Alcohol plays an important role in US Society; for many, social functions such as a trip to the ballgame or an evening out would not be complete without a beer or a glass of wine. The perils of alcohol are well known; it’s the leading cause of traffic fatalities in the United States and other health and social consequences of excess alcohol consumption are common. Largely in response to the social consequences of excess drinking, temperance societies have existed worldwide since the 1800s and were able to successfully ban alcohol for several years in many countries including Canada (1901–1924), Iceland (1915–1935), Finland (1919–1932), Norway (1916–1927) and the United States (1919–1933).

Wilson and colleagues found that less than half of older Americans drank at all, declining to less than one-third by age 80.1 Based on the amount consumed, they found that 15 % of older drinkers exceeded recommended limits, but when other health characteristics were taken into account, drinking was potentially harmful in over one-third of those who drank. Wilson’s findings are not new; they are similar to results reported in previous studies that included both the amount and the subject’s health characteristics in judging the healthiness of drinking.2 This study serves to remind providers that it’s not just the amount consumed that needs to be considered; even modest consumption may be harmful in patients with some health conditions. Unfortunately, most current alcohol screens rely heavily on classifying drinking based on the amount consumed,3 and don’t take into consideration comorbidities such as depression or chronic hepatitis. Unfortunately, problems in primary care providers’ communication with patients about drinking have been well documented.4,5 Screening and intervention for alcohol needs to be contextualized, taking into account more than just the amount consumed, and primary care providers need better training and tools to intervene in their older adults who could be engaging in harmful drinking.