Screening for Alcohol in Dental Practices

Carolyn Swenson, MSPH, MSN, FNP and Rachel Steffl, MA, LPC, LAC; Peer Assistance Services

According to the Centers for Disease Control and Prevention, at least 38 million Americans drink too much and most do not have an alcohol use disorder. Yet, only one in six people has ever talked with a healthcare professional about alcohol. Drinking too much includes binge drinking (more than three drinks in a sitting for women; more than four for men), weekly consumption above a moderate level, and any alcohol use under age 21 or by pregnant women.

We believe that dentists can play an important role in addressing this issue since they have an ongoing relationship with individuals and some people may see a dentist more often than they see a primary healthcare professional. In addition, unhealthy alcohol intake may co-occur with other substance use that is known to affect oral health such as tobacco, marijuana and illicit drugs. According to the American Cancer Society, heavy alcohol consumption combined with tobacco use has been identified as a primary risk factor for 75 % of oral cancers in the United States. Some patients who struggle to quit smoking tobacco are more likely to be successful if they change their pattern of alcohol and tobacco use at the same time. Additionally, heavy alcohol consumption has also been linked to periodontal disease and chronic tooth decay. Oral health complications are just some of the negative consequences related to heavy alcohol consumption. Dentists who take part in SBIRT can play a vital role in the prevention and intervention of costly and deadly diseases.

Screening for alcohol can be as simple as asking one question of all patients age 18 or older: “How many times have you had X or more drinks in a day?”, where X is four for women and five for men, and a response of 1 or more times is considered positive. Brief counseling can be as simple as interpreting the screening result for the patient so they are aware of what constitutes moderate drinking and giving advice to cut back or abstain. Screening and brief counseling can reduce alcohol consumption by as much as 25%. The earlier we intervene to address drinking above moderate levels, the more likely we are to prevent progression to a substance use disorder, prevent and improve other chronic health conditions, and prevent injuries and violence. Our experience in Colorado conrms the effectiveness of this prevention service. Since 2007, over 140,000 Coloradoans have received screening and brief counseling. Follow-up interviews conducted with a sample of patients from 2007-2011 found a 49.3% reduction in alcohol use and a 47.5% reduction in illegal drug use six months following screening.

Different members of the dental team can help to carry out screening and brief counseling as part of preventive oral health counseling; for example, dental hygienists and dentists. The SBIRT Colorado program at Peer Assistance Services, Inc. offers training and technical assistance to help health professionals in Colorado implement alcohol screening and brief counseling. Contact Carolyn Swenson for more information: cswenson@

About the Authors

Ms. Carolyn Swenson, MSPH, MSN, FNP is a family nurse practitioner with a Master of Science in Nursing from Pace University and a Master of Science in Public Health from the University of Colorado. She is the Manager of Training and Consultation for SBIRT- CO.

Rachel Steffl, MA, LPC, LAC is the Program Lead for the Dental Peer Health Assistance Program at Peer Assistance Services, Inc. Ms. Steffl holds a Master’s Degree in Counseling from Colorado Christian University, and is a Licensed Professional Counselor as well as a Licensed Addition Counselor. Rachel Steffl has over 6 years of experience working with individuals with substance use and co-occurring disorders.