Managing alcohol problems and risky drinking

While overall alcohol consumption and alcohol-related automobile deaths hav e declined, rates of alcohol dependence, liver cirrhosis, and alcohol-relat ed problems remain high among adults, and binge drinking continues as a maj or health risk for high school and college students. Some individual-level downstream interventions have been evaluated with sufficient rigor to recom mend widespread dissemination, and widened availability of new pharmacother apies could further increase effectiveness. Midstream population-based prog rams, such as screening and brief interventions in hospitals and managed ca re organizations, may have greater public health impact than tertiary treat ment because of early identification and low cost. Upstream programs and po licies that place limits on alcohol availability (e.g., higher legal purcha sing age) have the greatest potential to reduce morbidity and mortality at the least cost to society.