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Alcohol misuse is a major public health problem in the United States, where approximately 51% of adults 18 years and older are current regular drinkers (at least 12 drinks in the past year). Maximum recommended consumption for adult women and those older than 65 years is 3 or fewer drinks in any day (and less than 7 per week), and for adult men, 4 or fewer drinks in any day (and less than 14 per week). The spectrum of alcohol misuse includes risky drinking (alcohol consumption above the recommended daily, weekly, or per-occasion amounts), harmful use (a pattern causing damage to health), alcohol abuse (a pattern leading to clinically significant impairment or distress), and alcohol dependence (defined as three or more of the following: tolerance, withdrawal, increased consumption, desire to cut down use, giving up social activities, increased time using alcohol or recovering from use, continued use despite known adverse effects). Underdiagnosis and undertreatment of alcohol misuse is substantial, both because of patient denial and lack of detection of clinical clues. Treatment rates for alcohol dependence have slightly declined over the last several years. Only a quarter of alcohol-dependent patients have ever been treated.

As with cigarette use, clinician identification and counseling about alcohol misuse are essential. An estimated 15–30% of hospitalized patients have problems with alcohol abuse or dependence, but the connection between patients’ presenting complaints and their alcohol use is often missed. The USPSTF recommends screening adults aged 18 years and older for alcohol misuse.

The Alcohol Use Disorder Identification Test (AUDIT) consists of questions on the quantity and frequency of alcohol consumption, on alcohol dependence symptoms, and on alcohol-related problems (Table 1–7). The AUDIT questionnaire is a cost-effective and efficient diagnostic tool for routine screening of alcohol use disorders in primary care settings. Brief advice and counseling without regular follow-up and reinforcement cannot sustain significant long-term reductions in unhealthy drinking behaviors.

Table 1–7.Screening for alcohol abuse using the Alcohol Use Disorder Identification Test (AUDIT).

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