Alcoholism Treatment & Management

  • Author: Warren Thompson, MD, FACP; Chief Editor: Iqbal Ahmed, MBBS, FRCPsych (UK)   more...
 
Updated: Jan 11, 2012
 

Medical Care

A number of serious problems are closely linked to alcohol intoxication. In fact, according to the NIAAA, intoxication is present in 30% of homicides, 22% of suicides, and 33% of car crashes. Any patient who presents an imminent safety risk to themselves or another person should be considered a candidate for hospitalization. This may require the assistance of family members or medical consultation with a psychiatrist.

Many physicians believe no effective treatment is available for alcoholism; therefore, these physicians do not refer their patients for treatment. However, more than 13 studies representing more than 4000 patients demonstrate that brief interventions make a difference. Most of the patients in these studies drank heavily but did not yet have a problem with alcohol.

One study performed in Norway demonstrated that brief advice given early can affect gamma glutamyl transferase levels and reported alcohol consumption. Early warning makes a difference to persons who drink heavily. In a study of 200 workers with alcoholism, recalling a physician's warning about drinking at the beginning of the study was associated with a better prognosis 2 years later. Unfortunately, less than 25% had received warnings from their physicians, again illustrating the problem of missed diagnosis.

Alcoholism can also be categorized into 2 types: early-onset (biological predisposition to the disease) or late-onset (brought on by environmental or psychosocial triggers). Understanding and studying the difference between early- and late-onset alcoholism facilitate the selection of the appropriate therapy. Drugs that affect the rewarding behavior of neural activities, such as ondansetron, naltrexone, topiramate, and baclofen, have been shown to alter drinking behavior.[38]

The first step in treatment is brief intervention. The physician states unequivocally that the patient has a problem with alcohol and emphasizes that this determination stems from the consequences of alcohol in that patient's life, not from the quantity of alcohol consumed. Emphasizing the effects on family, friends, and occupation, as well as any physical manifestations, is important. Pointing out that loss of control and compulsive use indicate alcohol dependence also is important.

Present the diagnosis. Use explicit evidence; emphasize the consequences endured by the patient as a result of alcohol abuse. Be empathic and nonjudgmental. Avoid arguments about the diagnosis. Avoid use of the word alcoholic.

Indicate the responsibility for change is with the patient. Listen to the patient's goals and point out discrepancies between his or her goals and actions.

Determine the patient's readiness for change. Motivating a reluctant patient is one of the great challenges in treatment. To enhance the prospects of successful treatment, the clinician needs to have a basic concept of the stages of change. The 5 stages of change (Prochaska,) provide fundamental guidance for enhancing motivation. The Substance Abuse and Mental Health Services Administration, the Center for Substance Abuse Treatment presents this concept in detail through a Treatment Improvement Protocol titled "Enhancing Motivation for Change in Substance Abuse Treatment." The 5 stages of change are precontemplation, contemplation, preparation, action, and maintenance. Specific strategies aligned with each of the 5 stages help a clinician motivate and prepare the patient for change. The 5 stages of change represent a cycle, permitting and explaining behavior that moves in both progressive and regressive directions.

In the precontemplation phase, the individual does not express any interest in the need for change. Many individuals with substance use problems are firmly entrenched in this stage. The options in dealing with patients in this stage are limited and include pointing out the discrepancy between patient action and patient goals, suggesting that the patient bring a family member to the next appointment, and suggesting a 2-week abstinence trial.

Contemplation represents the first evidence of dynamic behavior. The individual expresses a tentative belief in the possibility that alcohol use might be harmful. The hallmark of this stage is ambivalence and skepticism. Skepticism is not the same as denial but instead allows some degree of personal reflection. The patient is receptive to new information, or just as likely reassured that current behavior is acceptable, in the absence of information. Thus, the clinician should influence the ambivalence characteristic of contemplation in a direction favoring change. This can include pointing out that the patient's actions are not congruent with their goals, giving pamphlets concerning alcohol abuse, and suggesting an abstinence trial.

When the clinician successfully alters the balance in favor of a healthy choice, the patient enters the preparation stage. The preparation stage is a thoughtful phase focused on making plans.

The action stage of change represents full recognition of a problem along with observable evidence of steps taken to reduce alcohol use. The clinician should reinforce and praise the decision to change. Emphasizing that the biggest error at this stage is to underestimate the amount of help needed to quit drinking is critical. The patient should be given a list of options for treatment including AA and pharmacotherapy.

Maintenance is the final and most mature stage of change. During the maintenance stage, motivational efforts are directed toward promoting hard won gains and preventing slips. Relapse prevention efforts are sustained by the patient's appreciation of specific environmental and biobehavioral triggers, which contribute to recurrence. See Follow-up.

As mentioned previously, the stages of change represent a cycle permitting both forward and backward movement.

The physician must state firmly, but empathically, that alcohol is a problem for the patient and that the patient determines the solution. Patients come for treatment through several means, often from a mixture of both coercion and concern. The clinician needs to understand the extent of resistance to effectively work with the patient. A good strategy is to learn about patients' goals and indicate discrepancies between their goals and their choices. Pointing out discrepancies is more effective initially than statements such as, "You have to quit," or, "You have to go to AA."

The patient's response determines the physician's next step. If the patient denies the problem, recommending joining AA will not work. Involving the family and/or suggesting a trial of abstinence is useful, and, importantly, the physician should follow up with the patient in a few weeks. The patient might be angry initially and storm out of the office, but then the patient might recall the physician's warning months or years later and stop drinking. For patients who recognize a problem and will consider referral, the cheapest (free) and most accessible option is AA.

The AA 12-step approach involves psychosocial techniques used in changing behavior (eg, rewards, social support networks, role models). Each new person is assigned an AA sponsor (a person recovering from alcoholism who supervises and supports the recovery of the new member). The sponsor should be older and should be of the same sex as the patient (opposite sex if the patient is homosexual).

Patients do not need a strong religious background to be successful in AA; they only need the belief in a power higher than themselves. Urge patients to use aspects of the program that can help them stay sober and ignore aspects that are not helpful.

Patients who have tried AA may have had a bad past experience. Patients should try at least 5-10 different meetings before giving up on the AA approach because each meeting is different. For example, women often do better at meetings for women only because the issues for female patients with alcoholism are different from the issues for male patients with alcoholism. A meeting in the suburbs might not be appropriate for someone from the inner city and vice versa.

The physician should have AA literature in the office (dates and places of meetings), have the AA phone number available, and know about other treatment services in the community, including referrals for medical consultants or specialists in chemical dependency. No randomized trials of AA have been performed, but a US Veterans Administration study suggested that patients who attended meetings did much better than those who refused to go.

AA can be reached via their Web site (Alcoholics Anonymous) or by mail (AA General Service; PO Box 459; Grand Central Station; New York, NY 10163). Physicians can order pamphlets and other patient education material from these sources.

Additional sources of help include the Substance Abuse Treatment FACILITY LOCATOR, Self-Help Group Sourcebook Online, and SMART Recovery. The acronym SMART is for Self-Management and Recovery Training.

Treatment of alcoholism involves the following:

  • Brief physician advice makes a difference.
  • While a trial period of controlled drinking with careful follow-up might be appropriate for a diagnosis of alcohol abuse, this approach increases a physician's professional liability. Complete abstinence is the only treatment for alcohol dependence. Emphasize that the most common error is underestimating the amount of help that will be needed to stop drinking. The differential diagnosis between alcohol abuse and dependence can be a difficult judgment call.
  • Hospitalize patients if they have a history of delirium tremens or if they have significant comorbidity. Consider inpatient treatment if the patient has poor social support, significant psychiatric problems, or a history of relapse after treatment.
  • Strongly recommend AA.
  • Encourage hospitalized patients to call AA from the hospital. AA will send someone to talk to them if the patient makes the contact. Patients need to attend meetings regularly (daily at first) and for a sufficient length of time (usually 2 y or more) because recovery is a difficult and lengthy process.
  • In the beginning of treatment, and perhaps ongoing, patients should remove alcohol from their homes and avoid bars and other establishments where strong pressures to drink may influence successful abstinence.
  • If the patient has an antisocial personality (ie, severe problems with family, peers, school, and police before age 15 y and before the onset of alcohol problems), recovery is less likely. If the patient has primary depression, anxiety disorder, or another potentially contributory disorder (the other disorder must antedate the problems with alcohol or it must be a significant problem during long periods of sobriety), treat this primary problem aggressively.

Strongly encourage family members of patients with alcoholism to contact Al-Anon and Alateen via its Web site (Al-Anon/Alateen) or mailing address (Al-Anon Family Group Headquarters; PO Box 182; Madison Square Garden Station; New York, NY 10159-0182).

Next

Consultations

Consultation with a psychiatrist might be indicated in cases in which questions of suicide, violence, or comorbid psychiatric disorders might be present.

Previous
Next

Diet

Persons with alcoholism often have a poor diet. Folate deficiency is common. Advise patients to eat plenty of fruits and vegetables and consider a multivitamin supplement. Supplemental enteral nutrition improves survival in persons with advanced liver disease.

Previous
Proceed to Medication
 
 
Contributor Information and Disclosures
Author

Warren Thompson, MD, FACP  Associate Professor, Department of Internal Medicine, Mayo Medical School

Warren Thompson, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Heart Association, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Coauthor(s)

R Gregory Lande, DO, FACN  Clinical Consultant, Army Substance Abuse Program, Department of Psychiatry, Walter Reed Army Medical Center

R Gregory Lande, DO, FACN is a member of the following medical societies: American Osteopathic Academy of Addiction Medicine and American Osteopathic Association

Disclosure: Nothing to disclose.

Raj K Kalapatapu, MD  Fellow, Addiction Psychiatry, Columbia University College of Physicians and Surgeons

Raj K Kalapatapu, MD is a member of the following medical societies: American Academy of Addiction Psychiatry, American Academy of Child and Adolescent Psychiatry, American Association for Geriatric Psychiatry, American Medical Association, and American Psychiatric Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Denis F Darko, MD  Executive Director, Clinical Research and Development, Global Neuroscience, AstraZeneca

Denis F Darko, MD is a member of the following medical societies: American College of Physicians and American Psychiatric Association

Disclosure: AstraZeneca Salary Management position

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Harold H Harsch, MD  Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin

Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: lilly Honoraria Speaking and teaching; Forest Labs None None; Pfizer Grant/research funds Speaking and teaching; Northstar None None; Novartis Grant/research funds research; Pfizer Honoraria Speaking and teaching; Sunovion Speaking and teaching; Otsuke Grant/research funds reseach; GlaxoSmithKline Grant/research funds research; Merck Honoraria Speaking and teaching

Chief Editor

Iqbal Ahmed, MBBS, FRCPsych (UK)  Faculty, Department of Psychiatry, Tripler Army Medical Center; Clinical Professor of Psychiatry, Clinical Professor of Geriatric Medicine, University of Hawaii, John A Burns School of Medicine

Iqbal Ahmed, MBBS, FRCPsych (UK) is a member of the following medical societies: Academy of Psychosomatic Medicine, American Association for Geriatric Psychiatry, American Neuropsychiatric Association, American Psychiatric Association, American Society of Clinical Psychopharmacology, and Royal College of Psychiatrists

Disclosure: Nothing to disclose.

References

  1. Vaillant GE. A long-term follow-up of male alcohol abuse. Arch Gen Psychiatry. Mar 1996;53(3):243-9. [Medline].

  2. Lopez-Quintero C, Cobos JP, Hasin DS, et al. Probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis, and cocaine: Results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Drug Alcohol Depend. May 1 2011;115(1-2):120-30. [Medline]. [Full Text].

  3. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. Mar 10 2004;291(10):1238-45. [Medline].

  4. Saitz R. Clinical practice. Unhealthy alcohol use. N Engl J Med. Feb 10 2005;352(6):596-607. [Medline].

  5. Nutt DJ, King LA, Phillips LD. Drug harms in the UK: a multicriteria decision analysis. Lancet. Nov 6 2010;376(9752):1558-65. [Medline].

  6. Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to alcohol consumption: a prospective study among male British doctors. Int J Epidemiol. Feb 2005;34(1):199-204. [Medline].

  7. Knoops KT, de Groot LC, Kromhout D, Perrin AE, Moreiras-Varela O, Menotti A. Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. JAMA. Sep 22 2004;292(12):1433-9. [Medline].

  8. Thun MJ, Peto R, Lopez AD, et al. Alcohol consumption and mortality among middle-aged and elderly U.S. adults. N Engl J Med. Dec 11 1997;337(24):1705-14. [Medline].

  9. Pletcher MJ, Varosy P, Kiefe CI, Lewis CE, Sidney S, Hulley SB. Alcohol consumption, binge drinking, and early coronary calcification: findings from the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Epidemiol. Mar 1 2005;161(5):423-33. [Medline].

  10. Ruidavets JB, Ducimetiere P, Evans A, Montaye M, Haas B, Bingham A. Patterns of alcohol consumption and ischaemic heart disease in culturally divergent countries: the Prospective Epidemiological Study of Myocardial Infarction (PRIME). BMJ. 2010;341:c6077. [Medline].

  11. Sood B, Delaney-Black V, Covington C, et al. Prenatal alcohol exposure and childhood behavior at age 6 to 7 years: I. dose-response effect. Pediatrics. Aug 2001;108(2):E34. [Medline].

  12. Baer JS, Sampson PD, Barr HM, et al. A 21-year longitudinal analysis of the effects of prenatal alcohol exposure on young adult drinking. Arch Gen Psychiatry. Apr 2003;60(4):377-85. [Medline].

  13. Arria AM, Caldeira KM, Kasperski SJ, Vincent KB, Griffiths RR, O'Grady KE. Energy Drink Consumption and Increased Risk for Alcohol Dependence. Alcohol Clin Exp Res. Nov 12 2010;[Medline].

  14. Enoch MA, Goldman D. Problem drinking and alcoholism: diagnosis and treatment. Am Fam Physician. Feb 1 2002;65(3):441-8. [Medline].

  15. Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA. Nov 10 1999;282(18):1737-44. [Medline].

  16. Boutin-Foster C, Ferrando SJ, Charlson ME. The Cornell Psychiatric Screen: a brief psychiatric scale for hospitalized medical patients. Psychosomatics. Sep-Oct 2003;44(5):382-7. [Medline].

  17. Nery FG, Stanley JA, Chen HH, Hatch JP, Nicoletti MA, Serap Monkul E, et al. Bipolar disorder comorbid with alcoholism: A (1)H magnetic resonance spectroscopy study. J Psychiatr Res. Oct 7 2009;[Medline].

  18. Hicks BM, Krueger RF, Iacono WG, McGue M, Patrick CJ. Family transmission and heritability of externalizing disorders: a twin-family study. Arch Gen Psychiatry. Sep 2004;61(9):922-8. [Medline].

  19. Schuckit MA, Smith TL. An 8-year follow-up of 450 sons of alcoholic and control subjects. Arch Gen Psychiatry. Mar 1996;53(3):202-10. [Medline].

  20. Chengappa KN, Levine J, Gershon S, Kupfer DJ. Lifetime prevalence of substance or alcohol abuse and dependence among subjects with bipolar I and II disorders in a voluntary registry. Bipolar Disord. Sep 2000;2(3 Pt 1):191-5. [Medline].

  21. Jacobsen LK, Southwick SM, Kosten TR. Substance use disorders in patients with posttraumatic stress disorder: a review of the literature. Am J Psychiatry. Aug 2001;158(8):1184-90. [Medline].

  22. Vlahov D, Galea S, Ahern J, Resnick H, Boscarino JA, Gold J. Consumption of cigarettes, alcohol, and marijuana among New York City residents six months after the September 11 terrorist attacks. Am J Drug Alcohol Abuse. May 2004;30(2):385-407. [Medline].

  23. Marshall RD, Galea S. Science for the community: assessing mental health after 9/11. J Clin Psychiatry. 2004;65 Suppl 1:37-43. [Medline].

  24. Shipherd JC, Stafford J, Tanner LR. Predicting alcohol and drug abuse in Persian Gulf War veterans: what role do PTSD symptoms play?. Addict Behav. Mar 2005;30(3):595-9. [Medline].

  25. Green B. Post-traumatic stress disorder: symptom profiles in men and women. Curr Med Res Opin. 2003;19(3):200-4. [Medline].

  26. Dobie DJ, Kivlahan DR, Maynard C, Bush KR, Davis TM, Bradley KA. Posttraumatic stress disorder in female veterans: association with self-reported health problems and functional impairment. Arch Intern Med. Feb 23 2004;164(4):394-400. [Medline].

  27. Substance Abuse and Mental Health Services Administration. Center for Substance Abuse Treatment. The Role of Biomarkers in the Treatment of Alcohol Use Disorders. US Department of Health and Human Services; September 2006. Pages 1-8. [Full Text].

  28. de Beaurepaire R, Lukasiewicz M, Beauverie P, Castéra S, Dagorne O, Espaze R, et al. Comparison of self-reports and biological measures for alcohol, tobacco, and illicit drugs consumption in psychiatric inpatients. Journal of European Psychiatry. November 2007;22 (8):540-548. [Medline].

  29. Das SK, Dhanya L, Vasudevan DM. Biomarkers of alcoholism: an updated review. Scand J Clin Lab Invest. 2008;68(2):81-92. [Medline]. [Full Text].

  30. Hannuksela ML, Liisanantti MK, Nissinen AE, Savolainen MJ. Biochemical markers of alcoholism. Clin Chem Lab Med. 2007;45(8):953-61. [Medline]. [Full Text].

  31. Niemelä O. Biomarkers in alcoholism. Clin Chim Acta. Feb 2007;377(1-2):39-49. [Medline].

  32. Sommers MS, Savage C, Wray J, Dyehouse JM. Laboratory measures of alcohol (ethanol) consumption: strategies to assess drinking patterns with biochemical measures. Biol Res Nurs. Jan 2003;4(3):203-17. [Medline].

  33. Bergström JP, Helander A. Clinical Characteristics of Carbohydrate-Deficient Transferrin (%Disialotransferrin) Measured by HPLC: Sensitivity, Specificity, Gender Effects, and Relationship with other Alcohol Biomarkers. Alcohol Alcohol. Apr 24 2008;[Medline].

  34. Peterson K. Biomarkers for alcohol use and abuse. Alcohol Research & Health. 2004/2005;28.

  35. Neumann T, Spies C. Use of biomarkers for alcohol use disorders in clinical practice. Addiction. Dec 2003;98 Suppl 2:81-91. [Medline].

  36. Bean P. State of the art contemporary biomarkers of alcohol consumption. MLO Med Lab Obs. Nov 2005;37(11):10-2, 14, 16-7; quiz 18-9. [Medline].

  37. Hietala J, Koivisto H, Anttila P, Niemelä O. Comparison of the combined marker GGT-CDT and the conventional laboratory markers of alcohol abuse in heavy drinkers, moderate drinkers and abstainers. Alcohol Alcohol. Sep-Oct 2006;41(5):528-33. [Medline].

  38. Johnson BA. Medication treatment of different types of alcoholism. Am J Psychiatry. Jun 2010;167(6):630-9. [Medline].

  39. Sinclair JD. Evidence about the use of naltrexone and for different ways of using it in the treatment of alcoholism. Alcohol Alcohol. Jan-Feb 2001;36(1):2-10. [Medline].

  40. Rosner S, Hackl-Herrwerth A, Leucht S, Vecchi S, Srisurapanont M, Soyka M. Opioid antagonists for alcohol dependence. Cochrane Database Syst Rev. Dec 8 2010;12:CD001867. [Medline].

  41. Pescosolido BA, Martin JK, Long JS, Medina TR, Phelan JC, Link BG. "A disease like any other"? A decade of change in public reactions to schizophrenia, depression, and alcohol dependence. Am J Psychiatry. Nov 2010;167(11):1321-30. [Medline].

  42. American Medical Association. Alcoholism in the elderly. Council on Scientific Affairs, American Medical Association. JAMA. Mar 13 1996;275(10):797-801. [Medline].

  43. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Washington, DC: American Psychiatric Association; 2000.

  44. Anton RF, Moak DH, Waid LR, et al. Naltrexone and cognitive behavioral therapy for the treatment of outpatient alcoholics: results of a placebo-controlled trial. Am J Psychiatry. Nov 1999;156(11):1758-64. [Medline].

  45. Bigby JA. Substance Abuse Education and General Internal Medicine: A Manual for Faculty. Washington, DC: Society of General Internal Medicine; 1993.

  46. Fleming MF, Barry KL, Manwell LB, et al. Brief physician advice for problem alcohol drinkers: A randomized controlled trial in community-based primary care practices. JAMA. 1997;277:1039-1045. [Medline].

  47. Garbutt JC, Kranzler HR, O'Malley SS. Efficacy and tolerability of long-acting injectable naltrexone for alcohol dependence: a randomized controlled trial. JAMA. Apr 6 2005;293(13):1617-25. [Medline].

  48. Heinz A, Reimold M, Wrase J, et al. Correlation of stable elevations in striatal {micro}-opioid receptor availability in detoxified alcoholic patients with alcohol craving: a positron emission tomography study using carbon 11-labeled carfentanil. Arch Gen Psychiatry. Jan 2005;62(1):57-64. [Medline].

  49. Kiefer F, Jahn H, Tarnaske T, et al. Comparing and combining naltrexone and acamprosate in relapse prevention of alcoholism: a double-blind, placebo-controlled study. Arch Gen Psychiatry. Jan 2003;60(1):92-9. [Medline].

  50. Malone SM, Iacono WG, McGue M. Drinks of the father: father's maximum number of drinks consumed predicts externalizing disorders, substance use, and substance use disorders in preadolescent and adolescent offspring. Alcohol Clin Exp Res. Dec 2002;26(12):1823-32. [Medline].

  51. Mayo-Smith MF, American Society of Addiction Medicine Working Group on Pharmacology. Pharmacological management of alcohol withdrawal: A meta-analysis and evidence-based practice guideline. JAMA. 1997;278:144-151. [Medline].

  52. Mendelson JH, Mello NK. Medical Diagnosis and Treatment of Alcoholism. New York, NY: McGraw-Hill; 1992.

  53. National Institute on Alcohol Abuse and Alcoholism. Etiology and Natural History of Alcoholism. [Full Text].

  54. NIAAA. Alcohol Involvement in Accidental Death, Homicide, and Suicide. [Full Text].

  55. O'Connor PG, Schottenfeld RS. Patients with alcohol problems. N Engl J Med. Feb 26 1998;338(9):592-602. [Medline].

  56. O'Malley SS, Jaffe AJ, Chang G, et al. Six-month follow-up of naltrexone and psychotherapy for alcohol dependence. Arch Gen Psychiatry. Mar 1996;53(3):217-24. [Medline].

  57. O'Malley SS, Rounsaville BJ, Farren C, et al. Initial and maintenance naltrexone treatment for alcohol dependence using primary care vs specialty care: a nested sequence of 3 randomized trials. Arch Intern Med. Apr 6 2005;163(14):1695-704. [Medline].

  58. Piccinelli M, Tessari E, Bortolomasi M, et al. Efficacy of the alcohol use disorders identification test as a screening tool for hazardous alcohol intake and related disorders in primary care: a validity study. BMJ. Feb 8 1997;314(7078):420-4. [Medline].

  59. Pletcher MJ, Varosy P, Kiefe CI, et al. Alcohol consumption, binge drinking, and early coronary calcification: findings from the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Epidemiol. Mar 1 2005;161(5):423-33. [Medline].

  60. Room R, Babor T, Rehm J. Alcohol and public health. Lancet. Feb 5 2005;365(9458):519-30. [Medline].

  61. Saitz R. Clinical practice. Unhealthy alcohol use. N Engl J Med. Feb 10 2005;352(6):596-607. [Medline].

  62. Saitz R, O'Malley SS. Pharmacotherapies for alcohol abuse. Withdrawal and treatment. Med Clin North Am. Jul 1997;81(4):881-907. [Medline].

  63. Samet JH, Rollnick S, Barnes H. Beyond CAGE. A brief clinical approach after detection of substance abuse. Arch Intern Med. Nov 11 1996;156(20):2287-93. [Medline].

  64. Sigvardsson S, Bohman M, Cloninger CR. Replication of the Stockholm Adoption Study of alcoholism. Confirmatory cross-fostering analysis. Arch Gen Psychiatry. Aug 1996;53(8):681-7. [Medline].

  65. Steinbauer JR, Cantor SB, Holzer CE 3rd, Volk RJ. Ethnic and sex bias in primary care screening tests for alcohol use disorders. Ann Intern Med. Sep 1 1998;129(5):353-62. [Medline].

  66. Thun MJ, Peto R, Lopez AD, Monaco JH, Henley SJ, Heath CW Jr. Alcohol consumption and mortality among middle-aged and elderly U.S. adults. N Engl J Med. Dec 11 1997;337(24):1705-14. [Medline].

  67. Volpicelli JR, Alterman AI, Hayashida M, O'Brien CP. Naltrexone in the treatment of alcohol dependence. Arch Gen Psychiatry. Nov 1992;49(11):876-80. [Medline].

  68. Walden B, McGue M, Lacono WG, et al. Identifying shared environmental contributions to early substance use: the respective roles of peers and parents. J Abnorm Psychol. Aug 2004;113(3):440-50. [Medline].

  69. Walsh DC, Hingson RW, Merrigan DM, Levenson SM, Coffman GA, Heeren T, et al. The impact of a physician's warning on recovery after alcoholism treatment. JAMA. Feb 5 1992;267(5):663-7. [Medline].

  70. Wilk AI, Jensen NM, Havighurst TC. Meta-analysis of randomized control trials addressing brief interventions in heavy alcohol drinkers. J Gen Intern Med. May 1997;12(5):274-83. [Medline].

  71. CDC Press Release. Binge drinking is bigger problem than previously thought. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/media/releases/2012/p0110_binge_drinking.html. Accessed January 10, 2012.

 
Previous
Next
 
Deaths while intoxicated. Data from the National Institute on Alcohol Abuse and Alcoholism (NIAAA).
Table 1. AUDIT Questions and Scoring System
Questions0 Points1 Point2 Points3 Points4 Points
1. How often do you have a drink containing alcohol?NeverMonthly or less2-4 times a month2-3 times a week4 or more times a week
2. How many drinks containing alcohol do you have on a typical day when you are drinking?1 or 23 or 45 or 67-910 or more
3. How often do you have 6 or more drinks on 1 occasion?NeverLess than monthlyMonthlyWeeklyDaily or almost daily
4. How often during the past year have you found that you were not able to stop drinking once you had started?NeverLess than monthlyMonthlyWeeklyDaily or almost daily
5. How often during the past year have you failed to do what was normally expected of you because of drinking?NeverLess than monthlyMonthlyWeeklyDaily or almost daily
6. How often during the past year have you needed a first drink in the morning to get yourself going after a heavy drinking session? NeverLess than monthlyMonthlyWeeklyDaily or almost daily
7. How often during the past year have you had a feeling of guilt or remorse after drinking?NeverLess than monthlyMonthlyWeeklyDaily or almost daily
8. How often during the past year have you been unable to remember what happened the night before because you had been drinking?NeverLess than monthlyMonthlyWeeklyDaily or almost daily
9. Have you or has someone else been injured as a result of your drinking?NoYes, but not in the past yearYes, during the past year
10. Has a relative, friend, or a doctor or other health care worker been concerned about your drinking or suggested you cut down? NoYes, but not in the past yearYes, during the past



year



Table 2. Sensitivity and Specificity of Alcohol Biomarkers*
BiomarkerSensitivity (%)Specificity (%)
AST15-6947-68
ALT18-5850-57
GGT34-8511-95
MCV34-8926-95
CDT39-9482-100
CDT + GGT90 † 98
Alcohol0-1000-100
EtG76-9177-92
*Values vary considerably according to gender, age, drinking pattern, prevalence of alcohol abuse/dependence, and prevalence of comorbidity, among other factors.[30, 31, 35, 36, 32]



† The sensitivity comes from one study in Finland, which uses a special formula. This study needs to be replicated.[37]



Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.