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Alcohol Abuse

Make the Diagnosis: Alcohol Abuse

Prior Probability

Data from the National Institute on Alcohol Abuse and Alcoholism suggest that 3 of 10 adults engage in risky drinking behaviors. In primary care clinics, the prevalence will be around 11% to 18%.

Populations for Whom Problem Drinking Should Be Assessed

  • All adults (see Tables 4-9 and 4-10)

  • Targeted populations/conditions requiring assessment include pregnant women (see Table 4-11), adolescents, and emergency patients

Table 4-9Detecting the Likelihood of At-risk, Harmful, or Hazardous Drinking in Adults
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Table 4-9 Detecting the Likelihood of At-risk, Harmful, or Hazardous Drinking in Adults
LR Range
AUDIT or AUDIT-C ≥ 8 6.8-12
AUDIT or AUDIT-C ≤ 8 0.46-0.62

Abbreviations: AUDIT, Alcohol Use Disorders Identification Test; AUDIT-C, AUDIT Consumption Questions; LR, likelihood ratio.

Table 4-10Detecting the Likelihood of Alcohol Abuse or Dependence in Adultsa
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Table 4-10 Detecting the Likelihood of Alcohol Abuse or Dependence in Adultsa
LR (95% CI)
CAGE ≥ 1 3.4 (2.3-5.1)
CAGE = 0 0.18 (0.11-0.29)

Abbreviations: CAGE, cut down, annoyed, guilty, eye opener; CI, confidence interval; LR, likelihood ratio.

aWomen have a lower sensitivity than men do but have a higher specificity. A cut point of ≥ 1 optimizes the sensitivity and, therefore, the negative LR.

Table 4-11Detecting the Likelihood of 2 or More Drinks/Day During Pregnancya
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Table 4-11 Detecting the Likelihood of 2 or More Drinks/Day During Pregnancya
LR Range
TWEAK ≥ 2 or T-ACE ≥ 1 3.6-4.0
TWEAK ≤ 1 or T-ACE = 0 0.12-0.15

Abbreviations: LR, likelihood ratio; T-ACE, tolerance, annoyed, cut down, eye opener; TWEAK, tolerance, worry, eye opener, amnesia, cut (kut) down.

aLRs are estimated from studies that have incorporation bias where the interviewer knew the results of the screening questionnaires.

Reference Standard Tests

Diagnostic interview schedule for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition,2 interview performed by an experienced provider in an alcohol-related interview.

Original Article: Does This Patient Have an Alcohol Problem?

Clinical Scenario

A 58-year-old man was admitted to the hospital for an elective cholecystectomy. ...

Education Guide

Alcohol Abuse
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Learning Tools

Critical Appraisal Worksheets
Diagnostic Tests
Differential Diagnosis
Information Cycle Worksheets
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Differential Diagnosis
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