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AUDIT (Alcohol Use Disorders Identification Test) Screening
Explain what is meant by “alcoholic beverages:” 12 oz beer, 5 oz wine,1.5 oz hard alcohol

AUDIT C (Questions 1,2,3): Total score of 4 or more indicates possible problem with alcohol
(Sens: 86%, Spec: 72%)
1. How often do you have a drink containing alcohol?
(0) Never [Skip to Qs 9-10]
(1) Monthly or less
(2) 2 to 4 times a month
(3) 2 to 3 times a week
(4) 4 or more times a week

 
2. How many drinks containing alcohol do you have on a typical day when you are drinking?
(0) 1 or 2
(1) 3 or 4
(2) 5 or 6
(3) 7, 8, or 9
(4) 10 or more

 
3. How often do you have six or more drinks on one occasion?   
(0) Never 
(1) Less than monthly
(2) Monthly
(3) Weekly
(4) Daily or almost daily

 
Skip to Questions 9 and 10 if Total Score for Questions 2 and 3 = 0   
4. How often during the last year have you found that you were not able to stop drinking once you had started?
(0) Never
(1) Less than monthly
(2) Monthly 
(3) Weekly
(4) Daily or almost daily

 
5. How often during the last year have you failed to do what was normally expected from you because of drinking? 
(0) Never
(1) Less than monthly
(2) Monthly
(3) Weekly
(4) Daily or almost daily

 
6. How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?
(0) Never
(1) Less than monthly
(2) Monthly
(3) Weekly
(4) Daily or almost daily

 
 7. How often during the last year have you had a feeling of guilt or remorse after drinking?
(0) Never
(1) Less than monthly
(2) Monthly
(3) Weekly
(4) Daily or almost daily

 
8. How often during the last year have you been unable to remember what happened the night before because you had been drinking?
(0) Never
(1) Less than monthly
(2) Monthly
(3) Weekly
(4) Daily or almost daily

 
9. Have you or someone else been injured as a result of your drinking? 
(0) Never
(2) Yes, but not in the last year
(4) Yes, during the last year

 
10. Has a relative or friend or a doctor or another health worker been concerned about your drinking or suggested you cut down?  
(0) Never
(2) Yes, but not in the last year
(4) Yes, during the last year 

 
Scoring:
8 – 15: are most appropriate for advice focused on the reduction of hazardous drinking. (Sens: 51-97% Spec:78-96%)
16 – 19: suggest brief counseling and continued monitoring. (Sens: 51-97% Spec:78-96%)
20+: clearly warrant further diagnostic evaluation for alcohol dependence (Sens: 51-97% Spec:78-96%)
SBIRT Model to Evaluate for and Treat Alcohol Abuse

SCREENING

• AUDIT
• CAGE (limited utility) - (Cutting Down, Angry with criticism, Guilty Feeling, Eye Opener): classic screening tool but has limitations, misses many people with moderate problems with alcohol use.
• Alternative Screening Tool: “Drinkers, When Quitting, Complain Most”
- Do you drink?  If no, why not (may reveal history of alcohol abuse or family history of abuse).
- When was your last drink? May help if last drink was long time ago.
- Ever cut down or quit? Normal drinkers don’t feel need to cut down or quit, while problem drinkers consider cutting down a sign of good control – exceptions pregnancy, weight loss.
- Anyone complain about your drinking? High correlation with problem drinking.  
- Most alcohol in one sitting in the past year? Tolerance suggests frequent/excessive use.  


If responses suggest a problem, explore further with: history of blackouts (alcohol-related amnesia), DUI arrests, AA attendance, substance abuse counseling, family history of alcoholism.

BRIEF INTERVENTION:
Brief motivational interview to open the subject and allow for communication. See alcohol challenge as one example of a “Brief Intervention” below.
• Alcohol Challenge Test: Ask patient to limit to 1 drink/day x 1 month or no alcohol for 3 weeks, with the understanding that exceeding this would indicate a loss of control (that s/he may have been denying)
Labs: CBC (MCV), Liver Function Tests (LFTs), Uric Acid, GGT (CLUG)
• Patient follows up to discuss results of lab tests and the above challenge.

REFERRAL TO TREATMENT:
• If patient is high risk or does not succeed in initial intervention, consider AA (aa.org) or other 12 step group, meds, and/or substance disorder counselor.
• Smart Recovery (smartrecovery.org) is a non-spiritual self help group based on Cognitive Behavioral Therapy. Some patients prefer this option to AA.

Prepared by Wayne Altman, MD; Poul LaPlante, MD (poul.laplante@comcast.net);
Zev Schuman-Olivier, MD; Neal Biddick, MD

 

Author(s): Wayne Altman, M.D.
Created: Wednesday November 14, 2012
Modified: Monday May 18, 2020

Copyright Information: Copyright 2012, Tufts University

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