DIAGNOSIS OF ALCOHOLISM
- Alcohol & other drug history
- When did you last drink? How much did you have?
- Do you drink every day? If not, how often?
- How much do you drink at a time?
- How much do you need to drink to get a buzz?
- How long have you been drinking in your current
- How old were you when you had your first drink?
- Social functioning
- Psych. sx
- 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
- Cut down (do you feel you need to
cut down on your drinking)
- Anger (do other people make you
angry or annoyed by commenting on your drinking)
- Guilt (do you ever feel guilty about
- 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)
- Do you feel you are a normal drinker? (By normal I mean
you drink less than or as much as most other people)
- Does anyone close to you (spouse, parent, etc.) ever
worry or complain about your drinking?
- Do you ever feel guilty about your drinking??
- Do friends or relative think you are a normal drinker?
- Are you able to stop drinking when you want to?
- Have you ever attended an AA meeting?
- Has drinking ever created problems between you and
someone close to you? (spouse, parent, etc.)
- Have you ever gotten into trouble at work because of your
- Have you ever neglected your obligations, family, or work
for two or more days in a row because you were drinking?
- Have you ever gone to anyone for help about your
- Have you ever been in a hospital because of drinking?
- Have you ever been arrested for DWI/DUI?
- Have you ever been arrested, even for a few hours,
because of other drunken behavior?
- (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):
- In the last year, have you used alcohol or drugs more
than you intended?
- Have you felt the need to cut down?
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
- 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)
- Worried: Have close friends or relatives
worried or complained about your drinking in the past
- Eye openers: Do you sometimes take a
drink in the morning when you first get up?
- 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?
- 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.
- 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
- Never = 0
- Monthly or less = 1
- 2-4x/mo = 2
- 2-3x/wk = 3
- 4-5x/wk = 4
- > 6x/wk = 4
- How many drinks did you have on a typical day when you
were drinking in the past year?
- 0-2 drinks = 0
- 3-4 drinks = 1
- 5-6 drinks = 2
- 7-9 drinks = 3
- > 9 drinks = 4
- How often did you have 6 or more drinks on one occasion
in the past year?
- Never = 0
- < monthly = 1
- Monthly = 2
- Weekly = 3
- Daily or almost daily = 4