Screening for alcohol problems: what makes a test effective?

Alcohol Research & Health, Wntr, 2004 by Scott H. Stewart, Gerard J. Connors

VOLK, R.J.; STEINBAUER, J.R.; CANTOR, S.B.; AND HOLZER, C.E. The Alcohol Use Disorders Identification Test (AUDIT) as a screen for at-risk drinking in primary care patients of different racial/ethnic backgrounds. Addiction 92(2):197-206, 1997.

RELATED ARTICLE: DEFINITIONS OF ALCOHOL-RELATED DISORDERS

A variety of terms are used in the scientific literature to describe alcohol use disorders (AUDs) and other conditions characterized by excessive alcohol consumption. AUDs are disorders for which specific diagnostic criteria exist, as defined in two disease classification systems--the Diagnostic and Statistical Manual of Mental Disorders (DSM), devised by the American Psychiatric Association (APA), and the International Classification of Diseases (ICD), by the World Health Organization (WHO).

DSM Criteria

The most recent version of the DSM, the DSM-IV-TR (APA 2000), includes two AUDs, alcohol abuse and alcohol dependence, which have the following diagnostic criteria:

Alcohol Abuse. Alcohol abuse is defined as a maladaptive pattern of alcohol use leading to clinically significant impairment or distress, as manifested by the occurrence of one (or more) of the following within a 12-month period:

* Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to alcohol use; alcohol-related absences, suspensions, or expulsions from school; neglect of children or household).

* Recurrent alcohol use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by alcohol).

* Recurrent alcohol-related legal problems (e.g., arrests for alcohol-related disorderly conduct).

* Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol (e.g., arguments with spouse about intoxication, physical fights).

In addition, the patient must have never met the criteria for alcohol dependence in the past.

Alcohol Dependence. Alcohol dependence is defined as a maladaptive pattern of alcohol use leading to clinically significant impairment or distress, as manifested by the occurrence of three (or more) of the following at any time in the same 12-month period:

* Tolerance, as defined by either of the following:

- A need for increased amounts of alcohol to achieve intoxication or the desired effect.

- Markedly diminished effect with continued use of the same amount of alcohol.

* Withdrawal, as manifested by either of the following:

- The characteristic withdrawal syndrome.

- Use of alcohol to relieve or avoid withdrawal symptoms.

* Drinking alcohol often in larger amounts or over a longer period than was intended.

* A persistent desire or unsuccessful efforts to cut down or control alcohol use.

* A great deal of time spent in activities necessary to obtain alcohol, use it, or recover from its effects.

* Giving up or reducing important social, occupational, or recreational activities because of alcohol use.