Alcohol and Alcohol Use Disorder _ _____________________________________________________________
• The abbreviated three-question AUDIT- Consumption (AUDIT-C) • The NIAAA-recommended Single Alcohol Screening Question (SASQ)
Or • One or more positive responses to the CAGE that have occurred in the past year When is screening for alcohol problems appropriate? • As part of a routine health examination • Before prescribing a medication that interacts with alcohol • In response to presenting problems that may be alcohol related One “yes” response to the CAGE questionnaire suggests an alcohol use problem. More than one “yes” is a strong indication that a problem exists [267; 268]. AUDIT Questionnaire If a patient is CAGE positive, or if clinical suspicion remains high, the AUDIT questionnaire may be administered and can be extremely useful in detecting alcohol problems [269]. The AUDIT was developed by the WHO to identify persons whose alcohol consumption has become problematic to their health [270]. Research has shown that the AUDIT may be especially useful when screening women and minorities and has shown promise when tested in adolescents and young adults [271]. The AUDIT consists of 10 screening questions with three questions about the frequency and amount of drinking, three about dependence, and four questions about problems caused by alcohol [263; 266; 272]. 1. How often do you have a drink containing alcohol? 0 Never 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 or 8 4 10 or more 3. How often do you have 6 or more drinks on one occasion? 0 Never 1 Less than monthly 2 Monthly 3 Weekly 4 Daily or almost daily
The USPSTF concludes that there is insufficient evidence to determine the benefits and harms of screening for unhealthy alcohol use in adolescents 12 to 17 years of age [263]. The three questions on the Alcohol Use Disorders Identification Test-Concise (AUDIT-C) inquire about frequency of alcohol use, typical amount of alcohol use, and occasions of heavy use. The test takes one to two minutes to administer. Preliminary evidence suggests that the USAUDIT-C (based on U.S. standards) may be more valuable in identifying at-risk college drinkers [265]. In contrast, the SASQ inquires about past-year alcohol use and takes less than one minute to administer [263]. The CAGE questionnaire is the best known and most often studied screening tool used to detect alcohol problems. In an office setting, the four CAGE questions are often used to detect alcohol problems [266]. The first question, “Have you ever felt the need to cut down on your drinking?” is an easy question to ask. It is not threatening and at the same time suggests to the patient that you understand their pathologic attachment to alcohol [266]. A positive answer to the first and second questions strongly suggests further evaluation and brief intervention [263]. However, by itself, the CAGE questionnaire is not an adequate screening for alcohol use problems; it should trigger more intensive screening if positive [266; 267]. CAGE Questionnaire Ask current drinkers the CAGE questions: 1. Have you ever felt that you should cut down on your drinking? 2. Have people annoyed you by criticizing your drinking? 3. Have you ever felt bad or guilty about your drinking? 4. Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (eye opener)? If there is a positive response to any of these questions: • Ask if this occurred during the past year. A patient may be at risk for alcohol-related problems if: • Alcohol consumption is: Men:
>14 drinks per week or >4 drinks per occasion
Women:
>7 drinks per week or >3 drinks per occasion
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MDMI1826
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