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Alcohol problems: Assessment and diagnosis

Key points

  • The Alcohol Use Disorders Identification Test and the Alcohol Use Assessment Form can aid in assessment and diagnosis.
  • Distinguish between at-risk drinking and the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) diagnoses of alcohol abuse and alcohol dependence.
  • Consider the possibility of co-occurring mental health problems.

Assessment tools

Alcohol Use Disorders Identification Test (AUDIT)

The AUDIT helps to identify at-risk drinking and alcohol dependence.

  • The 10-item survey can be given to clients to complete in the waiting room or in a face-to-face interview.
  • The questionnaire asks how much the person drinks and whether he or she has experienced negative consequences of drinking. AUDIT helps to identify at-risk drinking and alcohol dependence.

Download AUDIT questionnaire and manual [pdf].

Alcohol Use Assessment Form

The Alcohol Use Assessment Form can be used to:

  • take a history of alcohol use and collect other essential information, such as other drug use and drinking and driving
  • record physical examination and laboratory measures

The form includes a guide to diagnosing alcohol dependence versus at-risk drinking.

Download the Alcohol Use Assessment Form [pdf].

Diagnosis

Low-risk drinking guidelines (LRDG)

The LRDG define low-risk drinking as:

  • weekly intake of alcohol that does not exceed 15 standard drinks for males and 10 for females
  • daily consumption that does not exceed two standard drinks for females and three standard drinks for males.

Download Canada's Low-Risk Drinking Guidelines [pdf].

At-risk drinking

People whose drinking exceeds the low-risk drinking guidelines do not usually meet the criteria for alcohol abuse or dependence listed in the DSM. However, their drinking puts them at higher risk of developing an alcohol-related medical, psychological or social problem.

People who drink at an at-risk level are often not willing to accept a referral to a specialized addiction service. Moreover, the limited capacity of addiction services is often fully absorbed in helping clients with severe substance use disorders.

Primary care providers have a responsibility to advise clients who drink at at-risk levels. Simple and brief counselling interventions are often effective.

Alcohol abuse: DSM-IV-TR criteria

People may be diagnosed with alcohol abuse if they meet one or more of the following criteria in the last 12 months:

  • recurrent use resulting in failure to fulfill major role obligations at work, school or home
  • recurrent use in hazardous situations
  • recurrent use-related legal problems
  • use despite related social or interpersonal problems.

Alcohol dependence: DSM-IV-TR criteria

People may be diagnosed with alcohol dependence if they meet three or more of the following criteria in the last 12 months:

  • tolerance, or a need for more alcohol to get the same effect withdrawal symptoms
  • loss of control (i.e., drinking larger amounts or drinking for longer than planned)
  • unsuccessful attempts to cut down
  • salience, or significant time spent obtaining, using or recovering from the effects of alcohol
  • reduced engagement in social, occupational or recreational activities because of alcohol use
  • continued alcohol use despite knowledge of likely physical or psychological harm.

Note: DSM-5 combines alcohol abuse and alcohol dependence into one diagnosis.

Download a chart comparing at-risk drinking and alcohol abuse or alcohol dependence.

Co-occurring disorders

Health Canada recommends that:

  • all people seeking help from mental health services be screened for co-occurring substance use disorders
  • all people seeking help from substance use services be screened for co-occurring mental health disorders.

Prevalence of co-occurring disorders

Canadian population survey data shows that 28% of people identified with a current alcohol problem will also have a mental illness at some point in their lifetime. Moreover, rates of co-occurring disorders were two to three times higher among people in treatment. The highest rates of co-occurring disorders are found in institutions, including inpatient and outpatient mental health clinics, correctional facilities and addiction treatment programs.

Evidence summary

American Psychiatric Association (DSM-IV-TR). (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.). Washington, DC: Author.

Bondy, S., Rehm, J., Ashley, M., Walsh, G., Single, E. & Room, R. (1999). Low-risk drinking guidelines: The scientific evidence. Canadian Journal of Public Health, 90(4), 264–270.

Butt, P., Beirness, D., Cesa, F., Gliksman, L., Paradis, C. & Stockwell, T. (2011). Alcohol and Health in Canada: A Summary of Evidence and Guidelines for Low-Risk Drinking. Ottawa, ON: Canadian Centre on Substance Abuse.

Kahan, M. & Watts, K. (Eds.). (2010). Dealing with alcohol problems. In Primary Care Addiction Toolkit. Toronto, ON: Centre for Addiction and Mental Health.

National Institute for Health and Clinical Excellence. (2011). Alcohol-Use Disorders: Diagnosis, Assessment and Management of Harmful Drinking and Alcohol Dependence (Clinical Guideline 115). London, UK: Author.

Statistics Canada. (2002). Canadian Community Health Survey, Cycle 1.2. Ottawa: Author.


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I'd like to see more discussion of the differences between DSM IV and DSM 5 criteria.
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