Early diagnosis of unhealthy alcohol use or alcohol-use disorder can allow clinicians to initiate treatment promptly, in order to lessen the impact from emotional, medical, occupational, financial, and social complications. Screening for unhealthy alcohol use and assessment and diagnosis of alcohol-use disorder can be performed by clinicians at various points in the process of providing healthcare services:
As part of a routine examination
Prior to prescribing a medication that interacts with alcohol
In the accident and emergency department or trauma centre (especially with presentations secondary to trauma/injuries, violence)[56]American College of Surgeons. Best practices guidelines: screening and intervention for mental health disorders and substance use and misuse in the acute trauma patient. Dec 2022 [internet publication].
https://www.facs.org/media/nrcj31ku/mental-health-guidelines.pdf
During pregnancy
When there are health problems that might be alcohol-related (e.g., cardiac arrhythmia, dyspepsia, liver disease, hypertension, depression, anxiety, insomnia, trauma).
The United States Preventive Services Task Force recommends screening all adults in primary care settings over the age of 18, and to provide brief interventions for all patients who report at-risk drinking and offer treatment to those with alcohol-use disorder.[57]US Preventive Services Task Force, Curry SJ, Krist AH, et al. Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: US Preventive Services Task Force recommendation statement. JAMA. 2018 Nov 13;320(18):1899-09.
https://www.doi.org/10.1001/jama.2018.16789
http://www.ncbi.nlm.nih.gov/pubmed/30422199?tool=bestpractice.com
Nonetheless, only 23% of physicians used a validated instrument to screen for alcohol use, in one multi-site study.[58]Seale JP, Johnson JA, Clark DC, et al. A Multisite Initiative to Increase the Use of Alcohol Screening and Brief Intervention Through Resident Training and Clinic Systems Changes. Acad Med. 2015 Dec;90(12):1707-12.
https://www.doi.org/10.1097/ACM.0000000000000846
http://www.ncbi.nlm.nih.gov/pubmed/26200578?tool=bestpractice.com
A specific questionnaire that may be used to screen people for unhealthy alcohol use is the 10-question Alcohol Use Disorders Identification Test (AUDIT).[35]Agabio R, Nioi M, Serra C, et al. Alcohol use disorders in primary care patients in Cagliari, Italy. Alcohol Alcohol. 2006 May-Jun;41(3):341-4.
https://academic.oup.com/alcalc/article/41/3/341/93274
http://www.ncbi.nlm.nih.gov/pubmed/16490789?tool=bestpractice.com
The AUDIT is sensitive in identifying less severe drinking problems.[36]Berner MM, Kriston L, Bentele M, et al. The alcohol use disorders
identification test for detecting at-risk drinking: a systematic review and meta-analysis. J Stud Alcohol Drugs. 2007 May;68(3):461-73.
http://www.ncbi.nlm.nih.gov/pubmed/17446987?tool=bestpractice.com
A modified three-question version, the AUDIT-C, has been validated against the full AUDIT and has a similar sensitivity.[59]Bush K, Kivlahan DR, McDonell MB, et al. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Arch Intern Med. 1998 Sep 14;158(16):1789-95.
https://www.doi.org/10.1001/archinte.158.16.1789
http://www.ncbi.nlm.nih.gov/pubmed/9738608?tool=bestpractice.com