on which that ranking was based, and the first cost–
utility analysis of screening and brief intervention.
In 2004, the United States Preventive Services Task
Force (USPSTF) released its recommendation for primary
care interventions for alcohol problems. It gave a
B rating for “screening and behavioral counseling
interventions to reduce alcohol misuse by adults, including
pregnant women.”3,4 The USPSTF found evidence
that screening in primary care settings can
accurately identify patients whose levels or patterns of
alcohol consumption do not meet criteria for alcohol
dependence, but do place them at risk for increased
morbidity and mortality. It also found evidence that
brief behavioral counseling interventions with follow-up
in such patients can produce small-to-moderate reductions
in alcohol consumption that are sustained over 6-
to 12-month periods or longer. Finally, it identified
some limited evidence that such interventions lead to
positive health outcomes 4 or more years post-intervention,
and that screening and behavioral counseling
reduce alcohol-related morbidity. Since alcohol misuse
is a serious common health problem, even indirect
evidence that it can be affected by interventions in