Screening

Your Organizational Guidance

ebpracticenet urges you to prioritize the following organizational guidance:

Alcoholmisbruik bij jongerenPublished by: Federaal Wetenschapsbeleid (Belspo)Last published: 2015Alcoholmisbruik bij jongerenPublished by: Federaal Wetenschapsbeleid (Belspo)Last published: 2015

Early diagnosis of unhealthy alcohol use or alcohol use disorder facilitates prompt initiation of treatment, which lessens the impact from emotional, medical, occupational, financial, and social complications. Screening for unhealthy alcohol use and assessment and diagnosis of alcohol use disorder can be performed by clinicians at various points in the process of providing healthcare services:

  • As part of a routine examination

  • Prior to prescribing a drug that interacts with alcohol

  • In the emergency department or trauma center (especially with presentations secondary to trauma/injuries, violence)[69]​ 

  • During pregnancy

  • When there are health problems that might be alcohol-related (e.g., cardiac arrhythmia, dyspepsia, liver disease, hypertension, depression, anxiety, insomnia, trauma).

The United States Preventive Services Task Force, Department of Veterans Affairs/Department of Defense and American College of Gastroenterology recommend periodic to routine screening for unhealthy alcohol use in adults across settings, including primary care, general medical and mental health.[41][42][43]​​​​​ Brief interventions are advised for all patients who report at-risk drinking, and treatment should be offered to those with confirmed alcohol use disorder.​[41][42]​​​​​ Despite recommendations, the National Ambulatory Medical Care Survey (2014-2016) found that a validated screening tool had been used in only 2.6% of US primary care consults, with alcohol counseling documented for 0.8%.[70]​ Other US surveillance data (2017-2019) showed that although most pregnant women (80%) were screened, fewer than 1 in 5 with reported alcohol use were offered brief intervention.[71]

Globally, the World Health Organization (WHO) also recommends screening and brief intervention for unhealthy alcohol use, yet 20% of countries reporting in 2019 did not have such programs in place.[7]

The Single Item Alcohol Screening Questionnaire Question (SASQ) and abbreviated Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) have demonstrated accuracy as screening tools to assess past-year alcohol use.[41][42]​​ The SASQ single question screener can be useful in primary care and general settings where it can be integrated more easily into clinical interviews.[42]​ The AUDIT is a 10-question screener developed by the WHO and has been translated into many languages.[45][46]​​​ [ Alcohol Consumption Screening AUDIT Questionnaire Opens in new window ] ​​ The three-question version, AUDIT-C, has been validated against the full AUDIT, and demonstrated similar test performance for the identification of patients with heavy alcohol use or alcohol use disorder.[72] AUDIT-C has also demonstrated predictive validity for adverse health outcomes.[42]​ A positive screen on SASQ or AUDIT-C may be followed by a secondary screen using AUDIT.[41]​ Screening cannot, however, diagnose alcohol use disorder and diagnostic assessment is indicated.​

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