About the Core Resource on Alcohol
What is the Core Resource on Alcohol?
The Healthcare Professional’s Core Resource on Alcohol consists of 14 interconnected articles covering the basics of what every healthcare professional needs to know about alcohol. The “Core” was developed by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), a part of the National Institutes of Health. NIAAA is the lead federal agency for research on alcohol and health and the largest funder of alcohol research in the world.
With guidance from practicing physicians and clinical psychologists, NIAAA created the Core with busy clinicians in mind. The Core articles provide user-friendly, practical overviews of
- Foundational knowledge for understanding alcohol-related problems (4 articles)
- Clinical impacts of alcohol (4 articles)
- Strategies for prevention and treatment of alcohol problems (5 articles)
- How to “pull it all together” to promote practice change (1 article)
The Core articles are living documents that will be updated regularly.
Who are the main audiences for the Core?
The Core articles are aimed broadly at all practicing healthcare professionals. Much of the practical content is derived from clinical research in adult primary care, yet the strategies can be adapted by other specialties. The Additional Links for Patient Care section offers helpful resources for primary care as well as hepatology, emergency care, obstetrics, oncology, pain management, pediatric, and gerontology specialists; therapists; and pharmacists.
In addition to professionals in practice, the Core has two other key audiences:
- Instructors in health professional schools will find the Core a valuable resource to integrate into units related to alcohol and health.
- Quality improvement staff in healthcare plans can implement alcohol-related performance measures using the Core as a training component for their clinical staff.
Who can receive continuing education credit?
Free continuing education credit —0.75 to 1 credit hour for each of 14 articles (10.75 credit hours total)—is offered for physicians, physician assistants, nurses, pharmacists, and clinical psychologists.
Why was the Core developed?
- Alcohol is a major public health concern. Alcohol consumption contributes to more than 200 diseases or conditions and more than 140,000 deaths per year in the U.S.,1,2 making alcohol one of the leading causes of preventable death in the U.S.3 Heavy drinking* is especially risky but even lower levels are linked with health risks including breast cancer.4,5
- Heavy drinking and alcohol use disorder (AUD) often go unaddressed. Many healthcare professionals ask patients about their drinking, but few use validated screening tools or follow up with an assessment and brief intervention as recommended by the USPSTF.6–8 Fewer than 2% of people with AUD receive FDA-approved AUD medications,9 which can be prescribed easily in primary care.
- Healthcare professionals are in a prime position to make a difference. Alcohol screening and brief intervention in primary care can increase patients’ motivation to change their drinking, and, in turn, reduce their alcohol intake.10–12 Many common patient conditions such as hypertension and depression may be caused or worsened by alcohol, and visits for these conditions present key opportunities for alcohol screening.13 Helping a patient with alcohol problems can make a difference not only for the patient, but for a whole family.
- Most patients are open to alcohol screening, and if needed, advice thereafter. Most patients expect, and do not object to, alcohol screening in medical settings, and when needed, are open to advice to cut down or quit drinking.14 Most patients who screen positive for heavy drinking show some readiness to change, with greater readiness among those with more severe alcohol-related symptoms.15
How does the Core help healthcare professionals?
The Core was designed to help address common barriers to optimum alcohol-related healthcare16–21 by providing:
- Knowledge to fill common gaps in training about addiction, including the neuroscience of addiction, evidence-based AUD behavioral healthcare and medications, and the varied paths to recovery
- Quick, validated alcohol screening and assessment tools that address time constraints while providing a definitive picture of drinking levels and, in those who drink heavily, any AUD symptoms
- Clarity about what constitutes heavy drinking, AUD severity levels, and recovery to build confidence in providing brief advice to patients and collaborating on their plans for a healthier future
- Steps to reduce stigma surrounding alcohol-related problems and encourage greater patient acceptance of alcohol treatment when needed
How was the Core developed?
The 14 Core articles were written and reviewed with the help of about 20 NIAAA staff and 50 external contributors (see the Contributors). This group included many practicing physicians and clinical psychologists, as well as basic and clinical alcohol researchers. Each article was reviewed by between 4 and 10 external reviewers, as well as internal reviewers, who collectively provided hundreds of invaluable comments.
NIAAA worked to keep the resulting robust content clear, concise, and cohesive for our busy audiences. Key messages to help surmount barriers to alcohol care are reinforced across articles. Reviewer feedback was positive, with many comments such as:
- “Thorough, yet concise and digestible information.”
- “Written in an accessible way that should be helpful to non-specialist healthcare providers.”
- “Excellent job summarizing the literature in a provider-centered way that could help decrease stigma.”
The NIAAA is indebted to the many contributors who helped make the Core a one-stop center for healthcare professionals who wish to provide high impact, high quality care to patients who drink alcohol.
We welcome your feedback as well. Please send a message to NIAAACoreResource@nih.gov. And we invite you to spread the word about the Core and its free CME/CE credits to your colleagues and professional organizations.
*Heavy drinking has been defined for women as 4 or more drinks on any day or 8 or more per week, and for men as 5 or more drinks on any day or 15 or more per week.
The NIAAA Mission
NIAAA’s mission is to generate and disseminate fundamental knowledge about the effects of alcohol on health and well-being, and apply that knowledge to improve diagnosis, prevention, and treatment of alcohol-related problems, including alcohol use disorder, across the lifespan.
- Rehm J, Gmel GE, Gmel G, et al. The relationship between different dimensions of alcohol use and the burden of disease-an update. Addict Abingdon Engl. 2017;112(6):968-1001. doi:10.1111/add.13757
- Centers for Disease Control and Prevention (CDC). Alcohol and Public Health: Alcohol-Related Disease Impact (ARDI). Annual Average for United States 2015–2019 Alcohol-Attributable Deaths Due to Excessive Alcohol Use, All Ages. Accessed April 26, 2022. https://nccd.cdc.gov/DPH_ARDI/Default/Default.aspx
- Pilar MR, Eyler AA, Moreland-Russell S, Brownson RC. Actual Causes of Death in Relation to Media, Policy, and Funding Attention: Examining Public Health Priorities. Front Public Health. 2020;8:279. doi:10.3389/fpubh.2020.00279
- Cao Y, Willett WC, Rimm EB, Stampfer MJ, Giovannucci EL. Light to moderate intake of alcohol, drinking patterns, and risk of cancer: results from two prospective US cohort studies. BMJ. 2015;351:h4238. doi:10.1136/bmj.h4238
- Freudenheim JL. Alcohol’s Effects on Breast Cancer in Women. Alcohol Res Curr Rev. 2020;40(2):11. doi:10.35946/arcr.v40.2.11
- Chatterton B, Agnoli A, Schwarz EB, Fenton JJ. Alcohol Screening During US Primary Care Visits, 2014–2016. J Gen Intern Med. Published online 2022. doi:10.1007/s11606-021-07369-1
- McKnight-Eily LR, Okoro CA, Turay K, Acero C, Hungerford D. Screening for Alcohol Use and Brief Counseling of Adults - 13 States and the District of Columbia, 2017. MMWR Morb Mortal Wkly Rep. 2020;69(10):265-270. doi:10.15585/mmwr.mm6910a3
- Mintz CM, Hartz SM, Fisher SL, et al. A cascade of care for alcohol use disorder: Using 2015-2019 National Survey on Drug Use and Health data to identify gaps in past 12-month care. Alcohol Clin Exp Res. 2021;45(6):1276-1286. doi:10.1111/acer.14609
- Han B, Jones CM, Einstein EB, Powell PA, Compton WM. Use of Medications for Alcohol Use Disorder in the US: Results From the 2019 National Survey on Drug Use and Health. JAMA Psychiatry. 2021;78(8):922-924. doi:10.1001/jamapsychiatry.2021.1271
- Kaner EF, Beyer FR, Muirhead C, et al. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev. 2018;2:CD004148. doi:10.1002/14651858.CD004148.pub4
- Kaner EFS, Dickinson HO, Beyer F, et al. The effectiveness of brief alcohol interventions in primary care settings: A systematic review. Drug Alcohol Rev. 2009;28(3):301-323. doi:https://doi.org/10.1111/j.1465-3362.2009.00071.x
- Jonas DE, Garbutt JC, Amick HR, et al. Behavioral counseling after screening for alcohol misuse in primary care: a systematic review and meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med. 2012;157(9):645-654. doi:10.7326/0003-4819-157-9-201211060-00544
- Rehm J, Anderson P, Manthey J, et al. Alcohol Use Disorders in Primary Health Care: What Do We Know and Where Do We Go? Alcohol Alcohol. Published online 2016. doi:10.1093/alcalc/agv127
- Miller PM, Thomas SE, Mallin R. Patient attitudes towards self-report and biomarker alcohol screening by primary care physicians. Alcohol Alcohol Oxf Oxfs. 2006;41(3):306-310. doi:10.1093/alcalc/agl022
- Williams EC, Kivlahan DR, Saitz R, et al. Readiness to change in primary care patients who screened positive for alcohol misuse. Ann Fam Med. 2006;4(3):213-220. doi:10.1370/afm.542
- Tan CH, Hungerford DW, Denny CH, McKnight-Eily LR. Screening for Alcohol Misuse: Practices Among U.S. Primary Care Providers, DocStyles 2016. Am J Prev Med. 2018;54(2):173-180. doi:10.1016/j.amepre.2017.11.008
- van Boekel LC, Brouwers EPM, van Weeghel J, Garretsen HFL. Healthcare professionals’ regard towards working with patients with substance use disorders: comparison of primary care, general psychiatry and specialist addiction services. Drug Alcohol Depend. 2014;134:92-98. doi:10.1016/j.drugalcdep.2013.09.012
- Williams EC, Achtmeyer CE, Young JP, et al. Barriers to and Facilitators of Alcohol Use Disorder Pharmacotherapy in Primary Care: A Qualitative Study in Five VA Clinics. J Gen Intern Med. 2018;33(3):258-267. doi:10.1007/s11606-017-4202-z
- McNeely J, Kumar PC, Rieckmann T, et al. Barriers and facilitators affecting the implementation of substance use screening in primary care clinics: a qualitative study of patients, providers, and staff. Addict Sci Clin Pract. 2018;13(1):8. doi:10.1186/s13722-018-0110-8
- Johnson M, Jackson R, Guillaume L, Meier P, Goyder E. Barriers and facilitators to implementing screening and brief intervention for alcohol misuse: a systematic review of qualitative evidence. J Public Health Oxf Engl. 2011;33(3):412-421. doi:10.1093/pubmed/fdq095
- Winters AC, Aby ES, Fix OK, German M, Haque LYK, Im GY. Joining the Fight: Enhancing Alcohol Treatment Education in Hepatology. Clin Liver Dis. 2021;18(5):225-229. doi:10.1002/cld.1127