Screening

Alcohol misuse screening

The US Preventive Services Task Force recommends screening for unhealthy alcohol use in primary care settings in adults 18 years and older.[75] A thorough history of alcohol use should be obtained, and standard screening questionnaires performed.[1]​​

Standard, validated questionnaires are more effective in the detection and diagnosis of ARLD than any routine clinical or laboratory evaluations.[76] Popular questionnaires used to assess the presence of alcohol dependency are AUDIT (Alcohol Use Disorders Identification Test), AUDIT-C, and CAGE.[37][38][39] [ Alcohol Consumption Screening AUDIT Questionnaire Opens in new window ] ​​ The CAGE questionnaire is easier to use, but AUDIT and AUDIT-C are more reliable.

AUDIT (Alcohol Use Disorders Identification Test) questionnaire

The AUDIT questionnaire, developed by the World Health Organization, consists of 10 questions. A score of 8 or more (≥7 for age >65 years) indicates an alcohol use disorder and alcohol dependence with sensitivity >90% and specificity >80%, while a score of >3 in a man or >2 in a woman indicates alcohol use disorder with sensitivity >80%. An overall score of >4 in men or >2 in women identifies 84% to 86% of patients with an alcohol use disorder.[40] The American College of Gastroenterology and the European Association for the Study of the Liver both recommend the AUDIT questionnaire.[1][41] ​

AUDIT-C 3-item alcohol screen

Identifies people who are hazardous drinkers, or who have alcohol use disorder. It is a modified version of the 10-question AUDIT questionnaire. AUDIT-C comprises three questions asking about frequency of alcohol use, typical amount of alcohol use, and occasions of heavy use. AUDIT-C takes approximately 1-2 minutes to administer.

CAGE questionnaire

The CAGE questionnaire takes its name from its 4 simple questions and is a useful tool for screening alcohol misuse or dependency:

C: Have you ever felt you needed to CUT down on your drinking?

A: Have people ANNOYED you by criticising your drinking?

G: Have you ever felt GUILTY about drinking?

E: Have you ever felt you needed a drink first thing in the morning (EYE-OPENER) to steady your nerves or get rid of a hangover?

Two or more positive answers indicate alcohol dependency with sensitivity of 70% to 96% and specificity of 91% to 99%.[38][39]

Hepatocellular carcinoma screening

Serial imaging studies such as ultrasound have been used for hepatocellular carcinoma (HCC) screening in patients with alcohol-related cirrhosis. Ultrasound of the abdomen with or without alpha-fetoprotein estimation approximately every 6 months is used to screen for HCC in patients with ARLD with cirrhosis.​[1][77]​​[78]​​​​​​ The sensitivity of ultrasound for HCC detection is 60% and the specificity 97%.​[79]

Use of this content is subject to our disclaimer