Poor Alcohol Screening Results Often Cause for Intensive Intervention

Poor Alcohol Screening Results Often Cause for Intensive Intervention Alcohol screenings are testing procedures primarily designed to detect people whose drinking behaviors put them at risk for developing a diagnosable case of alcohol use disorder (alcoholism or non-addicted alcohol abuse). In a study published in February 2014 in the journal Drug and Alcohol Dependence, researchers from several U.S. institutions investigated how often individuals flagged in these screenings already have a diagnosable case of alcohol use disorder or any other type of substance use disorder. These researchers found that a significant number of both men and women with poor alcohol screening results are already affected by serious substance-related problems.

Alcohol Screening Basics

During an alcohol screening, a doctor or some other qualified health professional will ask questions designed to determine such things as how often an individual drinks, how much an individual drinks, how often an individual drinks to excess in a single session, how often an individual experiences alcohol-related life disruptions and whether or not an individual has received warnings from others about his or her typical pattern of alcohol consumption.

The most commonly used alcohol screening procedure in the U.S. is a World Health Organization questionnaire called AUDIT (the Alcohol Use Disorders Identification Test). The full version of this procedure includes 10 multiple-choice questions; a shorter version, called AUDIT-C, contains three multiple-choice questions. The highest possible score on the full AUDIT is 40, a result that indicates severe problems with alcohol use. Anyone who receives a score of eight or higher has an increased chance of developing alcohol use disorder. Men with an AUDIT-C score of four or higher have identified risks for alcohol use disorder; women have such risks if they score three or higher on the procedure.

Alcohol Use Disorder/Substance Use Disorder

Alcohol use disorder and substance use disorder are terms created by the American Psychiatric Association to identify people who have life-impairing problems related to the consumption of alcohol or life-impairing problems related to the consumption of illegal drugs or prescription medications. Alcohol use disorder applies strictly to individuals affected by alcoholism or alcohol abuse, while substance use disorder applies to all forms of substance-based addiction or abuse. A person with alcohol use disorder or any other type of substance use disorder has as many as 11 symptoms that indicate an impairing chemical dependence on substance use or an impairing pattern of non-dependent abuse. At minimum, a diagnosis of these conditions requires two to three symptoms that indicate problems with abuse or addiction. In May 2013, the alcohol use disorder diagnosis replaced independent diagnoses for alcohol abuse or alcoholism; the substance use disorder diagnosis does the same thing for all previously independent diagnoses for substance-related issues.

Frequency of Detection

Alcohol screenings are known for their usefulness in identifying people already affected by alcohol abuse or alcoholism. In the study published in Drug and Alcohol Dependence, researchers from the U.S. Department of Veterans Affairs, the University of Washington and the Group Health Research Institute used a large-scale analysis of almost 64,000 Veterans Affairs patients to determine how common diagnosable cases of alcohol use disorder (or any other substance use disorder) are in people flagged during a screening procedure. These patients ranged in age from 18 to 90. All of them took part in an AUDIT-C alcohol screening and received testing results that indicated significant problems with alcohol consumption.

The researchers concluded that roughly 25 percent of the participating women and 28 percent of the participating men qualified for a diagnosis of alcohol use disorder or another substance use disorder. They also concluded that the chances of having diagnosable problems rise along with the scores registered during AUDIT-C screening. Fully 82 percent of the women identified as high-risk by AUDIT-C had alcohol use disorder or another substance use disorder; 69 percent of the men identified as high-risk also qualified for an official diagnosis. The rate of alcohol- and substance-related diagnoses remained essentially the same for young adults, middle-aged adults and older adults.

Significance and Considerations

The authors of the study published in Drug and Alcohol Dependence note the frequency with which people with problematic scores in AUDIT-C screenings already have diagnosable problems with alcohol or other substances. They believe that these results are common enough for doctors and other healthcare professionals to be prepared in advance to offer effective treatment options for people identified as at-risk in alcohol screening procedures.

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