Alcohol Use Screening: The Questions Asked and What the Scores Mean

What it involves

MedlinePlus explains that alcohol use screening tests are questionnaires about your drinking, used to check for unhealthy alcohol use and your risk of alcohol use disorder, or AUD. The tests carry no physical risk, need no preparation, and are often done as part of an ordinary health care visit.

Who this is for

• Patients who want a straight answer on whether their drinking pattern is in a healthy range
• Patients whose family or friends have commented on their drinking
• Patients with liver test changes, high blood pressure, poor sleep or low mood that alcohol may be feeding
• Patients who have tried to cut down and found it harder than expected

What to expect

• A handful of questions about how often and how much you drink, asked in a private room
• A score that places your pattern in a lower-risk range or flags it for a longer conversation
• Plain information on what the score means, with no pressure to reach any conclusion that day
• Counseling, support group or medicine options discussed if a problem is identified, and referral when more help is needed

The questionnaires providers actually use

MedlinePlus names several. The Alcohol Use Disorders Identification Test, known as AUDIT, has 10 multiple-choice questions about how much and how often you drink and whether it has caused problems. Answers are scored on a point system, and it says a score of 8 or more may indicate AUD. A shorter version, AUDIT-C, has three questions, each valued from 0 to 4 points, and a higher total makes AUD more likely. A one-question screen from the National Institute on Alcohol Abuse and Alcoholism asks how many times in the past year you had four or more drinks in a day for women, or five or more for men.

What counts as binge drinking

MedlinePlus defines binge drinking as drinking so much at once that blood alcohol concentration reaches 0.08 percent or more. For a man that usually takes five or more drinks within a few hours, and for a woman about four or more. It adds that not everyone who binge drinks has AUD, but they are at higher risk of developing it. The point of that definition is practical: a person who never drinks daily can still be drinking in a way that raises risk.

Signs that a conversation is overdue

MedlinePlus lists symptoms that a screening may bring out: drinking more or for longer than planned, trying to cut down and not managing it, strong cravings, hiding bottles and glasses, and continuing to drink despite trouble in relationships, work or health. Building a tolerance, drinking when it is not safe such as before driving, and withdrawal symptoms like tremor, headache, weakness, sweating or nausea when you stop are also on the list. MedlinePlus says you may have AUD if you answer yes to two or more of its questions about the past year.

What the scores are for

A questionnaire is a starting point and not a diagnosis. MedlinePlus groups results by severity: two to three symptoms is mild, four to five is moderate, and six or more is severe. A mild result may lead to steps toward changing drinking habits, a moderate one to a brief intervention, which is a short counseling session, and a severe one to more intensive care that can include a specialist, medicines, support groups or recovery programs. The CAGE questions are still used in some places, but MedlinePlus says they are no longer recommended because better tools exist.

Why alcohol belongs in a primary care visit

According to MedlinePlus, heavy drinking can raise the risk of certain cancers, lead to liver diseases such as alcohol-associated liver disease and cirrhosis, and damage the brain and other organs. It also increases the risk of death from car crashes and injuries. Several of those problems show up first in ordinary office measurements. The liver function tests guide explains one common blood panel, and the high blood pressure guide covers another number that alcohol can move.

If you want to cut back or stop

MedlinePlus says some people with AUD can change their behavior to cut back, while others need to stop completely, and that which path fits depends on severity. Treatments it lists include brief or long-term counseling with a mental health provider who specializes in AUD, peer support groups, and medicines that can reduce cravings or help prevent a return to drinking. A primary care provider can start the conversation, check your general health, and refer you. Stopping suddenly after heavy use can bring withdrawal symptoms, so tell your provider before you change anything.

Sources

• MedlinePlus — Alcohol Use Screening Tests
• MedlinePlus — Alcohol Use Disorder (AUD)