DIAGNOSIS OF ALCOHOLISM

I. History:

  1. Alcohol & other drug history
  1. When did you last drink? How much did you have?
  2. Do you drink every day? If not, how often?
  3. How much do you drink at a time?
  4. How much do you need to drink to get a buzz?
  5. How long have you been drinking in your current pattern?
  6. How old were you when you had your first drink?
  1. Social functioning
  2. Psych. sx
  3. Medical Hx/Px for EtOH-related illnesses

II. Labs: LFT's inc. GGT, MCV. n.b. 37% of alcoholics will have nl GGT

III. CAGE questionnaire--often considered inadequately sensitive; I may have the wording slightly off

  1. Cut down (do you feel you need to cut down on your drinking)
  2. Anger (do other people make you angry or annoyed by commenting on your drinking)
  3. Guilt (do you ever feel guilty about drinking)
  4. Eye opener (do you ever have a drink when you first get up in the morning)

IV. SHORT MICHIGAN ALCOHOLISM SCREENING TEST (SMAST)

(3 or more concerning answers > 90% sens. for alcoholism; 2 answers raise concern; can be given to pt or spouse-original source, J. Stud. Alcohol 36:124, 1975)

  1. Do you feel you are a normal drinker? (By normal I mean you drink less than or as much as most other people)
  2. Does anyone close to you (spouse, parent, etc.) ever worry or complain about your drinking?
  3. Do you ever feel guilty about your drinking??
  4. Do friends or relative think you are a normal drinker?
  5. Are you able to stop drinking when you want to?
  6. Have you ever attended an AA meeting?
  7. Has drinking ever created problems between you and someone close to you? (spouse, parent, etc.)
  8. Have you ever gotten into trouble at work because of your drinking?
  9. Have you ever neglected your obligations, family, or work for two or more days in a row because you were drinking?
  10. Have you ever gone to anyone for help about your drinking?
  11. Have you ever been in a hospital because of drinking?
  12. Have you ever been arrested for DWI/DUI?
  13. Have you ever been arrested, even for a few hours, because of other drunken behavior?
  14. (NOT IN THE QUESTIONNAIRE BUT A GOOD QUESTION) Have you ever had a blackout? (relatively early sx of EtOHism)

(Source: AFP article, 1988 or so)

V. 2-question screening: the following 2 questions were found in a study of 434 pt were found to have neg. pred. value 93% and pos. predictive value 59% (for answering positively to at least one; J. Fam. Prac 44:151, 1997-JW):

VI. The TWEAK questionnaire--more sensitive than CAGE or AUDIT in women (JAMA 280:166, 1998) Score 2 points each for T, W; 1 point each for others.; cutoff is >1 point

  1. Tolerance: How many drinks can you hold? (>5 indicates tolerance) or How many drinks does it take before you begin to feel the first effects of the alcohol? (>2 indicates tolerance)
  2. Worried: Have close friends or relatives worried or complained about your drinking in the past year?
  3. Eye openers: Do you sometimes take a drink in the morning when you first get up?
  4. Amnesia: Has a friend or family member ever told you about things you said or did while you were drinking that you could not remember?
  5. Kut down: Do you sometimes feel the need to cut down on your drinking?

V. AUDIT-C: Had 95% sensitivity and 60% specificity for active alcohol abuse (using structured interview by telephone as a gold standard) in a series of 243 men in a VA setting (Arch. Int. Med. 158:1789, 1998--JW)

  1. How often did you have a drink containing alcohol in the past year? Consider a "drink" to be a can or bottle of beer, a glass of wine, a wine cooler, or one cocktail or a shot of hard liquor (like scotch, gin, or vodka).
    1. Never = 0
    2. Monthly or less = 1
    3. 2-4x/mo = 2
    4. 2-3x/wk = 3
    5. 4-5x/wk = 4
    6. > 6x/wk = 4
  2. How many drinks did you have on a typical day when you were drinking in the past year?
    1. 0-2 drinks = 0
    2. 3-4 drinks = 1
    3. 5-6 drinks = 2
    4. 7-9 drinks = 3
    5. > 9 drinks = 4
  3. How often did you have 6 or more drinks on one occasion in the past year?
    1. Never = 0
    2. < monthly = 1
    3. Monthly = 2
    4. Weekly = 3
    5. Daily or almost daily = 4