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All patients aged 15 years and older should be asked about the quantity and frequency of their alcohol intake,12,70 with the results logged in the patient record. The Alcohol Use Disorders Identification Test (AUDIT) or abbreviated, three-item AUDIT-C tool (Figure 2) can be utilised for this purpose.71,72
While formal assessment with such a tool is recommended in UK73 and Australian guidelines,74 GPs perceive barriers to its use.75
The AUDIT-C is a brief alcohol screen that reliably identifies patients who are hazardous drinkers or have active alcohol use disorders.
Each AUDIT-C question has a choice of five answers. It is scored on a scale of 0–12.
In men, a score of 4 or more, and in women, a score of 3 or more, is considered positive, optimal for identifying hazardous drinking or active alcohol use disorders. However, when the points are all from Question 1 alone (questions 2 and 3 are zero), it can be assumed that the patient is drinking below recommended limits and it is suggested the provider review the patient’s alcohol intake over recent months to confirm accuracy.76 Generally, the higher the score, the more likely it is that the patient’s drinking is affecting their safety.
Figure 2. The AUDIT-C tool
Date of visit:
AUDIT-C is based on The Alcohol Use Disorders Identification Test. Reproduced, with the permission of the publisher, from The Alcohol Use Disorders Identification Test: guidelines for use in primary care, AUDIT, second edition. Geneva: World Health Organization; 2000. P 17.[Accessed 22 January 2015].
As some patients may be sensitive to your questions, it is important to be non-judgmental. A careful systematic enquiry is the most valid indicator of the patient’s current level of alcohol consumption and is more reliable than using a number of laboratory tests, including gamma glutamyl transferase (GGT) and mean cell volume (MCV).12
The lifetime risk of harm from drinking alcohol increases with the amount consumed. The risk of an alcohol-related problem increases dramatically with an increase in the number of drinks consumed.77 For healthy men and women, drinking no more than two standard drinks on any day reduces the lifetime risk of harm from alcohol-related disease or injury.12 Short-term risks stem from the risks of accidents and injuries occurring immediately after drinking.
Alcohol consumption is calculated from the amount of alcoholic beverages, such as beer, cider, wine, spirits and mixed drinks, typically consumed in a day, combined with the number of days per week in which alcohol is usually consumed. Alcohol consumption is most often measured in standard drinks. An Australian standard drink contains 10 g of alcohol, which is equivalent to 12.5 mL of alcohol.12
How often should I screen?
How should I screen?
Ask about the quantity and frequency of alcohol intake. The AUDIT-C tool can be utilised for this.
Every 2–4 years
Who is at risk?
All patients aged 15 and older.
Who is at increased risk?
At preconception and antenatal visits (PP)12,96–98
What are the benefits and risks of preventive actions?
Numerous studies in Australia and the UK have shown that GPs providing brief advice have resulted in a 25–30% reduction in alcohol consumption and a 45% reduction in the number of excessive drinkers.
Brief interventions to reduce alcohol consumption should be offered to all patients drinking at potentially risky or high-risk levels (A).12 People with at-risk patterns of alcohol consumption should be offered brief advice to reduce their intake,99 while people with high-risk use patterns should be provided with interventions using brief motivational interviewing.12,100,101
The number needed to treat (return on effort) using brief interventions is one in eight: eight hazardous drinkers need to be treated to produce one who will reduce drinking to low-risk levels.82,84,99,102,103 Patients are more likely to be responsive to changing their drinking if they see a connection between their drinking and a health problem, if they believe they can change and things will improve if they do.
Level of evidence and strength of recommendation
What advice should be given to adults who drink alcohol?
Advise to drink two drinks per day, or less, and no more than four drinks on any one occasion.
What advice should be given to children and adolescents?
Advise children younger than 15 not to drink.
Advise young people aged 15–17 to delay drinking as long as possible.
What advice should be given to:
Inform them there is an increased risk of potential harm from drinking.
What advice should be given to individuals who are participating or supervising risky activities (eg. driving, boating, extreme sports, diving, using illicit drugs)?
Advise that non-drinking is the safest option.
(III-C) other areas85–90
What advice should be given to women who are pregnant or planning a pregnancy?
What advice should be given to individuals with a physical condition made worse by alcohol, including:
Advise that non-drinking is the safest option, but weigh up pros and cons for each individual.
Advise those with hypertension, or taking antihypertensive medication, to limit alcohol intake to no more than two (for men) or one (for women) standard drinks per day.
Advice to patients and treatment options need to be tailored to patients’ needs and priorities.
Patients drinking at potentially risky or high-risk levels should be assessed according to their readiness to change their drinking pattern. Patients who are not ready should be offered information about the risks associated with their level of alcohol use. Avoid arguing with patients.
Patients who are ready should be provided with brief motivational counselling. Patients should be encouraged to set their own goals. Try to reach an agreement about the number of drinks per day and the number of alcohol-free days. Ask them to assess their own motivation and confidence in making a change.
Try to help patients to identify high-risk situations and encourage them to avoid these. Appropriate social support such as friends or family should be enlisted. Patients should also be given self-help material and information about available support services.
For those who typically score 20 or more on the AUDIT questionnaire or ≥5 on AUDIT–C,104 consider offering:
Consider inpatient or residential-assisted withdrawal if the person meets one or more of the following criteria:
After a successful withdrawal for people with moderate and severe alcohol dependence, consider offering acamprosate* or oral naltrexone* in combination with an individual psychological intervention (cognitive behavioural therapies, behavioural therapies or social network and environment-based therapies) that focuses specifically on alcohol misuse. Obtain and document informed consent before prescribing.105
Consider offering interventions to promote abstinence and prevent relapse as part of an intensive and structured community-based intervention for people with moderate and severe alcohol dependence who have:
* Contraindicated in pregnancy and severe liver or renal disease.
Patients who have more severe problems with their alcohol consumption or who fail to respond to brief interventions should be referred to a local drug and alcohol counsellor or service. Patients who drink alcohol at high-risk or potentially risky levels who also have a chronic medical condition and complex needs may benefit from a GP Management Plan and Team Care Arrangement under Medicare’s CDM GP services (formerly Enhanced Primary Care). Refer to Chapter 4 and Chapter 5 for more information about what is available under Medicare, including links to MBS templates.
Alcohol and Drug Information Service (ADIS) 24-hour hotline
New South Wales
Ph: (02) 9361 8000
Toll free number: 1800 422 599
Ph: (08) 9442 5000
Toll free number: 1800 198 024
Ph: (07) 3236 2414
Toll free number: 1800 177 833
Ph: (08) 8363 8618
Toll free number: 1300 131 340
Ph: (08) 8922 8399
Toll free number: 1800 131 350
Ph: (03) 9416 1818
Toll free number: 1800 811 994
Australian Capital Territory
Ph: (02) 6207 9977
Ph: Alcohol and Drug Direct Line 1800 888 236
Further referral services can be found in Chapter 5. A local directory of services for patients with alcohol services may be compiled for a general practice (refer to Section 4.5.4).
Patients should be reviewed 1–3 months after their first visit in order to monitor progress and review their goals. The practice information system should generate reminders or lists of patients overdue for follow-up (refer to Section 4.5.1). Most relapses in behaviour occur in the first few weeks and patients should be counselled that they should keep trying even if they have relapsed.
Smoking, nutrition, alcohol, physical activity (SNAP) 2nd Edition (PDF 1 MB)