Universal Alcohol Screening
USPSTF: Screen all adults 18+ years
All Pathways
Family MedicineDiagnostic
Alcohol Use Disorder Screening & Brief Intervention (AUDIT-C)
Alcohol Use Disorder Screening & Brief Intervention (AUDIT-C): Universal Alcohol Screening → AUDIT-C Questions → Negative Screen.
Pathway Overview
12 steps
Algorithm Steps
12 total
01Start 02Action AUDIT-C Questions
3-question screening tool (0-12 points)
- Q1: How often do you have a drink? (0-4)
- Q2: How many drinks on a typical drinking day? (0-4)
- Q3: How often 6+ drinks on one occasion? (0-4)
- Positive screen: Men ≥4, Women ≥3
03Outcome Negative Screen
Reinforce healthy choices, rescreen annually
04Action Positive AUDIT-C
Further assessment needed
- Ask about drinking patterns
- Assess quantity/frequency in detail
- Screen for consequences: legal, social, health
- Consider full AUDIT (10 questions)
05Decision Determine Risk Level
NIAAA drinking limits
- Low-risk limits: Men ≤14/week, ≤4/day; Women ≤7/week, ≤3/day
- Heavy drinking: Exceeds these limits
- Binge drinking: ≥4 (women) or ≥5 (men) in 2 hours
06Action At-Risk/Hazardous Use
Brief intervention (SBIRT)
- Express concern, provide feedback
- Advise to cut down
- Agree on specific goals
- Arrange follow-up
- Provide educational materials
07Action Follow-Up
Monitor progress
- Repeat AUDIT-C at visits
- LFTs, MCV (biomarkers)
- Assess treatment adherence
- Address relapses non-judgmentally
- Continue supporting recovery
08Decision DSM-5 AUD Criteria
≥2 of 11 criteria in past year = AUD
- Impaired control (4 criteria)
- Social impairment (3 criteria)
- Risky use (2 criteria)
- Pharmacologic dependence (2 criteria)
- Mild: 2-3, Moderate: 4-5, Severe: ≥6
09Action Mild AUD (2-3 criteria)
Brief intervention + motivational enhancement
- Brief intervention (15-30 min)
- Motivational interviewing
- Self-help resources (AA, SMART Recovery)
- Consider pharmacotherapy
- Follow up in 1-2 weeks
10Action FDA-Approved Pharmacotherapy
Can be initiated in primary care
- Naltrexone: 50mg daily PO or 380mg IM monthly
- Acamprosate: 666mg TID (renally dosed)
- Disulfiram: 250mg daily (supervised only, liver risk)
- Off-label: topiramate, gabapentin
- Path rejoins step 07Shared downstream outcome
11Warning Moderate-Severe AUD (≥4 criteria)
Specialty referral + pharmacotherapy
- Refer to addiction medicine/psychiatry
- Consider outpatient or residential treatment
- Pharmacotherapy: naltrexone, acamprosate, topiramate
- Assess for withdrawal risk if stopping
- Address co-occurring mental health
12Warning Assess Withdrawal Risk
Before stopping heavy use
- CIWA-Ar scoring if withdrawing
- Risk factors: daily drinking, prior withdrawal, seizure history
- Severe withdrawal requires inpatient detox
- Outpatient detox possible in selected patients
- Path rejoins step 10Shared downstream outcome
- Path rejoins step 10Shared downstream outcome
Guideline Source
USPSTF Screening for Unhealthy Alcohol Use + NIAAA Guidelines
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- AUDIT-C is screening only - clinical assessment required for diagnosis
- Does not address alcohol withdrawal management
- Brief intervention skills require training
- Pharmacotherapy initiation simplified
- Does not address polysubstance use
Contraindicated Populations
pediatric
Applicable Regions
USAUUKEU
AU: RACGP recommends AUDIT-C in primary care
UK: NICE recommends AUDIT-C for case identification
US: USPSTF Grade B recommendation for screening adults
Version 1Next review: 2028-01-01
Next steps
Finish the workflow by opening the most relevant calculator, then convert the session into a live account when you are ready.
Related Resources
Frequently Asked Questions
What is the Alcohol Use Disorder Screening & Brief Intervention (AUDIT-C)?
The Alcohol Use Disorder Screening & Brief Intervention (AUDIT-C) is a diagnostic clinical algorithm for Family Medicine. It provides a structured decision tree to guide clinical decision-making, based on USPSTF Screening for Unhealthy Alcohol Use + NIAAA Guidelines.
What guideline is the Alcohol Use Disorder Screening & Brief Intervention (AUDIT-C) based on?
This algorithm is based on USPSTF Screening for Unhealthy Alcohol Use + NIAAA Guidelines (DOI: 10.1001/jama.2018.16789).
What are the limitations of the Alcohol Use Disorder Screening & Brief Intervention (AUDIT-C)?
Known limitations include: AUDIT-C is screening only - clinical assessment required for diagnosis; Does not address alcohol withdrawal management; Brief intervention skills require training; Pharmacotherapy initiation simplified; Does not address polysubstance use. Individual patient factors may require deviation from these recommendations.
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