How extensive is the alcohol problem? First, you have to ask.

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Relax with WineBy the CDC s definitions, over 38 million Americans drink too much, and alcohol causes or significantly contributes to 88,000 premature deaths each year in the U.S. Despite these grim statistics, a new survey carried out by the CDC seems to show that our nation s healthcare providers by and large, physicians are failing to address an important aspect of their patients health status, by a factor of about 5 to 1.

The survey, published in MMWR, obtained data through the annual Behavioral Risk Factor Surveillance System telephone survey. The researchers asked almost 167,000 adults over the latter half of 2011 about their alcohol use, and their recollections of discussions with providers.

Only 16 percent of the total group remembered any conversation with a healthcare professional about their alcohol intake. Perhaps even more disturbing, only slightly more than 17 percent of pregnant women had such a memory.

The CDC s director, Dr. Thomas Frieden, bemoaned this situation, as he told a press conference: Alcohol screening and brief interventions, which include brief counseling, can substantially reduce the amount of alcohol consumed. But unfortunately, it's not happening often enough.

He also discussed the report with Medscape Medical News: We really do want this to be routine. We know that if doctors try to use their preconceived notions of who may be at risk, they get it wrong. So if you don't ask, you don't get the answer.

Worse still, he added, "For every 1 person who is an alcoholic, there are about 6 who are problem drinkers, drinking enough to adversely affect their lives, their health, their work situation, or their family situation, but who are not alcoholic. The CDC defines "drinking too much" as high average weekly use and/or any binge drinking, as well as any use of alcohol by those younger than 21 years or by those who are pregnant. The CDC officially asserts that alcohol screening and brief intervention (ASBI) "can reduce the amount of alcohol consumed on an occasion by 25% among those who drink too much. It is recommended for all adults, including pregnant women."

However, a completely different perspective can be found thanks to Jacob Sullum s commentary on Forbes.com, Do You Drink Too Much? Don't Ask The CDC. Here is the essence of his argument, i.e. that the CDC is being too rigid and dare I say it? judgmental, even moralistic:

[T]he government s notion of a binge encompasses common patterns of social drinking that cause no measurable harm to anyone or anything, except for the CDC s sensibilities e.g., an after-work cocktail, followed by wine during dinner with friends and an after-dinner drink. I confess I have been known to binge in this manner from time to time. Once a month is all it takes to be counted among the 38 million, the vast majority of whom would not qualify for a diagnosis of alcohol dependence or even alcohol abuse but who nevertheless need to change their ways, according to the CDC.

ACSH s Dr. Gilbert Ross had this comment: While surely not disagreeing with Mr. Sullum s skeptical view of the CDC on personal behavior regular Dispatch readers will have sensed our own frequent disdain for that agency as a former clinician, I find it inexcusable to not even inquire about a patient s drinking habits, which do often play a key role in their overall health.