Alcohol use-related problems in general hospitals and primary care settings: Screening, intervention, and referral to treatment

Table 1 Screening tools for alcohol use-related problems

Tool	Publication year	No. of items	Score range	Cut-off	Recommendations
CAGE	1984	4	0-4	≥ 2, alcohol-related problem	/
AUDIT	1993	10	0-40	≥ 8, hazardous and harmful alcohol use, possible alcohol dependence	Zone I (0-7): Alcohol-related education; Zone II (8-15): Simple advice; Zone III (16-19): Simple advice, brief counseling continued monitoring; Zone IV (20-40): Referral to specialist for diagnostic evaluation and treatment
AUDIT-C	1998	3 (AUDIT Q1, Q2, Q3)	0-12	≥ 3 (women) or ≥ 4 (men), unhealthy alcohol use	/
SASQ	2001	1	/	Response of any time in the past 3 months to “When was the last time you had more than x drinks in one day?” (x = 4 for women, 5 for men)	Positive response: Further assessment
ASSIST	2002	8	0-39 for one substance	For alcohol: ≤ 10, low risk; 11-26, moderate risk; ≥ 27, high risk. For other substances: ≤ 3, lower risk; 4-26, moderate risk; ≥ 27, high risk	Low risk: Feedback, encouragement to remain low risk; Moderate risk: Brief (3-15-minutes) intervention; High risk: Brief intervention, encouragement of detailed clinical assessment and appropriate specialist treatment
Alcohol Symptom Checklist	2015	11	0-11	≥ 2, AUD diagnosis supported AUD severity per DSM-5: 2-3, mild; 4-5, moderate; 6-11, severe	/
STAD	2018	2 (AUDIT Q3 and Q7)	0–8	≥ 2 (women) or ≥ 3 (men), at-risk drinking	/

AUDIT: Alcohol Use Disorders Identification Test; AUDIT-C: Consumption-related AUDIT derivative; ASSIST: Alcohol, Smoking and Substance Involvement Screening Test; AUD: Alcohol use disorder; DSM-5: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; SASQ: Single Alcohol Screening Question; STAD: Screening Test for At-risk Drinking.

Table 2 Advantages and disadvantages in three dimensions

Dimensions	Advantages	Disadvantages
Screening	Broad use	Self-report tools
	Early detection	Lack of reliable objective markers
	Convenient
	Good validity
Intervention	Effectiveness in mild cases	Limited impact on severe AUD
	Flexibility	Cultural barriers
	Cost effective	Limited long-term impact
		Lack of training
Referral to treatment	Specialized care	Low referral rate and engagement
	Multidisciplinary support	Referral delay in practice