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Doctors reluctant to talk with patients about binge drinking

FILE - In this Sept. 16, 2017, file photo, young people celebrate the opening of the 184th Oktoberfest beer festival in Munich, Germany. (Matthias Schrader / AP)
FILE - In this Sept. 16, 2017, file photo, young people celebrate the opening of the 184th Oktoberfest beer festival in Munich, Germany. (Matthias Schrader / AP)

Outside of a handful of college dormitories, most adults probably know slamming back shots isn’t a good strategy for long-term health.

But most Washingtonians who engage in binge drinking report their doctors haven’t talked to them about cutting back, according to a new study from the Washington Health Alliance.

The WHA surveyed about 52,000 people across Washington about their experiences with primary care providers, which included questions about alcohol use.

About one-third of respondents said they never drank. But among those who did, 25 percent reported having five or more drinks on one occasion at least once in the past year, and only 28 percent said their doctor had talked to them about cutting back.

Women were less likely to be talked to about their alcohol use than men, the study showed, though women typically reported engaging in binge drinking less frequently than men.

Five drinks in a sitting is the cutoff for binge drinking in men, said Susie Dade, deputy director of the WHA. For women, four or more drinks in a single occasion is considered binge drinking.

Health care providers also measure problem drinking by the amount someone drinks in a typical week. Having more than seven drinks a week for women or 14 for men is considered unhealthy, but Dade said the survey didn’t have space to ask about that.

In total, about 1,300 people said they had five or more drinks at least weekly. Weekly binge drinkers said doctors talked to them about 60 percent of the time, and daily drinkers said they were advised to cut back about 74 percent of the time.

“Providers appear to be more likely to give advice when the frequency of drinking accelerates,” Dade said. But the practice is far from universal.

A cautionary note from a doctor might sound like a minor intervention, but there’s research showing it does reduce alcohol consumption.

The U.S. Preventative Services Task Force, an independent group of health care providers that analyzes research on the effectiveness of medical treatments, found that primary care doctors briefly asking about alcohol use and advising heavy drinkers to cut back is “effective in reducing heavy drinking episodes in adults engaging in risky or hazardous drinking.” It’s also a low-cost strategy with few harmful side effects.

The survey is based on patient perceptions of their interactions with doctors, so it’s possible a patient was told to cut back and misremembered the conversation, Dade said. Some doctors may opt not to raise the issue for any number of reasons.

But a larger issue may be that doctors simply aren’t asking patients about their drinking, preventing them from identifying people who routinely engage in binge drinking.

“You’ve gotta ask the question to know whether drinking is a problem for someone,” Dade said.

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