An update to Canadian guidance on screening for high-risk drinking and alcohol use provides streamlined recommendations in CMAJ (Canadian Medical Association Journal) that authors hope will make it easier for health care professionals to talk to patients about alcohol use https://www.cmaj.ca/lookup/doi/10.1503/cmaj.251759 .
"Excessive alcohol use frequently underlies many reasons people see their doctor, such as poor sleep or anxiety, but this explanation routinely goes undetected in health care settings," says Dr. Evan Wood, co-chair of the guideline writing committee and an addiction medicine specialist at the British Columbia Centre on Substance Use and the University of British Columbia, Vancouver, BC. "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."
This guideline is an evidence-based update by the Canadian Research Initiative in Substance Matters (CRISM), funded by the Canadian Institutes of Health Research, to screening recommendations from an earlier CRISM guideline published in 2023. Research showed many previously recommended tools were impractical and not effective at detecting problematic alcohol use.
The 5 screening recommendations in the guideline update are aimed at helping primary care clinicians and medical professionals in emergency departments and medical wards counsel youth (aged 12 to 25) and adults who may have undiagnosed alcohol problems.
"We developed 5 recommendations to identify and address both risky alcohol consumption and more serious alcohol-related problems, recognizing that patients may exhibit diverse patterns of drinking and risk," says Dr. Wood. "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."
A team of researchers, clinicians, and people with lived and living experience of substance use from across Canada helped develop the national guideline.
"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 (CAMH). "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."
The authors recommend that screening for alcohol use should be part of conversations between health care providers and patients about the health risks and harms of psychoactive substances overall.
A related editorial https://www.cmaj.ca/lookup/doi/10.1503/cmaj.260640 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 follow-up with intervention," write Drs. Shannon Charlebois, medical editor, CMAJ, and Shawn Kelly, a pediatrician and addictions medicine specialist at the University of Ottawa, Ottawa, Ontario. "This is particularly important for youth, because the earlier substance use starts, the higher the risk of future misuse and addiction."
They note that even a short conversation can make a difference, and that anyone who works with adolescents can have an impact.
"Increasingly, addiction medicine experts agree that asking about features of substance withdrawal during a brief intervention can increase its efficacy, because doing so can identify teens for whom substance use is already a substantial problem and prompt appropriate intervention," write Drs. Charlebois and Kelly.
