Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

How to Have Effective Discussions About Alcohol 


Talking with patients about the risks of heavy alcohol consumption and the benefits of change can have a positive impact on their health. 

In recent years, the national dialogue surrounding substance use has centered on drug overdose deaths. But a new study by Orly Termeie and colleagues, published in the American Journal of Medicine, highlights the critical role of another substance in preventable death: alcohol. The study shows alarming increases in mortality from cirrhosis, or scarring of the liver, due to alcohol use among people ages 25 years and older. Using mortality data from the CDC, the researchers found a three-fold increase in mortality from 1999 to 2019.  


We should regularly screen for alcohol use, as recommended by the U.S. Preventive Services Task Force, and counsel patients who consume large amounts of alcohol about the health risks: people with heavy alcohol consumption have the highest mortality rates. While the evidence is still emerging, some research suggests that screening followed by brief interventions to motivate changes in alcohol consumption, such as motivational interviewing, and referral to treatment when needed, can help people to reduce alcohol consumption.  


More than 95,000 people in the U.S. die from alcohol-related causes, making it the third leading cause of preventable death. The study by Termeie highlights the importance of integrating alcohol screening into our standard set of preventive services and ensuring that people with heavy consumption receive appropriate counseling and, if needed, treatment for alcohol use disorder. Here’s what we can do: 


1. Ask patients about alcohol use nonjudgmentally, including indirect questions such as, “How do you handle a stressful day?” 


2. For patients who use alcohol, ask about binge drinking using the NIAAA single question screen: 

Men: How many times in the past year have you had five or more drinks in a day?

Women: How many times in the past year have you had four or more drinks in a day? 


3. Positive screens should trigger a discussion about whether there have been consequences of binge drinking, including drinking and driving, falls/injuries, unsafe sex, calling in sick to work, or relationship difficulties. 


4. Clinician advice about risks of heavy alcohol consumption and the benefits of change has been shown to have positive impact and contribute to change in patients with binge drinking. 


5. Patients with moderate/severe alcohol use disorder should be encouraged to receive treatment. 







This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.