From the Guidelines
The AUDIT (Alcohol Use Disorders Identification Test) is the most appropriate screening tool for identifying both alcohol use disorder and hazardous drinking, as it provides a comprehensive assessment of consumption patterns, dependence symptoms, and alcohol-related problems 1.
Key Features of AUDIT
- Evaluates consumption patterns, dependence symptoms, and alcohol-related problems
- 10-question assessment
- Can be used alone or embedded in broader health risk or lifestyle assessments
Alternative Screening Tools
- CAGE questionnaire: 4 questions focusing on feeling the need to Cut down, Annoyance by criticism, Guilty feelings, and Eye-openers (morning drinking)
- MAST (Michigan Alcohol Screening Test): 25-question evaluation
- TWEAK and T-ACE tools: specifically designed for pregnant women
Importance of Screening
- Identifies patterns of problematic drinking before severe addiction develops
- Allows for earlier intervention
- Should be conducted in a non-judgmental environment
- Positive screens should be followed by appropriate referrals to addiction specialists, counseling services, or treatment programs
Recent Recommendations
- The US Preventive Services Task Force recommends using the AUDIT, AUDIT-C, or single-question screening to detect alcohol misuse in adults, young adults, and pregnant women 1
- The AUDIT shows an optimal balance of sensitivity and specificity for detecting all forms of alcohol misuse when cutoff points of 4 or more are used 1
From the Research
Alcohol Addiction Screening Tools
- The Alcohol Use Disorders Identification Test (AUDIT) is a widely used instrument for screening alcohol misuse in primary health care 2.
- The AUDIT-C is a version of the AUDIT that focuses on the consumption elements, but it has methodological problems with validation 2.
- The USAUDIT is a new version of the AUDIT adapted to US standard drink size and hazardous drinking guidelines, providing greater accuracy in measuring alcohol consumption 2.
Screening and Treatment
- Routine screening for heavy alcohol use can identify patients with alcohol use disorder (AUD) and has been recommended, but only 1 in 6 US adults report ever having been asked by a health professional about their drinking behavior 3.
- Patients receiving a diagnosis of AUD should be given brief counseling and prescribed a first-line medication (e.g., naltrexone) or referred for a more intensive psychosocial intervention 3.
- Four medications are approved by the US Food and Drug Administration to treat AUD: disulfiram, naltrexone, acamprosate, and topiramate 3, 4, 5.
Pharmacotherapy
- Naltrexone reduces the likelihood of a return to any drinking by 5% and binge-drinking risk by 10% 3.
- Disulfiram, naltrexone, and acamprosate are effective in reducing drinking outcomes, with disulfiram appearing superior, especially during the continuous medication period 4.
- Anticonvulsants, such as baclofen, are of growing interest for the treatment of AUD, although currently none are FDA approved for this indication 5.
- Combined pharmacotherapy may be beneficial in addressing specific symptoms of AUD or in specific subpopulations, but the evidence is limited by low statistical power and heterogeneity of drug combinations and outcome measures 6.