The 10 Questions That Can Help Identify Problem Drinkers

About half of those who find themselves in the emergency room following an accident or injury have something in common: Alcohol is in their system. Of that group, about 10% will be back at the same hospital within the year suffering from more trauma.

What the ER doctor treating the injured person doesn’t always know, though, is whether the alcohol use is regular and excessive, a signal that there is a serious drinking problem.

This is vital to find out. Research shows that identifying high-risk drinkers and spending time explaining to them the dangers of alcohol use, their responsibility for change, and available treatment options can reduce future trauma visits by almost half.

ER teams have traditionally relied on blood tests to tell them which patients have alcohol in their systems and might be in need of such intervention. Alcohol is broken down by the body quickly, so a single alcohol test performed hours after an accident will often miss it. It also can't distinguish between someone who had two beers at a picnic from someone who is intoxicated all the time. Blood alcohol tests rope in some who don’t need help—and misses others who do. One alternative is 20% more effective, according to a new study from researchers at Loyola University Medical Center: A simple 10-point questionnaire developed decades ago by the World Health Organization but which has been refined several times over the years.

The Alcoholism Test

Called the Alcohol Use Disorders Identification Test, or AUDIT, the questionnaire quickly zeroes in not only on the frequency of a person’s alcohol use but on their feelings about it, and has been proven to be an accurate measure of drinking risk across ages, genders, and cultures.

Wonder how you’d do on such a test? Ask yourself the 10 AUDIT questions and add up the numbers next to your answers:

1. How often do you have a drink containing alcohol?

(0) Never

(1) Monthly or less

(2) 2 to 4 times a month

(3) 2 to 3 times a week

(4) 4 or more times a week

2. How many drinks containing alcohol do you have on a typical day when you are drinking?

(0) 1 or 2

(1) 3 or 4

(2) 5 or 6

(3) 7, 8, or 9

(4) 10 or more

3. How often do you have six or more drinks on one occasion?

(0) Never

(1) Less than monthly

(2) Monthly

(3) Weekly

(4) Daily or almost daily

Note: If your total for questions 2 and 3 add up to zero, skip to questions 9 and 10.

4. How often during the last year have you found that you were not able to stop drinking once you had started?

(0) Never

(1) Less than monthly

(2) Monthly

(3) Weekly

(4) Daily or almost daily

5. How often during the last year have you failed to do what was normally expected from you because of drinking?

(0) Never

(1) Less than monthly

(2) Monthly

(3) Weekly

(4) Daily or almost daily

6. How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?

(0) Never

(1) Less than monthly

(2) Monthly

(3) Weekly

(4) Daily or almost daily

7. How often during the last year have you had a feeling of guilt or remorse after drinking?

(0) Never

(1) Less than monthly

(2) Monthly

(3) Weekly

(4) Daily or almost daily

8. How often during the last year have you been unable to remember what happened the night before because you had been drinking?

(0) Never

(1) Less than monthly

(2) Monthly

(3) Weekly

(4) Daily or almost daily

9. Have you or someone else been injured as a result of your drinking?

(0) No

(2) Yes, but not in the last year

(4) Yes, during the last year

10. Has a relative or friend or a doctor or another health worker been concerned about your drinking or suggested you cut down?

(0) No

(2) Yes, but not in the last year

(4) Yes, during the last year

What Your Score Means

A score of eight or above indicates risk for hazardous and harmful drinking—and the higher the score, the greater the potential danger. It’s important to remember, though, that a single number can’t tell the whole story. A person’s gender, age, weight, and metabolism all play a role in how well the body handles alcohol. Cultural norms surrounding drinking must be considered as well. Even so, the AUDIT scale has been used worldwide to study and treat alcohol use disorders, and it is correct far more often than not.

Recognizing those limitations, AUDIT recommends these guidelines:

• Those who score 8-15 should be considered as having a medium level of alcohol problems. In a clinical setting, a simple intervention offering advice about reducing hazardous drinking would be appropriate.
• Those who score 16-19 have a high level of alcohol problems. They would benefit from counseling and continued monitoring.
• Those who score 20 and above should not delay in getting a complete diagnostic evaluation from a specialist who can recommend treatment for possible alcohol dependence.

The researchers who studied the use of AUDIT in emergency rooms see the intervention it inspires as vital in getting people the help they need and in reducing the health care costs surrounding repeat hospital visits. All of us, though, can benefit from knowing our AUDIT number. It’s far from an exact science, but it can show us where we stand and be a motivator for healthier behavior. In a society in which drinking plays such a prominent role, it can be easy to forget that recommended guidelines are only one drink a day for women and two for men.

If your tally has you worried, keep a few things in mind:

• Help is available.
• Change is possible.
• By asking yourself the tough questions now, you make it less likely that you’ll find yourself doing so in an emergency room someday.

David Sack, MD, is a psychiatrist, addiction blogger and CEO of Elements Behavioral Health, a nationwide network of addiction treatment programs that includes Journey Healing Centers alcohol rehab in Utah and Clarity Way alcohol treatment center in Pennsylvania.