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Make the Diagnosis: Alcohol Use Disorder
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Prior Probability of Alcohol Use Disorder
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According to the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) criteria,1 alcohol use disorder is present when alcohol causes clinically significant impairment or distress and at least 2 of 11 criteria are met. Persons who drink alcohol but who do not currently meet DSM-5 criteria1 for alcohol use disorder may still have excessive alcohol use that puts them at risk of various harms, including the development of alcohol use disorder. More than 60% of individuals aged 12 years and older in the US have used alcohol in the last year.2 Alcohol use disorder was reported in 3.4% of people in the US aged 12 to 17 years; 15% in those aged 18 to 25 years; and 10.7% in those 26 years of age and older.2 The prevalence of excessive drinking varies widely according to heterogenous definitions and internationally.
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Population Who Should Be Screened for Alcohol Use Disorder
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Because individuals with alcohol use disorder may not express symptoms or exhibit obvious signs of excessive alcohol use, the US Preventive Services Task Force has recommended screening for unhealthy alcohol use in all adults aged 18 years and older (including pregnant persons), although there was insufficient evidence to recommend routine screening in those aged 12 to 17 years.3 Screening can occur in any setting and studies suggest current screening levels in primary care are low.
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Assessing the Likelihood of Alcohol Use Disorder
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The Alcohol Use Disorders Identification Test (AUDIT) (Box 113-1) is useful to identify alcohol use disorder in adults (threshold, ≥8) and, according to one study, in individuals within 48 hours postpartum (threshold, ≥4) (Table 113-1). The AUDIT is a 10-item, open-access assessment tool intended to screen for risky or hazardous alcohol consumption or any alcohol use disorder; it takes 2 to 4 minutes to complete and can be self-administered. A positive test performed better among females (LR, 6.9; 95% CI, 3.9-12) than males (LR, 3.8; 95% CI, 2.6-5.5; P = .003 for the comparison). The US National Institute on Alcohol Abuse and Alcoholism (NIAAA) single-item, clinician-administered screening test, which asks “How many times in the past year have you had “x” or more drinks in a day”? (where “x” is ≥5 for men or ≥4 for women and where ≥1 day is considered a positive response), may be particularly useful in adults, but it requires further studies.4 The NIAAA youth screening tool has questions and thresholds that vary by age, and it appears helpful to identify children and adolescents with alcohol use disorder. Importantly, the widely used AUDIT-C, which is an abbreviated form of the full AUDIT limited to the first 4 consumption questions, appears useful for some measures of high-risk drinking but at a ...