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nhealthy alcohol use, the range of drink-
ing that includes at-risk drinking and al- Diagnosis
cohol use disorder (1), is common and
associated with a range of adverse health and
social consequences. For example, data from Treatment
the third National Epidemiologic Survey on Al-
cohol and Related Conditions (NESARC-III) indi-
cate that 14% of adults have a current alcohol Practice Improvement
use disorder and 29% have had an alcohol use
disorder over their lifetime, with rates highest
among men and younger persons (2). As such,
unhealthy alcohol use is the third leading cause Tool Kit
of preventable death and costs the United
States over $220 billion each year (3).
Patient Information
The CME quiz is available at www.annals.org/intheclinic.aspx. Complete the quiz to earn up to 1.5 CME credits.
With the assistance of additional physician writers, the editors of Annals of Internal Medicine
develop In the Clinic using MKSAP and other resources of the American College of Physicians.
In the Clinic does not necessarily represent ofcial ACP clinical policy. For ACP clinical guidelines,
please go to https://www.acponline.org/clinical_information/guidelines/.
2016 American College of Physicians
2016 American College of Physicians ITC2 In the Clinic Annals of Internal Medicine 5 January 2016
5 January 2016 Annals of Internal Medicine In the Clinic ITC3 2016 American College of Physicians
2016 American College of Physicians ITC4 In the Clinic Annals of Internal Medicine 5 January 2016
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2016 American College of Physicians ITC6 In the Clinic Annals of Internal Medicine 5 January 2016
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2016 American College of Physicians ITC8 In the Clinic Annals of Internal Medicine 5 January 2016
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2016 American College of Physicians ITC12 In the Clinic Annals of Internal Medicine 5 January 2016
Practice Improvement
What factors do U.S. measure for initiation and en-
stakeholders use to evaluate gagement of alcohol and other
the quality of care for patients drug dependence treatment. It
with unhealthy alcohol use? indicates that the percentage of
The 2014 Centers for Medicare & patients who initiated treatment
Medicaid Services (CMS) Elec- within 14 days of a diagnosis of
tronic Health Records Incentive alcohol or drug dependence as
Program includes the National well as the percentage of pa-
Committee for Quality Assurance tients who initiated treatment
5 January 2016 Annals of Internal Medicine In the Clinic ITC13 2016 American College of Physicians
2016 American College of Physicians ITC14 In the Clinic Annals of Internal Medicine 5 January 2016
Tool Kit
/CliniciansGuide2005/guide.pdf
www.niaaa.nih.gov/publications/brochures-and-fact
-sheets
National Institute on Alcohol Abuse and Alcoholism
www.cdc.gov/alcohol/fact-sheets.htm
Centers for Disease Control and Prevention
5 January 2016 Annals of Internal Medicine In the Clinic ITC15 2016 American College of Physicians
Patient Information
friends can help, too. There are other ways to
Unhealthy alcohol use is also associated with in- reduce alcohol use, including:
creased risk for diabetes, HIV and other sexually Talk therapy
transmitted infections, and depression. It can 12-step programs or Alcoholics Anonymous
lead to unhealthy behaviors that may cause: Certain medicines
Car accidents
Accidents like falling or drowning How Can I Use Alcohol Safely?
Firearm injuries Talk with your doctor about whether it is safe for
Intimate partner violence you to drink alcohol if you:
Homicide Take prescription medicines
Suicide Are older than age 65
Are a young adult
Have a chronic health condition
AUDIT
Questions Points
0 1 2 3 4
1. How often do you have a drink Never Monthly 24 times a 23 4 or more
containing alcohol? or less month times a times a
week week
2. How many drinks containing 12 34 56 79 10 or more
alcohol do you have on a typical day
when you are drinking?
3. How often do you have 5 or more Never Less than Monthly Weekly Daily or
drinks on one occasion? monthly almost
daily
4. How often during the last year Never Less than Monthly Weekly Daily or
have you found that you were not monthly almost
able to stop drinking once you daily
started?
5. How often during the last year Never Less than Monthly Weekly Daily or
have you failed to do what was monthly almost
normally expected of you because of daily
drinking?
6. How often during the last year Never Less than Monthly Weekly Daily or
have you needed a first drink in the monthly almost
morning to get yourself going after a daily
heavy drinking session?
7. How often during the last year Never Less than Monthly Weekly Daily or
have you had a feeling of guilt or monthly almost
remorse after drinking? daily
8. How often during the last year Never Less than Monthly Weekly Daily or
have you been unable to remember monthly almost
what happened the night before daily
because of your drinking?
9. Have you or someone else been No Yes, but Yes, during
injured because of your drinking? not in the the last year
last year
10. Has a relative, friend, doctor, or No Yes, but Yes, during
other health care worker been not in the the last year
concerned about your drinking or last year
suggested you cut down?
Scoring: Points for each of the ten items are added together. Total score of 8 for men up to age
60 years or 4 for women, adolescents, and persons older than 60 years are considered positive.
Cutoffs may vary depending on purpose and population of interest.
AUDIT-C
Questions Points
0 1 2 3 4
1. How often did you have a drink Never Monthly 24 times 23 4 or more
containing alcohol in the past year? or less a month times a times a
week week
2. How many drinks did you have on None 34 56 79 10 or more
a typical day when you were or 12
drinking in the past year?
3. How often did you have 5 or more Never Less than Monthly Weekly Daily or
drinks on one occasion in the past monthly almost
year? daily
Scoring: Points for each of the three items are added together. Total score of 6 for men and 4
for women is considered positive. Cutoffs may vary depending on purpose and population of
interest.
AUDIT = Alcohol Use Disorders Identification Test; NIAAA = National Institute on Alcohol
Abuse and Alcoholism.
* Figure adapted from reference 5.
5 January 2016 Annals of Internal Medicine In the Clinic 2016 American College of Physicians