Note: This content is derived from the 2015 VA/DOD Clinical Practice Guideline for the Management of Substance Use Disorders. For the latest clinical practice guideline for this condition, visit https://www.healthquality.va.gov/guidelines/MH/.

According to the 2015 VA/DOD Clinical Practice Guideline for the Management of Substance Use Disorders, screening should be conducted annually for patients in general medical and mental health care settings using the three-item Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) or Single Item Alcohol Screening Questionnaire (SASQ).

• The AUDIT-C was developed by the World Health Organization (WHO). It is a brief alcohol screen that can help identify patients who engage in hazardous drinking or have active alcohol use disorders.
• The SASQ is a single-item screen that is often easier to integrate into clinical interviews as primary care providers may be unlikely to recall response options and scoring for the AUDIT-C.

A Positive Screen

A screening for unhealthy alcohol use is considered positive if an individual obtains:

• An AUDIT-C score of greater than or equal to four points for men and greater than or equal to three points for females.
• On the SASQ if individuals report drinking four or more drinks on an occasion (female) or five or more drinks (males) on an occasion in the past year.

Patients without documented alcohol use disorder who screen positive for unhealthy alcohol use should be provided a single initial brief intervention regarding alcohol-related risks and advice to abstain or drink within nationally established age and gender-specific limits for daily and weekly consumption.

Screening, Brief Intervention, and Referral to Treatment (SBIRT)

SAMHSA’s Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a comprehensive, integrated, public health approach to the delivery of early intervention and treatment services for individuals with substance use disorders, as well as those who are at risk of developing these disorders. Primary care centers, hospital emergency rooms, trauma centers and other community settings provide opportunities for early intervention with people at risk for substance misuse before more severe consequences occur.

The SBIRT process consists of the following elements:

Screening quickly assesses the severity of substance use and identifies the appropriate level of treatment.

Brief Intervention focuses on increasing insight and awareness regarding substance use and motivation toward behavioral change.

Referral to Treatment provides those identified as needing more extensive treatment with access to specialty care.

Co-occurring Disorders with Alcohol Misuse

Some individuals with alcohol misuse have co-occurring psychosocial problems that affect their likelihood of establishing and maintaining good clinical outcomes and improved functional status. Several mental health conditions, such as bipolar disorders, schizophrenia and antisocial personality disorder, are associated with increased rate of alcohol use disorder. Anxiety and depressive disorders may also correlate with alcohol use disorder.

Individuals with alcohol and substance use disorders may also have co-occurring physical conditions. Drinking alcohol at levels above weekly or daily limits can damage the heart, interfere with brain communication pathways, lead to liver inflammation and other liver problems, weaken the immune system, and increase the risk of developing mouth, throat, esophagus, liver and breast cancer, according to the National Institute on Alcohol Abuse and Alcoholism.