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By Linda Carroll

At least 38 million Americans binge drink — regularly downing at least four alcoholic beverages in a single bout — but many doctors are failing to discuss with their patients how dangerous this behavior can be, a new government report shows.  

Only one in six adults, and one in four binge drinkers, say that a health care professional has ever discussed alcohol use with them, according to the report released Tuesday by the Centers for Disease Prevention and Control.

“Alcohol causes more health and social problems than most people recognize, from problems with your liver to infections to risk of injury to a whole bunch of social problems, like problems at work,” CDC director Dr. Tom Frieden told NBC News. “A small conversation can make a big difference and help people reduce their alcohol use, but those conversations aren't happening.”

Studies link excessive alcohol use to 88,000 deaths per year in the United States and to an estimated cost of $224 billion for 2006, according to CDC researchers.

The new report was based on surveys completed by 166,753 adults from 44 states and the District of Columbia.

CDC researchers found a number of reasons doctors avoided the subject, including a lack of time and doubts about treatment effectiveness. And many doctors are embarrassed to bring up the topic of alcohol because they may be heavy drinkers themselves, said Dr. Charles O’Brien, the Kenneth Appel Professor in the department of Psychiatry at the Perelman School of Medicine, Philadelphia.

“Doctors tend to abuse alcohol, too, so they’re embarrassed to talk about it with patients when they realize their own use might be just as much as the patient they’re talking to.”

It’s a very important discussion to have, O’Brien said. A person doesn't have to give up drinking completely, "just cutting back can make a big difference," he added.

The CDC defines heavy drinking as 15 or more drinks a week for men and eight or more drinks a week for women. Many of these heavy drinkers aren't alcoholics, but even those who drink less than that per week might be in the health danger zone if they consume too much alcohol in a day: five or more drinks for men, four or more for women.

Many people fail to realize the toll that drinking takes on the heart, said Dr. Joon Lee, chief of cardiology at the University of Pittsburgh Medical Center. “At high doses alcohol can have a direct toxic effect on the heart, weakening the heart muscle itself. It can also bring on atrial fibrillation.”

The sooner you cut back the better chance you’ll have to reverse the damage, he added. “So there’s a lot of incentive to stop drinking.”

A drink is five ounces of wine; 12 ounces of beer and no more than 1.5 ounces of 80 proof liquor a day. The CDC recommends no more than two drinks a day for men and no more than one drink a day for women.