Alcohol problems: Assessment and diagnosis
- 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.
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.
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.
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.
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.
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.
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.