Diagnosis of Alcohol Dependence

Table 1.

C Have you ever felt you should cut down on your drinking?

A Have people annoyed you by criticizing your drinking?

G Have you ever felt bad or guilty about your drinking?

E Eye opener: Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?

The CAGE can identify alcohol problems over the lifetime. Two positive responses are considered a positive test and indicate further assessment is warranted.

CAGE

Source: National Institute on Alcohol Abuse and Alcoholism. Alcohol Alert. Number 65. April 2005. Available at: http://pubs.niaaa.nih.gov/publications/aa65/AA65.htm. Accessed August 24, 2006.

Table 2.

Please circle the answer that is correct for you.
1. How often do you have a drink containing alcohol?
Never	Once per month or less	2-4 times per month	2-3 times per week	≥ 4 times per week
2. How many drinks containing alcohol do you have on a typical day when you are drinking?
1 or 2	3 or 4	5 or 6	7 to 9	≥ 10
3. How often do you have 6 or more drinks on one occasion?
Never	Less than once per month	Once per month	2-3 times per week	≥ 4 times per week
4. How often during the last year have you found that you were not able to stop drinking once you had started?
Never	Less than once per month	Once per month	2-3 times per week	≥ 4 times per week
5. How often during the last year have you failed to do what was normally expected of you because of drinking?
Never	Less than once per month	Once per month	2-3 times per week	≥ 4 times per week
6. How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?
Never	Less than once per month	Once per month	2-3 times per week	≥ 4 times per week
7. How often during the last year have you had a feeling of guilt or remorse after drinking?
Never	Less than once per month	Once per month	2-3 times per week	≥ 4 times per week
8. How often during the last year have you been unable to remember what happened the night before because you had been drinking?
Never	Less than once per month	Once per month	2-3 times per week	≥ 4 times per week
9. Have you or someone else been injured as a result of your drinking?
No	Yes, but not in the last year		Yes, during the last year
10. Has a relative or friend, or a doctor or other healthcare worker, been concerned about your drinking or suggested you cut down?
No	Yes, but not in the last year		Yes, during the last year
The Alcohol Use Disorders Identification Test (AUDIT) can detect alcohol problems experienced in the last year. A score of 8+ on the AUDIT generally indicates harmful or hazardous drinking. Questions 1-8 = 0, 1, 2, 3, or 4 points. Questions 9 and 10 are scored 0, 2, or 4 only.

Alcohol Use Disorders Identification Test (AUDIT)

Adapted from National Institute on Alcohol Abuse and Alcoholism. Alcohol Alert. Number 65. April 2005. Available at: http://pubs.niaaa.nih.gov/publications/aa65/AA65.htm. Accessed August 28, 2006.

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Introduction

Alcohol use disorders (AUDs) are a subset of substance-related disorders characterized by either recurrent, excessive drinking that impairs function and leads to negative physical, legal, or social sequelae (alcohol abuse); or by physiologic dependence -- with associated tolerance and withdrawal -- and continued use despite knowledge of the physiologic and social psychological ramifications of continued drinking (alcohol dependence).^[1]

AUDs -- often collectively termed alcoholism -- represent a costly and prevalent problem in the United States. The annual cost of AUDs in the United States exceeds $185 billion,^[2] and approximately 100,000 individuals die each year from alcohol-related disease or injury.^[3] Individuals with alcohol-related medical illnesses have more frequent hospitalizations and longer hospital stays compared with individuals without alcoholism.^[4] In fact, the price of healthcare resulting from AUDs in the United States is estimated at more than $26 billion per year.^[5] The financial impact of alcoholism from alcohol-related illness, crimes, and premature deaths exceeds $134 million per year.^[5]

Unfortunately, alcohol abuse and dependence are frequently underdiagnosed in the clinical setting, typically due to inadequate screening and the unreliability of self-reported alcohol use. Many individuals with AUDs present to primary care and specialty clinics (eg, psychiatry) with alcohol-related problems. However, AUDs are often underdiagnosed and undertreated. In one study, retrospective analysis demonstrated that only 21% of individuals admitted to hospital who screened positively for AUD received inpatient alcohol intervention, and only 24% of those identified with AUD were referred for alcoholism treatment.^[6] In a second study, patients in primary care practices received assessment and referral to treatment only 10% of the time.^[7] Clearly, there is much room for improvement in the diagnosis of alcohol abuse and dependence in the clinical setting.

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Epidemiology

References

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Table 1.

Table 2.

References

Faculty and Disclosures

Diagnosis of Alcohol Dependence

Introduction

Table of Contents