Objective Four

To describe a well researched method for assessing the level of severity of problems related to alcohol and other drug use.

As described in The Physician's' Guide To Helping Patients With Alcohol Problems the second step in the process is to assess those patients who screen positive for alcohol, tobacco or other drug problems.

The notion here is to ask appropriate questions that will allow you to determine if your patient is:

One excellent way to accomplish this is to use the Alcohol Use Disorders Identification Test (AUDIT) which was developed by the World Health Organization (WHO) in 1982. This screening device was in response to a request by the WHO to have an international group of investigators develop a simple screening instrument that would allow health workers to identify persons at risk of developing alcohol related problems. The research conducted to create this instrument was carried out in six different countries including the United States of America, Australia, Bulgaria, Kenya, Mexico and Norway. Among the conclusions of this series of studies was that because alcohol use poses serious health risks and can cause a variety of health problems, systematic screening of alcohol use by health care workers is likely to contribute preventive medicine and public health.

The AUDIT is a two part alcohol screening test developed for use in primary care settings.

Part I, or the core AUDIT, consists of ten questions dealing with alcohol use, dependence symptoms and other alcohol related problems.

Part II, or the clinical AUDIT, consists of a brief physical examination, several questions about trauma history, and the results of a liver function test.

When using the AUDIT it is best to embed the questions and physical exam in an overall health interview and exam. When presented in this context by a concerned and interested interviewer it is not likely to evoke a negative or defensive response by the patient. Patients tend to be most honest when:

When these conditions are not possible it may be better to simply use the the clinical screening procedure as a starting point.
 
Scoring and interpretation of the AUDIT will be discussed in your training sessions. If you are reading this material but are not enrolled in our course you may want to contact Bonnie McRee at The University of Connecticut School of Medicine for information on materials and training.
 
Evidence of one or more of the following symptoms in the past year is an indication that you should consider your patient at risk for dependence.
 

 
This selective listing of dependence symptoms is offered as an initial assessment procedure and not for the purpose of making a diagnosis. For a diagnostic evaluation, refer your patient to a specialist or use the diagnostic procedures outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)

Study Questions:

  1. What are the three levels of problem severity described in step II of The Physician's' Guide To Helping Patients With Alcohol Problems?
  2. List at least three medical problems that may be alcohol related.
  3. How would you assess the following patients if the facts given are all you know?
    Please choose from these three options for your assessment:
       A: at increased risk for developing alcohol or other drug problems;
       B: currently experiencing alcohol or drug-related problems; 
       C: may be alcohol or other drug dependent)

Patient 1:

Patient 2:

Patient 3:

Patient 4:

Patient 5:

Patient 6:

Patient 7:

Patient 8:

The method for answering all these questions are found either above (under Objective four) or in The Physician's' Guide To Helping Patients With Alcohol Problems