Unhealthy alcohol use 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). The 2015–2020 US Dietary Guidelines for Americans recommends that if alcohol is consumed, it should be consumed in moderation—up to one drink per day for women and two drinks per day for men—and only by adults of legal drinking age. The spectrum of alcohol use disorders includes alcohol dependence, harmful pattern use of alcohol, and entities such as alcohol intoxication, alcohol withdrawal, and several alcohol-induced mental disorders. The ICD-11 includes a new category: hazardous alcohol use. Categorized as a risk factor, hazardous alcohol use is a pattern of alcohol use that appreciably increases the risk of physical or mental health harmful consequences to the user.
Underdiagnosis and undertreatment of alcohol misuse is substantial, both because of patient denial and lack of detection of clinical clues.
As with cigarette use, clinician identification and counseling about unhealthy alcohol use are essential. The USPSTF recommends screening adults aged 18 years and older for unhealthy alcohol use. The National Institute on Alcohol Abuse and Alcoholism recommends the following single-question screening test (validated in primary care settings): “How many times in the past year have you had X or more drinks in a day?” (X is 5 for men and 4 for women, and a response of more than 1 time is considered positive.)
Those who screen positive on the single-item questionnaire should complete the Alcohol Use Disorder Identification Test (AUDIT), which consists of questions on the quantity and frequency of alcohol consumption, on alcohol dependence symptoms, and on alcohol-related problems (Table 1–7).
Table 1–7.Screening for alcohol abuse using the Alcohol Use Disorder Identification Test (AUDIT). ||Download (.pdf) Table 1–7. Screening for alcohol abuse using the Alcohol Use Disorder Identification Test (AUDIT).
|(Scores for response categories are given in parentheses. Added together, Total Scores range from 0 to 40, with scores of 1 to 7 suggesting low-risk drinking; 8 to 14, hazardous or harmful drinking; and >15, alcohol dependence.) |
| 1. How often do you have a drink containing alcohol? |
|(0) Never ||(1) Monthly or less ||(2) Two to four times a month ||(3) Two or three times a week ||(4) Four or more times a week |
| 2. How many drinks containing alcohol do you have on a typical day when you are drinking? |
|(0) 1 or 2 ||(1) 3 or 4 ||(2) 5 or 6 ||(3) 7 to 9 ||(4) 10 or more |
| 3. How often do you have six or more drinks on one occasion? |
|(0) Never ||(1) Less than monthly ||(2) Monthly ||(3) Weekly ||(4) Daily or almost daily |
| 4. How often during the past year have you found that you were not able to stop drinking once you had started? |
|(0) Never ||(1) Less than ...|