AUDIT-C for Alcohol Use
Why Use
Physicians often overlook alcohol problems in patients. ( Kitchens JM 1994 ) Simply asking patients how much they drink often leads to an estimate lower than the actual number of alcoholic drinks per day. Alcohol disorders are treatable despite physician bias otherwise. ( Kitchens JM 1994 ) Without identification and treatment alcohol problems lead to significant morbidity and mortality: Alcohol is a major factor in suicides, homicides, violent crimes, and fatal motor vehicle accidents. Nearly 88,000 people die from alcohol-related causes annually, making it the third leading preventable cause of death in the United States. ( Centers for Disease Control and Prevention 2014 ) Alcohol is primarily or secondarily implicated in a large number of medical problems. The mortality rate in those who drink six or more drinks per day is 50% higher than the rate in matched controls. ( Klatsky AL 1992 )
When to Use
The 4-item CAGE questionnaire is the briefest effective screening test for lifetime alcohol abuse/dependence, but it is not sensitive for detecting heavy drinking and does not distinguish between active and past problem drinking. The AUDIT-C is more effective in identifying this population. AUDIT-C can be included among standard history questions or general health intake questionnaires in primary care, emergency department, psychiatric and inpatient hospital settings. Other at-risk populations where AUDIT-C or another alcohol screening assessment is indicated include: Pregnant women College students Arrested and incarcerated persons, especially DWI and domestic violence offenders
Formula
Pearls / Pitfalls
AUDIT-C is a 3-item alcohol screen that can help identify persons who are hazardous drinkers or have active alcohol use disorders. The AUDIT-C is a modified, shortened version of the 10-question AUDIT instrument. Its briefer design makes it more practical for incorporation into routine patient interviews or health history questionnaires in a primary care setting. AUDIT-C is a screening tool. An abnormal or positive screening result may thus “raise suspicion” about the presence of an alcohol use problem, while a normal or negative result should suggest a low probability of an alcohol use problem. Assessment for purposes of diagnosis occurs in subsequent stages of evaluation.
Management
When screening results are positive, the patient should be referred for further evaluation and treatment of an alcohol use problem. This will vary based on available resources but is ideally to an addiction psychiatrist, psychologist, or addiction treatment program.
Critical Actions
In any hospital setting where access to alcohol may be limited, always monitor for signs/symptoms of alcohol withdrawal, even in patients who have not screened positive for an alcohol problem.
Advice
If a clinician suspects that the patient is minimizing his or her alcohol use, or if a patient’s score is near the cutoff, one may consider utilizing a more lengthy screening test to better determine the nature and extent of the problem. ( The Physicians' Guide to Helping Patients With Alcohol Problems 1995 ) Other validated tests for further assessment include: Michigan Alcoholism Screening Test (MAST) Alcohol Use Disorders Identification Test (AUDIT)
More Information
The AUDIT-C (Alcohol Use Disorder Identification Test) quantifies alcohol misuse, based on 3 questions posed to patients about their consumption habits. It was adapted from the longer AUDIT , which is mainly used in primary care settings. Score interpretation: Males: Scores ≥4 suggest alcohol misuse. Females: Score ≥3 suggest alcohol misuse. Higher score correlates with greater severity of alcohol misuse.