? Carers, caring and respite care services. Child, family and relationship services. Disability services. Emergency, crisis and support services.
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Alcohol and drug treatments and programs Share show more. Listen show more. More show more. For advice and referral to alcohol and drug treatment and programs, call DirectLine — Victoria's free and confidential hour telephone counselling phone line. If you or someone you know has a drug or alcohol problem, your local doctor will be able to refer you for treatment or direct you into a program that is right for you. Taking the first step with alcohol or drug problems Counsellors , doctors and other healthcare professionals can help if you think you may have a problem with alcohol or drugs.
They are legally bound to keep whatever you tell them confidential. They will usually start by assessing your alcohol or drug use and then refer you to a service where you can get the help and support you need. Counselling — online and phone support Counselling is the most common kind of treatment, and there are a number of different approaches that might be taken.
Phone counsellors at DirectLine can provide: immediate counselling and support, including crisis intervention support in dealing with the impact of drug use on the family assistance in developing strategies to deal with alcohol or drug problems information about how to reduce the harm associated with drug use information and referral to treatment and support services across Victoria links to further information and education resources.
Withdrawal services Withdrawal services are for people experiencing specific symptoms affecting their physical or mental health after they stop using alcohol or drugs. Depending on the extent of your problem, your local doctor or DirectLine may direct you to: Residential withdrawal — this usually involves a short stay in a community residential drug withdrawal service or hospital.
Home-based withdrawal — this involves a series of intensive individual sessions over a short period, followed by ongoing counselling. It is provided by an experienced nurse and a doctor for people whose withdrawal symptoms are only mild to moderate, and for whom support is available from a family member or friend at home. Home-based withdrawal can either be access through a community-based service, or as an outpatient at a hospital. Methadone and other pharmacotherapies 'Pharmacotherapies' is a term that means using medication to help treat conditions such as addiction.
Rehabilitation Your local doctor or DirectLine can help you access several services that are available to people who need rehabilitation or ongoing treatment after the withdrawal stage, including: Residential rehabilitation — this provides a safe and supported environment for people who are not able to reduce or overcome their drug use issues through other programs, to address underlying issues leading to their drug use. It provides a range of interventions, such as individual and group counselling with an emphasis on mutual self-help and peer support, and supported reintegration into the community.
Therapeutic day rehabilitation — this is aimed at supporting people who are at risk of short-term harm as a result of their alcohol or drug problem and needing intensive support. Unlike residential rehabilitation, people accessing therapeutic day rehabilitation will be able to remain at home while accessing support. Peer support — this is help from a person with first-hand experience of alcohol and drug use. Peer support groups or activities are usually set up by current or past alcohol and drug users. Care and recovery coordination If you are receiving drug treatment, but are also engaged in a range of services or programs such as housing, mental health, employment programs , you may be assigned a care and recovery coordinator who will work collaboratively with the other services you are engaged with to ensure each of your needs are met, while ensuring you are supported in the community.
Services for families Families can provide a much needed support network for people experiencing problems with alcohol or drugs, but they themselves may need support to do this. Services for family members are available by phoning Family Drug Help on and include: Family drug help — there are many self-help groups for family members of alcohol and drug users across Victoria. They provide support, information and advice for families. Parent support — these programs are provided by alcohol and drug professionals to groups of parents across the state.
They provide support to parents and families of alcohol and drug users and guide them through supporting a child or other family member with a substance problem. Sibling support — these programs address the mental health and wellbeing of brothers and sisters affected by addiction in the family.
Family counselling — these services are provided to families who are looking for assistance, counselling and support for a family member who has a substance problem. Services for young people Services available specifically for young people include: youth outreach and support — assessment, support and ongoing case coordination for young people in their own environment youth residential withdrawal — provided through a community residential drug withdrawal service or through hospital-based treatment youth home-based withdrawal — provided where the withdrawal is of mild to moderate severity, and the person can be supported by a family member or friend at home youth residential rehabilitation — hour staffed residential programs that provide a range of interventions for young people whose established use of drugs has caused them significant harm youth supported accommodation — a supportive residential environment to help young people achieve lasting change and help with their re-introduction into the community.
Services for Aboriginal people Alcohol and drug treatment services are available throughout Victoria for Aboriginal people who are affected either directly or indirectly or who are at risk of being affected by substance abuse. Send us your feedback. Rate this website Your comments Questions Your details. Excellent Good Average Fair Poor. Next Submit Now Cancel. Please note that we cannot answer personal medical queries. Enter your comments below optional. Did you find what you were looking for?
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Submit Now Cancel. Thank you. Your feedback has been successfully sent. Alcohol and drug services topics. Alcohol and drug services explained Getting help Living with substance abuse issues Alcohol and drug services explained Alcohol and drugs - dependence and addiction Asking for help when you first suspect you have an alcohol or drug problem is important. Alcohol and drug treatments and programs Counsellors, doctors and other healthcare professionals can help if you have a problem with alcohol or drugs Paying for alcohol and drug treatments services In Victoria, the state government funds non-government organisations to deliver alcohol and drug treatment services for free or at a reduced cost to eligible Medicare card holders Assessing your alcohol and drug use If you are worried about your alcohol or drug use or, call DirectLine on for counselling, information and referral, or speak with your local doctor Getting help Family help for alcohol and drug addiction The stress and influence of harmful substance use on family relationships is significant but there is a range of support available to help families cope with drug or alcohol addiction problems Overdose - what to do in an emergency If you are worried about your alcohol or drug use or, call DirectLine on for counselling, information and referral, or speak with your local doctor Substance dependency services Some people need to explore different treatment options for drug dependency before they find what works for them Substance misuse and mental illness — dual diagnosis Dual diagnosis means someone has both a mental illness and a substance use problem Talking to health professionals about drugs, alcohol or addiction Talking with your doctor or healthcare professional is an important step in getting care for issues of drug or alcohol addiction or dependence Talking with your doctor about sensitive issues Building a strong, trusting relationship with your doctor can make it easier to talk with them about sensitive issues Living with substance abuse issues Reducing harm from alcohol and other drug use Harm reduction is about reducing the negative impact ongoing drug use can have Related Information.
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