Implementing Screening and Treatment of Unhealthy Alcohol Use During COVID-19

Sitting in my exam room, a woman in her 30s shared how the COVID-19 pandemic had affected her life. Even though she had not been diagnosed with COVID-19, it had changed her previously busy work and social life to one of unemployment and gradually increasing alcohol consumption. It had started with a glass of wine with dinner and, slowly, she had increased her alcohol intake to fill in the loneliness and loss of direction that COVID-19 had brought.

As we recognize April as Alcohol Awareness Month, we understand her story as one commonly heard by today’s primary care clinicians. Since the onset of the COVID-19 pandemic in March 2020, alcohol sales have increased dramatically in many States across the country and rates of unhealthy alcohol use are rising in parallel. Unhealthy alcohol use, which refers to the full spectrum of alcohol misuse from risky or hazardous drinking to alcohol use disorder, is associated with adverse consequences, including poorer physical and mental health outcomes as well as negative socioeconomic effects.

As the lead Federal agency charged with improving the safety, quality, and equity of America’s healthcare system, AHRQ is responding to the rise in unhealthy alcohol use by supporting the implementation of evidence around unhealthy alcohol use screening and treatment.

The evidence being implemented comes from two important sources. The U.S. Preventive Services Task Force (USPSTF) recommends that primary care clinicians screen all adult patients for unhealthy alcohol use and provide brief behavioral counseling interventions to those engaged in risky drinking. Complementing this recommendation, AHRQ’s Effective Health Care Program completed a systematic review on medications for alcohol use disorder, finding strong evidence for specific medications. Despite these evidence-based recommendations, implementation of routine screening for unhealthy alcohol use and treatment for those with alcohol use disorder remains low in primary care practices, resulting in many patients remaining undiagnosed and untreated.

In 2019, AHRQ launched its EvidenceNow: Managing Unhealthy Alcohol Use Initiative. This initiative funded 6 grantees to implement screening for unhealthy alcohol use, brief behavioral counseling for those identified at high risk, and medication prescribing in primary care practices for those with alcohol use disorder. Each grantee is using a range of evidence-based strategies, including practice facilitation, to support implementation in approximately 700 practices.

The onset of COVID-19 has led to both challenges and opportunities for this initiative. The largest challenge is the difficulty in recruiting primary care practices when many are struggling with the best ways to serve their patients and protect their staff. Another challenge is the need to adapt from a model of predominantly in-person practice facilitation to one of virtual practice facilitation and support.

However, the pandemic has intensified the interest of many clinicians who want to effectively care for patients whose alcohol consumption has become unhealthy. COVID-19 has also expanded the opportunity for AHRQ and its grantees to learn about how to best provide virtual facilitation. Importantly, to maximize our learning, AHRQ is supporting collaboration between grantees by facilitating a virtual learning community so that grantees can share lessons learned around practice recruitment, virtual facilitation, data collection, evaluation, and other issues.

During this time, AHRQ is maintaining a publicly-accessible compendium of resources and tools to help primary care clinicians find, adapt, and use evidence-based recommendations on unhealthy alcohol use. The resources and tools are targeted towards clinicians, health system leaders, and patients with the goal of facilitating the implementation of evidence-based approaches to managing the spectrum of unhealthy alcohol use.

Through screening, my previously mentioned patient was able to open up about her difficulties during the pandemic and discuss her increasing reliance on alcohol. After reviewing various evidence-based treatment options, she chose medication as a strategy to treat her alcohol use disorder.

While this anecdote represents just one case, AHRQ’s EvidenceNow: Managing Unhealthy Alcohol Use Initiative represents an important opportunity to help clinicians support many patients like her receive the appropriate diagnosis, counseling, and treatment for unhealthy alcohol use by implementing the best patient-centered outcomes research findings available to improve health.

Sebastian Tong, a senior staff fellow in AHRQ’s Center for Evidence and Practice Improvement, is a member of the Agency’s Managing Unhealthy Alcohol Use Initiative team.

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