It is important to consider an individual’s alcohol consumption when planning their diet, as alcohol is a source of energy that can affect overall health. To assess alcohol consumption and potential harm, the U.S Alcohol Use Disorders Identification Test (USAUDIT-C) is recommended as a first step. This test has been adjusted to reflect the higher ethanol content in a U.S. standard drink and U.S. low-risk drinking guidelines, which differ from other countries. Keeping track of alcohol consumption is easier with the USAUDIT-C.
The USAUDIT-C is a tool used to determine an individual’s alcohol consumption and potential for harm. It consists of three questions that assess the frequency and amount of alcohol consumption, as well as binge drinking. A positive score (7 or more for men and 5 or more for women and men over 65) indicates a risk for alcohol-related harm. If the score is positive, further evaluation using the full AUDIT questionnaire is recommended to understand the level of dependence and harm. Based on the results, the individual may need education, counseling, or intervention to reduce the risk of future harm.
|How often do you have a drink containing alcohol?||Never||Less than monthly||Monthly||Weekly||2-3 times a week||4-6 times a week||Daily|
|How many drinks containing alcohol do you have on a typical day you are drinking?||1 drink||2 drinks||3 drinks||4 drinks||5-6 drinks||7-8 drinks||10 or more drinks|
|How often do you have X (5 for men; 4 for women & men over age 65) or more drinks on one occasion?||Never||Less than monthly||Monthly||Weekly||2-3 times a week||4-6 times a week||Daily|
|How often during the last year have you found that you were not able to stop drinking once you had started?||Never||Less than monthly||Monthly||Weekly||Daily or almost daily|
|How often during the past year have you failed to do what was expected of you because of drinking?||Never||Less than monthly||Monthly||Weekly||Daily or almost daily|
|How often during the past year have you needed a drink first thing in the morning to get yourself going after a heavy drinking session?||Never||Less than monthly||Monthly||Weekly||Daily or almost daily|
|How often during the past year have you had a feeling of guilt or remorse after drinking?||Never||Less than monthly||Monthly||Weekly||Daily or almost daily|
|How often during the past year have you been unable to remember what happened the night before because you had been drinking?||Never||Less than monthly||Monthly||Weekly||Daily or almost daily|
|Have you or someone else been injured because of your drinking?||No||Yes, but not in the past year||Yes, during the past year|
|Has a relative, friend, doctor, or other health care worker been concerned about your drinking and suggested you cut down?||No||Yes, but not in the past year||Yes, during the past year|
Scoring the USAUDIT
|Risk Level||Intervention||USAUDIT Score||Possible AUD (DSM-5, ICD-10)|
|Zone I||Feedback||0-6/7 (Women/Men)||None|
|Zone II||Feedback||7/8-15 (Women/Men)||Mild AUD, hazardous use|
Feedback/monitoring brief outpatient treatment
|16-19||Moderate AUD, harmful use|
|Zone IV||Referral to evaluation and treatment||20-40||Moderate/severe AUD, alcohol dependence|
TAKE AN HOUR
Zone I refers to either low-risk drinking or not drinking alcohol. The majority of patients are in this category and no additional steps are required other than to inform them of the recommended low-risk alcohol consumption levels and acknowledge their adherence to those guidelines or abstinence. Approximately 80% of primary care patients fall into this category (Madras et al., 2009; Rubinsky, Kivlahan, Volk, Maynard, & Bradley, 2010).
Zone II is assigned to individuals who drink above low-risk guidelines, as indicated by a USAUDIT score of 7-15 for women or 7-8 for men. For these patients, the best approach is a brief intervention involving feedback, reflective conversations, and education materials. Approximately 16% of primary care patients fall into this category, according to studies (Madras et al., 2009; Rubinsky et al., 2010).
Patients who score between 16 to 19 on the USAUDIT are considered to have harmful drinking habits. The best approach to managing their alcohol consumption is through a combination of feedback, repeated brief interventions, and monitoring, with further diagnostic evaluation if the patient does not show improvement or is suspected of having alcohol dependence. If a behavioral health service provider is available in the primary care clinic, these patients may be eligible for brief outpatient treatment.
Zone IV is indicated by a score of 20 or higher on the USAUDIT test and indicates probable alcohol dependence. These patients should receive a referral to a specialist for diagnostic evaluation and treatment. If specialist services are not available, the patient may receive care in primary care, especially if the provider has access to medications, behavioral health services, and support from mutual-help organizations. The healthcare provider may also screen the patient for additional medical needs that may require immediate attention.