Today, I review, link to, and excerpt from resources for screening for alcohol use disorder.
- Curbsiders Addiction Medicine #4 Wrapping Our Heads Around Alcohol Use Disorder Meds
July 28, 2022 | By Zina Huxley-Reicher. - Rethinking Drinking: Alcohol And Your Health. Accessed 3-31-2025.
- AUDIT: Alcohol Use Disorders Identification Test. Accessed 3-31-2025
All that follows is from the above resources.
All that follows is from reference 1 above.
- Curbsiders Addiction Medicine #4 Wrapping Our Heads Around Alcohol Use Disorder Meds
July 28, 2022 | By Zina Huxley-Reicher.
Diagnosing Alcohol Use Disorder
Take an alcohol use history – Dr. Peterkin recommends starting with general questions about how much a patient drinks in one sitting and how often in a week. Unhealthy alcohol use includes both binge drinking and heavy drinking. Binge drinking means exceeding daily limits – 4 or more drinks consumed on one occasion for women, or 5 or more drinks consumed on one occasion for men. Heavy drinking means exceeding weekly limits – 8 or more drinks or more per week for women, or 15 or more drinks per week for men (CDC 2019).
Assess whether a patient meets the criteria for unhealthy use or alcohol use disorder (AUD) using the following tools:
- First, use a single-item, calendar-based screener that is validated in primary care settings (Smith, 2009). Ask “How many times in the past year have you had X or more drinks in a day?”, where X is 5 for men and 4 for women. A response of >1 means that the patient meets the criteria for unhealthy alcohol use.
- Other screening tools include the AUDIT and AUDIT-C, but these are lengthier so they might be less user-friendly. The CAGE questionnaire has low sensitivity for detecting mild cases of unhealthy use (Dhalla, 2007).
- Next, assess for AUD using criteria from the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) (NIAAA, 2021). These eleven criteria determine whether someone has experienced problems related to alcohol use. If a patient answers yes to two or more criteria, then they carry a diagnosis of AUD. Depending on the number of criteria that a patient meets, you can diagnose a mild, moderate, or severe use disorder. The criteria are included below.
11 – DSM-V Criteria
- Substance is taken in larger amounts or over a longer period of time than intended
- There is a persistent desire or unsuccessful efforts to cut down or control substance use
- A great deal of time is spent in activities necessary to obtain, use or recover from its effects
- Craving, or a strong desire to use the substance
- Recurrent substance use resulting in failure to fulfill major role obligations at work, school, or home
- Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of substances
- Important social, occupational, or recreational activities are given up or reduced because of substance use
- Recurrent substance use in situations in which it is physically hazardous
- Continued use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by substance
- Tolerance (defined as a need for markedly increased amounts of substance to achieve intoxication or desire effects, OR markedly diminished effect with continued use of the same amount of a substance)
- Withdraw
Defining a standard drink:
Patients (and providers) may not have a great sense of what a standard drink is, so we need to clarify units to quantify use. Use familiar metrics such as a bottle of wine or 12-ounce beer. Walk through this visual tool*with patients or with this interactive tool where a patient “pours” their drink can help.
All that follows is from reference 2 above. 2. Rethinking Drinking: Alcohol And Your Health. Accessed 3-31-2025.
The examples above serve as a starting point for comparison. For different types of beer, wine, or malt liquor, the alcohol content can vary greatly. Some differences are smaller than you might expect, however. Many light beers, for example, have almost as much alcohol as regular beer—about 85% as much, or 4.2% versus 5.0% alcohol by volume (alc/vol), on average.
Although the U.S. standard drink (alcoholic drink equivalent) amounts are helpful for following health guidelines, they may not reflect customary serving sizes. In addition, while the alcohol concentrations listed are “typical,” there is considerable variability in alcohol content within each type of beverage.
Do you drink cocktails or a beverage containing alcohol not listed above? If you’re curious and willing to do a little research on your beverage’s alcohol content, you can use Rethinking Drinking’s calculators to estimate the number of U.S. standard drinks (alcoholic drink equivalents) in a cocktail or container.
1 Distilled spirits include vodka, whiskey, gin, rum, and tequila.
What are the U.S. Guidelines for Drinking?
Developed by the U.S. Department of Agriculture and the U.S. Department of Health and Human Services, the 2020–2025 Dietary Guidelines for Americans provide recommendations on what the average American should eat and drink to promote health and help prevent chronic disease. According to the guidelines, adults of legal drinking age can choose not to drink or to drink in moderation by limiting intake to two drinks or less in a day for men and one drink or less in a day for women when alcohol is consumed. Drinking less is better for health than drinking more. There are some adults who should not drink alcohol, such as women who are pregnant. Adults who choose to drink, and are not among the individuals listed below who should not drink, are encouraged to limit daily intakes to align with the Dietary Guidelines. People who do not drink should not start drinking for any reason.
When Is Drinking in Moderation Still Too Much?
According to the 2020–2025 Dietary Guidelines for Americans, certain individuals should not consume alcohol. It’s safest to avoid alcohol altogether if you are:
- Taking medications that interact with alcohol
- Managing a medical condition that can be made worse by drinking
- Under the age of 21, the minimum legal drinking age in the United States
- Recovering from alcohol use disorder (AUD) or unable to control the amount you drink
- Pregnant or might be pregnant
In addition, certain individuals, particularly older adults, who are planning to drive a vehicle or operate machinery—or who are participating in activities that require skill, coordination, and alertness—should avoid alcohol completely.
All that follows is from reference 3 above. 3. AUDIT: Alcohol Use Disorders Identification Test. Accessed 3-31-2025:
3. AUDIT: Alcohol Use Disorders Identification Test
The AUDIT (Alcohol Use Disorders Identification Test) is a simple and effective method of screening for unhealthy alcohol use, defined as risky or hazardous consumption or any alcohol use disorder.
A. CHECK YOUR DRINKING: An interactive self-test
The AUDIT questionnaire is designed to help in the self-assessment of alcohol consumption and to identify any implications for the person’s health and wellbeing, now and in the future.
It consists of 10 questions on alcohol use. The responses to these questions can be scored and the total score prompts feedback to the person and in some cases offers specific advice.
Conduct a quick self-test with the AUDIT link. Click on “submit” at the end for an instant assessment.
The AUDIT has 10 questions and the possible responses to each question are scored 0, 1, 2, 3 or 4, with the exception of questions 9 and 10 which have possible responses of 0, 2 and 4.
The range of possible scores is from 0 to 40 where 0 indicates an abstainer who has never had any problems from alcohol. A score of 1 to 7 suggests low-risk consumption according to World Health Organization (WHO) guidelines. Scores from 8 to 14 suggest hazardous or harmful alcohol consumption and a score of 15 or more indicates the likelihood of alcohol dependence (moderate-severe alcohol use disorder).
Results from the original WHO study showed that the term “drink” in questions 2 and 3 encompassed amounts of alcohol ranging from 8 grams to 13 grams. Where a standard drink is defined as an amount outside this range (e.g. 20 grams) it is recommended that the response categories are modified accordingly.
See: Drink-Less Program, AUDIT Decision Tree, Interactive AUDIT Test and FAQs
