Prevalence Key Points

• Alcohol abuse is more common than diabetes mellitus.

• Heavy alcohol use is more common in men.

• More screening and brief interventions are needed in primary care settings, which results in decreased drinking.

• Screening in hospitals, EDs, and trauma settings can be valuable, but brief interventions in these settings have produced inconclusive results.

In the United States, an estimated 140 million persons use alcohol, making it the most popular psychoactive substance (Baldwin et al., 1993). A reanalysis of the 1994 national comorbidity study found that 8% to 10% of the U.S. population reported lifetime alcohol abuse or dependence (Narrow et al., 2002). About 61% of the U.S. population drinks alcohol (CDC, 2003). The number of U.S. adults who abuse alcohol or are alcohol dependent rose from 3.8 million (7.41%) in 1991-1992 to 17.6 million (8.46%) in 2001-2002, according to NESARC, a study directed by the National Institute on Alcohol Abuse and Alcoholism (NIAAA, 2003). Heavy use is found more frequently in men (10.3%) than women (2.5%). Ethnic variation is minimal in whites (6.4%), His-panics (7.3%), and African Americans (4.8%) (OAS, 1995). The prevalence of binge drinking, that is, drinking five or more drinks at least once in the preceding month, is 14.2% (Winick, 1996).

The prevalence of alcohol use disorders (abuse and dependence) is almost 15% in the population who consumes alcohol. Compared with other chronic medical conditions in family medicine, alcohol use disorders appear to be of significant importance for early recognition and intervention. Hypertension is estimated to affect at least 50 million Americans, and diabetes mellitus (DM) type 2 affects more than 2% of the U.S. population, or 5.4 million adults. Alcohol use disorders rank almost as high as hypertension and much higher than DM in terms of prevalence. The key for the family physician is to increase the screening, diagnosis, and treatment of alcohol abuse in the clinical setting to the level of importance attached to hypertension or DM. Screening in hospitals, EDs, and trauma care settings can add value (ACS, 2008; Gentillelo et al., 1999; Smothers et al., 2004). However, brief interventions for alcohol use in patients with acute injuries in the ED and in hospital admissions have been inconclusive (Dappen et al., 2007; Emmen et al., 2004). A meta-analysis of screening and brief intervention (SBI) was found effective in reducing alcohol consumption at 6 and 12 months among non-treatment-seeking primary care patients, regardless of gender (Fleming, 2002). Some evidence suggests that SBI for prevention is also effective in pregnancy care settings (Floyd, 2007).

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