Chapter 3 Screening, assessment and treatment planning - Alcohol

hazardous drinking (Skipsey et al. 1997). The AUDIT has also been evaluated inpsychiatric patients and in one study demonstrated very high sensitivity andspecificity at detecting alcohol abuse using a cut- off of 10 (Cassidy et al. 2008). TheAUDIT-C also performed well against the S-MAST and CAGE in detecting riskdrinking among people with any past-year mood disorder (Dawson et al. 2005). Inanother study of patients affected by a mood disorder, AUDIT and CAGE werecompared with the first 2 questions of the NIAA guide (“do you sometimes drinkalcohol?” and “how many times in the past year have you had 5 drinks [men] 4[women] in a day?”). Both instruments achieved high sensitivity, using a cut-off of 5for AUDIT and 1 for CAGE (Agabio et al. 2007).Overall it appears that the AUDIT is superior to other instruments in detecting variousaspects of a range of alcohol problems. CAGE is proven to be insufficient to detectlower levels of alcohol abuse among primary care patients, and conventionallaboratory tests were proved in at least one study to be of no use in this setting(Aertgeerts et al. 2001).The AUDIT can be also used effectively to identify hazardous, problem anddependent alcohol consumption amongst psychiatric patients; AUDIT-C can be usedto detect alcohol use disorders, using a cut-off of 5 (Dawson et al. 2005).Other questionnairesThe Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) is auseful screening questionnaire, recommended by the World Health Organization,which includes alcohol with other substances (World Health Organization 2002).A number of other screening instruments have been developed to overcome thelimitations of existing inventories. These are most useful for research rather thanclinical settings and are not considered further in these guidelines.Recommendation3.6 AUDIT is the most sensitive of the currentlyavailable screening tools and is recommendedfor use in the general population.Strength ofrecommendationALevel ofevidenceIScreening for alcohol use in special populations: Pregnant WomenThe NHMRC guidelines recommend that it is safest to consume no alcohol duringpregnancy (NHMRC 2009). The low levels of consumption highlighted as a concernin recent guidelines cannot be identified using current questionnaires. A clinicalhistory to estimate the quantity and frequency of alcohol use is the preferred method.In light of the potential for adverse effects on the foetus, screening for alcohol useshould be included in the usual antenatal history. All pregnant women should beasked about their level of alcohol consumption.TWEAK and T-ACE questionnaires22