A preventive health screening we’re not using

by Ray Hanley (rhanley@afmc.org) 586 views 

Excessive alcohol use is the third leading preventable cause of death, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA). About a third of U.S. adults consume alcohol at a level that increases their risk for physical, mental and social problems. One in 10 deaths – 88,000 annually – can be attributed to alcohol use or its complications. Almost one in three traffic deaths is alcohol related.

The extremely high health care costs required to treat the effects of risky alcohol use are largely preventable. The health, safety and productivity losses linked to alcohol abuse in the United States exceed $185 billion annually. Alcohol-related traffic deaths and injuries alone cost the nation $51 billion every year.

The physical and mental toll that alcohol misuse extracts is immense. Continuous alcohol use is linked to heart and liver disease, stroke, digestive problems, high cholesterol, depression and anxiety and several types of cancers. Risky drinkers have an increased risk of death from injuries, violence, suicide and poisoning.

Identification and management of people with alcohol use disorders (AUD) ranks among the highest-performing preventive services, based on health impact and cost effectiveness. Yet it remains one of the least used.

Alcohol screening should be part of everyone’s annual preventive health services unless they’re already in AUD treatment. The United States Preventive Services Task Force’s guidelines recommend that all adults aged 18 years or older be screened for alcohol misuse. Simple screening tools are readily available and there are three FDA-approved, low-risk medications that are effective in reducing drinking and avoiding relapse.

Experts also recommend that those engaged in risky or hazardous drinking receive brief behavioral counseling to reduce alcohol misuse. Brief counseling from a physician has significant and lasting effects in reducing binge drinking, total alcohol consumption and in following recommended drinking limits. About 20 percent of people who visit their primary care doctor have high-risk alcohol use or AUD. Without screenings, these disorders are commonly overlooked.

The tragedy that excessive alcohol consumption brings to adults, is compounded in infants whose mothers drank during pregnancy. Drinking during pregnancy can cause miscarriage, stillbirth, prematurity and fetal alcohol spectrum disorder (FASD). FASD is the only birth defect that can be completely avoided by the mother’s decision not to drink during pregnancy.

FASD refers to the range of problems, including physical, mental, behavioral and learning disabilities that can have lifelong implications. FASD affects nearly 40,000 newborns annually. The nation spends $6 billion annually to treat FASD. The lifetime costs for one individual with FASD exceeds $2 million. We cannot even begin to measure the human toll it takes.

A woman’s partner, family, friends and health care providers are a powerful influence on her decision not to drink during pregnancy. FASD can be prevented. Don’t be silent; start conversations with women of childbearing age about the lifelong heartbreak of FASD.

Many cases of AUD begin in adolescence when the prevalence of drinking and binge drinking increases dramatically, peaking in the early 20s. Each year, more than 5,000 18- to 24-year-olds die from unintentional injuries related to alcohol.

Those who begin drinking before age 15 are four times more likely to report symptoms of AUD, compared to those who wait until they are 21 or older. Alcohol exposure during adolescence can affect brain development and compromise both short- and long-term brain function.

Preventing or delaying when young people start drinking is an important goal for policy makers as well as our health care system. Binge drinking is of special concern because it increases the risks for blackouts, alcohol poisoning, sexual assault, sexually transmitted diseases, poor academic performance and developing AUD as an adult.

There are special concerns for older adults who drink. Many health and disease consequences of AUD emerge as one ages. Older adults are more sensitive to the sedative effects of alcohol and its impairment of reaction time, balance, attention and driving skills. Combined with multiple medications and depression, alcohol can be deadly for our elders. Mental health issues like AUD often go undetected when physical ailments are being treated.

Alcohol misuse destroys opportunities – lost family and friends, lost jobs and lost lives. It costs our state millions in health care costs. Young or old, denial is expensive and can be deadly.

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Editor’s note: Ray Hanley is President and CEO of the Arkansas Foundation for Medical Care. The opinions expressed are those of the author.

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