Alcohol misuse: Updated guidelines aim to make screening easier, more effective

The just-released update to Canadian guidance on screening for high-risk drinking and alcohol use provides streamlined recommendations aimed at making it easier and quicker for healthcare professionals to talk to patients about alcohol use and detect underlying issues.“Screening for high-risk drinking and alcohol use disorder: update of the 2023 national clinical practice guideline,” is an evidence-based update by the Canadian Research Initiative in Substance Matters, funded by the Canadian Institutes of Health Research and published in the Canadian Medical Association Journal (CMAJ).Current screening tools for harmful alcohol use have not kept pace with evolving evidence on alcohol-related health risks, note the authors, led by Dr. Evan Wood, co-chair of the guideline writing committee and an addiction medicine specialist at the British Columbia Centre on Substance Use and at UBC in Vancouver.“Excessive alcohol use frequently underlies many reasons people see their doctor, such as poor sleep or anxiety, but this explanation routinely goes undetected in healthcare settings,” said Dr. Wood, in a release.“These updated recommendations aim to support clinicians with a practical approach to initiating conversations about alcohol use and identifying those with potential problems earlier so patients can receive factual advice and care when needed.”Noting that clinician time constraints are the most commonly reported barrier to universal alcohol screening, the authors developed five recommendations involving a simple screening method. The recommendations offer guidance on identifying and addressing both unhealthy alcohol consumption and more serious problems related to alcohol for youth age 12 to 25 and adults.It also provides a table of a simple screening algorithm that incorporates suggested questions to aid in applying the five recommendations.“We hope the easy-to-use tables with tips on how to reduce alcohol use and more will help clinicians focus on patients’ unique needs, allowing them to save time when circumstances allow while focusing on those with identified alcohol problems,” says Wood.The updated recommendations were developed by a multidisciplinary cross-Canada team, which included people with lived and living experience, clinicians and researchers. “Despite the burden of alcohol-related harms, there remains a gap between what we know is effective intervention and treatment and the care many patients actually receive,” says Dr. Jürgen Rehm, co-chair of the guideline writing committee and senior scientist at the Centre for Addiction and Mental Health in Toronto. “Improving screening in primary care can help intervene in circumstances of excessive drinking and help identify alcohol problems earlier and connect people with effective treatments and supports.”A related editorial, “Brief intervention can change the trajectory of youth substance use,” on youth substance use emphasizes the importance of screening and talking to youth about substance abuse.“Screening patients for the use of alcohol and other substances is important, but to be effective, a positive screen needs followup with intervention,” write Drs. Shannon Charlebois, medical editor, CMAJ, and Shawn Kelly, a pediatrician and addictions medicine specialist at the University of Ottawa, in the editorial. Even a short conversation can make a difference, they note. “This is particularly important for youth, because the earlier substance use starts, the higher the risk of future misuse and addiction.”

Alcohol misuse: Updated guidelines aim to make screening easier, more effective

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