We Ask Everyone: How to Properly Screen Patients for Alcohol Misuse

Many people drink alcohol as a way to wind down from the day and relax or they may indulge in drinks with family and friends in social situations. While alcohol consumption may not be viewed as dangerous or a high priority, it is important for individuals to understand that consuming large amounts of alcohol can have detrimental effects to their health, interpersonal relationships, and possibly lead to alcohol dependence.

Screening patients for alcohol misuse in the primary care setting is similar to other preventive screenings like depression or tobacco use. The results allow the healthcare professional to treat the whole patient, giving the capacity to address potential harmful interactions with medications or conditions exacerbated by alcohol consumption and can help to address problem drinking behaviors before developing an alcohol use disorder.

When considering the implementation of alcohol screenings into your healthcare organization it’s important to keep the following questions in mind:

  • Who will be screened?
  • When and how will patients be screened?
  • What screening tool will be utilized and who is responsible for conducting the screening?
  • What protocols are in place for patients with a positive screen?

Determining Who will be Screened

Asking all patients ages 14 years or older about their alcohol consumption can help healthcare professionals consistently screen their entire patient population. Having an established policy that “We Ask Everyone” can ease patients’ feelings about questions regarding their alcohol use. It is important for staff and clinicians to be mindful of how they approach patients before the screening. Presenting the questions or screening tool in a non-judgmental manner can help alleviate patient concerns, as well as normalizing the questions by embedding them into a larger health screening such as an annual wellness exam can help prepare the patient.

Selecting a Screening Tool

Determining which screening tool your organization will use may seem overwhelming with the number of choices. The SAMHSA-HRSA Center for Integrated Health Solutions has a comprehensive list of alcohol use and drug screening tools including, but not limited to the following:

  • AUDIT– The Alcohol Use Disorder Identification Test (AUDIT) is a 10-item questionnaire developed by the World Health Organization (WHO) to screen for hazardous or harmful alcohol consumption.
  • CAGE-AID– The CAGE-AID is a five-item tool used to screen for both drug and alcohol use. If a person answers yes to two or more questions, a complete assessment is advised.
  • DAST-10The Drug Abuse Screen Test (DAST) is a 10-item questionnaire condensed from its original 28-item DAST to screen for both drug and alcohol use.

Once a tool had been selected, determine how the screening will be implemented. For example, will patients complete the screening on paper in the waiting room or will medical staff ask the patient verbally in the exam room? There are advantages to most methods. Some may be a better fit based on your organization’s staffing and technology capabilities; a method that works for one organization may not be feasible in another.

Handling a Positive Screen

A positive screen for alcohol misuse does not indicate the patient is an alcoholic, but rather, it is simply a signal to have an additional discussion with the patient. Every healthcare organization should have a written protocol in place to determine how positive screens are handled and the appropriate staff should be trained on these protocols.

Depending upon which screening tool is utilized, the recommended action could vary from an additional assessment, referral and treatment to brief education, treatment, intervention and counseling. If your healthcare organization does not have integrated behavioral healthcare or a behavioral health clinician onsite, it is recommended that you develop a local referral resources list. Resources may include addiction and recovery centers, community mental health centers, residential or outpatient substance abuse centers, and individual or group counseling such as Alcoholics Anonymous.

Being prepared to respond to a positive screen can help you and others to feel more confident and allow your organization to handle these screens more smoothly.