1-10: Prevention of Substance Use Disorder: Alcohol & Illicit Drugs

Unhealthy alcohol use is a major public health problem in the United States, where approximately 51% of adults 18 years and older are current regular drinkers (at least 12 drinks in the past year). The 2015–2020 US Dietary Guidelines for Americans recommends that if alcohol is consumed, it should be consumed in moderation—up to one drink per day for women and two drinks per day for men—and only by adults of legal drinking age. The spectrum of alcohol use disorders includes alcohol dependence, harmful pattern use of alcohol, and entities such as alcohol intoxication, alcohol withdrawal, and several alcohol-induced mental disorders. The ICD-11 includes a new category: hazardous alcohol use. Categorized as a risk factor, hazardous alcohol use is a pattern of alcohol use that appreciably increases the risk of physical or mental health harmful consequence to the user.

Underdiagnosis and undertreatment of alcohol misuse is substantial, both because of patient denial and lack of detection of clinical clues.

As with cigarette use, clinician identification and counseling about unhealthy alcohol use are essential. The USPSTF recommends screening adults aged 18 years and older for unhealthy alcohol use.

The Alcohol Use Disorder Identification Test (AUDIT) consists of questions on the quantity and frequency of alcohol consumption, on alcohol dependence symptoms, and on alcohol-related problems (Table 1–6). The AUDIT questionnaire is a cost-effective and efficient diagnostic tool for routine screening of alcohol use disorders in primary care settings. Brief advice and counseling without regular follow-up and reinforcement cannot sustain significant long-term reductions in unhealthy drinking behaviors.