Screening

The reasons for screening patients for alcohol use include identifying problem drinkers, and prevention of progression of alcohol abuse and related medical complications.

Screening tools

Patients should be screened for alcohol use disorder (AUD) using a formal assessment tool such as AUDIT-C (Alcohol Use Disorders Identification Test - Consumption), FAST (Fast Alcohol Screening Test), or CAGE.[9][43] Alcohol use disorders identification test consumption (AUDIT C) Opens in new window Fast Alcohol Screening Test (FAST) Opens in new window CAGE questionnaire Opens in new window The full AUDIT (Alcohol Use Disorders Identification Test) may also be used, but it takes longer to perform than the other screening tools and therefore may not be suitable in an acute hospital setting.[9][43][57] The National Institute on Alcohol Abuse and Alcoholism (NIAAA) recommends an initial one-question screen to identify potential alcohol use disorder, which is: “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.[9][43][44] This test is positive if the patient’s response is >1, and a formal assessment tool such as AUDIT should then be used.[9][43][44]

Alcohol screening may be difficult to perform in a busy clinical setting (e.g., emergency department) due to limited resources and/or lack of time. Simple screening tools such as CAGE and FAST (4 questions) can be performed in around 12 seconds, while AUDIT (10 questions) requires up to 78 seconds to perform.[81] It is important, therefore, to select the appropriate screening tool for clinical application.

Patients who have tested positive for AUD and are at risk of alcohol withdrawal should have their degree of alcohol dependence assessed using a formal screening tool such as the Severity of Alcohol Dependence Questionnaire or the Leeds Dependence Questionnaire.[9][45][46][47][82] AUDIT-C, FAST, CAGE, and AUDIT only identify alcohol use disorder and do not predict which patients are at risk of alcohol withdrawal.

Patients with a reduced conscious level, and unable to be screened by the above methods, should be monitored for clinical signs of alcohol withdrawal.[5] Patients in the intensive care unit who are suspected to be dependent on alcohol should receive prophylactic treatment for alcohol withdrawal.[5]

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