It’s with great excitement that I announce and share the Centers for Disease Control (CDC) 2014 Alcohol Screening and Brief Counseling guidelines, along with NIAAA’s (National Institute on Alcohol Abuse and Alcoholism) Single Question Screen.  I’m particularly excited about how easily these can be used by health care professionals to assess and help both “sides” of – meaning, both individuals affected by – a person’s drinking: the person drinking and the person coping with their drinking behaviors (the behaviors that result when alcohol changes their brain functioning), aka secondhand drinking.

To break this down, I’m framing this post around two points: #1) we now have a number – a target at which a person’s drinking should be held if they are to remain in control of their brain health and behaviors, and #2) this number – this target – can help the millions of family members with a loved one who drinks too much better understand how much is too much, which opens the door to helping the family members help themselves (and in that process, better help their loved one).

Point #1 Screening for “Too Much” – the person drinking

To Point #1, the NIAAA’s Single Question Screen can be used by health care professionals (or someone worried about a loved one’s drinking, for that matter) to identify “at-risk” drinking patterns – to start the process outlined in Step 1 of CDC’s Infographic shown below:

For women: How many times in the past year have you had 4 or more standard drinks on any day?

For men: How many times in the past year have you had 5 or more standard drinks on any day?

Standard drink is defined as 5 ounces of wine, 12 ounces of regular beer and 1.5 ounces of 80 proof hard liquor.

Using NIAAA’s Single Question Screen helps the health care professional hone in on how much because too much is what causes a persons behaviors to change; it’s what harms a person’s brain and physical health; and it’s what causes secondhand drinking (impacts of a person’s drinking behaviors for others). The NIAAA single question screen doesn’t leave wiggle room for, “occasionally” or “only on the week-ends,” or “a couple of glasses of wine a night.” [For more on what’s considered “low-risk” or “normal” drinking, visit NIAAA’s Rethinking Drinking Website > How Much is Too Much?]

And why might the simplicity of this question and the resulting answers be important?

Consider these statistics from the CDC’s Alcohol Screening and Counseling Vitalsigns™:

Point #2 – Screening for Secondhand Drinking – the person on the receiving end of drinking behaviors

So the above addresses my Point #1. Now to my Point #2 – helping the millions of family members affected by a loved one’s drinking.

As someone with decades of personal experience with various loved ones and close friends’ drinking behaviors caused by their alcohol misuse and someone who has been working in this area for over a decade, helping the family member identify alcohol misuse in a loved one and the impacts it’s had on them, using a slightly revised version of NIAAA’s Single Questions Screen, can explain a whole host of physical and emotional ailments that person may be experiencing. Not only this latter point, but I’ve also observed, time and again, how growing up coping with SHD has contributed to a person developing a drinking problem, themselves.

Here is the NIAAA Single Question Screen revised to identify Secondhand Drinking (SHD):

How many times in the past year has someone in your family or someone with whom you are in a close relationship had:
4 or more standard drinks on any day? (for women)
5 or more standard drinks on any day? (for men).

An answer of once or more identifies potential SHD. How? Because it identifies “at-risk” drinking – you’ll understand why “at-risk” drinking is a concern in my related post, “Alcohol Abuse Going On in the Family? If Only My Doctor Had Asked.”

Using these Single Question Screens (and to be clear, the revised version to identify SHD is not NIAAA’s, it’s my own, so I do not want to imply they’ve endorsed this concept) and the following CDC Alcohol Screening and Brief Counseling guidelines, health care professionals can help patients on both sides of alcohol misuse help themselves. [My post, “Family Disease of Addiction – Expand Health Care to Treat Both Sides,” provides further background on the importance of this.]

Now to the CDC’s new guidelines for Alcohol Screening and Brief Counseling

Let me first present their info graphic, which first appeared on their link titled, CDC-Alcohol Screening and Counseling Infographic | Vital Signs, on January 7, 2014:

In their post sharing this Infographic at this link, CDC-Alcohol Screening and Counseling Infographic | Vital Signs, the CDC continues with the following guidelines – note: content in [ ] is added by me –

• The key steps in alcohol screening and brief counseling include:

  1. Ask patients about their drinking [and a good way to ask is using NIAAA’s Single Question Screen explained above]
  2. Talk with patients in plain language about what they think is good and not so good about their drinking
  3. Provide options: ask if patient wants to stop drinking, cut down, seek help, or continue with their present drinking pattern and come up with a plan [a good resource for this is NIAAA’s Rethinking Drinking website > Strategies for Cutting Down]
  4. Close on good terms regardless of patient response

• Screening and counseling should occur in many places including primary care practices, obstetrics/gynecology practices, emergency departments and trauma centers

• Making sure it happens in routine medical practices includes five steps:

  1. Make sure staff understands that most patients who drink too much need brief counseling but may not need specialized alcoholic treatment.
  2. Involve and build support with others in the medical practice, using current guidelines.
  3. Develop a plan with them to make it part of standard service.
  4. Train staff on how to screen and provide brief counseling.
  5. Pilot test the plan to see if it works and change it as needed.

Bottom Line

There’s a lot to digest in this post, to be sure. I hope the following take-aways come through:

1. The CDC has now provided guidelines for Alcohol Screening and Brief Counseling that health care professionals can use in conversations with all of their patients because at least 38 million Americans drink too much.

2. The NIAAA’s Single Question Screen provides a simple way of beginning the screening conversation.

3.  Health care professionals can also use both (the NIAAA Single Question Screen slightly revised, however) to screen for secondhand drinking in order to help the millions of family members affected by a loved one’s drinking.

© 2014 Lisa Frederiksen

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Lisa Frederiksen

Author | Speaker | Consultant | Founder at BreakingTheCycles.com

Lisa Frederiksen is the author of hundreds of articles and 12 books, including her latest, "10th Anniversary Edition If You Loved Me, You'd Stop! What you really need to know when your loved one drinks too much,” and "Loved One In Treatment? Now What!” She is a national keynote speaker with over 30 years speaking experience, consultant and founder of BreakingTheCycles.com. Lisa has spent the last 19+ years studying and simplifying breakthrough research on the brain, substance use and other mental health disorders, secondhand drinking, toxic stress, trauma/ACEs and related topics.

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