Alcohol screening: adults 18 and over
Screen all adults in primary care, including pregnant women. Rescreen at least yearly. Not for under 18s, acute intoxication or withdrawal.
All Pathways
Family MedicineDiagnostic
Alcohol Use Disorder Screening & Brief Intervention (AUDIT-C)
Alcohol Use Disorder Screening & Brief Intervention (AUDIT-C): Alcohol screening: adults 18 and over → Pregnant, planning pregnancy or breastfeeding: no...
Pathway Overview
16 steps
Algorithm Steps
16 total
01Start 02Warning Pregnant, planning pregnancy or breastfeeding: no alcohol is safest
No safe amount of alcohol is known in pregnancy or breastfeeding.
- Any alcohol use counts as a positive screen and as above limits: give brief intervention and, with her consent, involve the antenatal team
- Do not use the adult drinking limits for her
- AUD medicines: specialist advice first. Acamprosate and disulfiram are contraindicated; topiramate can harm the fetus
03Action AUDIT-C: 3 questions (score 0-12)
Ask in standard drinks (Australia: 1 standard drink = 10 g alcohol).
- Q1: How often do you have a drink containing alcohol? (0-4)
- Q2: How many standard drinks on a typical drinking day? (0-4)
- Q3: How often do you have 6 or more standard drinks on one occasion? (0-4)
- Positive: men 4 or more; women 3 or more; pregnant: any drinking
04Decision AUDIT-C positive?
Men 4 or more, women 3 or more, or any drinking in pregnancy
- If Yes
05Action Positive AUDIT-C: assess further
Clinical assessment before any advice or treatment
- Full AUDIT (10 questions): 8 or more = hazardous or harmful drinking; 15 or more = assess for dependence
- Quantity and frequency in standard drinks over a typical week
- Harms: physical health, mental health, injuries, social and legal problems
- Other drugs, including opioids and sedatives; current medicines
06Warning Before any advice to stop: assess withdrawal risk
Sudden stopping in a dependent drinker can cause withdrawal seizures or delirium. Current severe withdrawal, seizure or delirium: send to hospital (000). Confusion, ataxia or eye signs: treat as Wernicke encephalopathy now (parenteral thiamine, send to hospital).
- Risk: daily heavy drinking, morning drinking, past withdrawal, withdrawal seizures or delirium, benzodiazepine or other sedative use
- At risk: plan supervised withdrawal. Home only if mild-moderate predicted severity, no past withdrawal seizures or delirium, no heavy use of other drugs, safe home with daily support, and no severe comorbidity; otherwise residential unit or hospital
- Thiamine for all patients in withdrawal, before any glucose. Well nourished: 300 mg orally daily for 3-5 days, then 100 mg daily (1-2 weeks in total). Malnourished: 300 mg IM or IV daily for several days, then 300 mg orally daily for several weeks
07Decision DSM-5 alcohol use disorder: how many of 11 criteria in the past 12 months?
0-1: no AUD. 2-3: mild. 4-5: moderate. 6 or more: severe. Criteria: impaired control, social impairment, risky use, tolerance and withdrawal.
- 0-1 criteria
08Decision No AUD (0-1 criteria): drinking above NHMRC limits?
Above limits: more than 10 standard drinks a week or more than 4 on any one day. Pregnant, planning pregnancy or breastfeeding: any alcohol.
- If Yes
09Action No AUD, above limits: brief intervention
Brief intervention (for example FRAMES) in primary care
- Give feedback on the AUDIT-C score and the personal risks
- Advise to cut down to within NHMRC limits (pregnant: stop)
- Agree a specific goal with the patient
- Offer written information and arrange follow-up
10Action Follow-up
Review at each visit
- Drinking in standard drinks or repeat AUDIT-C
- LFTs during naltrexone or disulfiram treatment
- GGT, MCV or CDT only support self-report; they are less accurate than AUDIT
- Continue treatment through a lapse; respond without judgement
- Step up care if drinking does not improve
If No11Outcome No AUD, within limits: give feedback, rescreen yearly
Explain the AUDIT-C result and the NHMRC limits. Rescreen at least yearly.
- 2-3 criteria
12Action Mild AUD (2-3 criteria): brief intervention and motivational interviewing
Goal of abstinence or reduced drinking, agreed with the patient
- Brief intervention with motivational interviewing
- Mutual-help groups (AA, SMART Recovery); National Alcohol and Other Drug Hotline 1800 250 015 (24 hours)
- Relapse-prevention medicines are recommended for moderate to severe AUD, not routinely for mild AUD
- Arrange follow-up; step up to AOD or specialist care if drinking continues
- Path rejoins step 10Shared downstream outcome
- 4 or more criteria
13Action Moderate-severe AUD (4 or more criteria): treat and refer
Psychosocial treatment plus relapse-prevention medicine
- Plan withdrawal first if dependent (see withdrawal step)
- Refer to AOD service or addiction medicine; residential treatment if severe or unsafe at home
- Psychosocial treatment: CBT, motivational interviewing, relapse prevention
- Assess and treat co-occurring mental health problems, other drug use and suicide risk (crisis: 000 or Lifeline 13 11 14)
14Warning Before AUD medicines: check opioids, pregnancy, liver and kidneys
Check LFTs, bilirubin and creatinine before you start.
- Any opioid use (codeine, tramadol, oxycodone, morphine, methadone, buprenorphine), planned opioid pain relief or opioid withdrawal: no naltrexone. Confirm opioid-free: ask, check real-time prescription monitoring, urine drug screen if unsure
- Pregnant or breastfeeding: no acamprosate or disulfiram; specialist advice before any AUD medicine
- Acute hepatitis or liver failure: no naltrexone; LFTs well above normal: specialist advice before naltrexone. Creatinine above 120 micromol/L or Child-Pugh C: no acamprosate
15Action Moderate-severe AUD: relapse-prevention medicine (adults)
Start after withdrawal settles (about 3-7 days after the last drink). Continue for at least 3-6 months with psychosocial care.
- Naltrexone 50 mg orally once daily (may start 25 mg daily). Must be opioid-free for 7-10 days. Stop 48-72 hours before planned opioid pain relief
- Acamprosate 333 mg tablets with meals: 60 kg or more, 666 mg three times daily; under 60 kg, 666 mg morning, 333 mg midday, 333 mg night
- Disulfiram (specialist, supervised, abstinence goal only, only with the patient's informed consent): only after at least 24 hours without alcohol; never when intoxicated. Start 100 mg daily for 7-14 days, then 200 mg daily (max 300 mg). Not with heart disease, past stroke, hypertension, psychosis, suicide risk, advanced liver or kidney disease, metronidazole or paraldehyde. Warfarin: monitor INR. No alcohol (including in medicines) until 14 days after the last dose
- Second line, specialist only (off-label): topiramate (fetal harm: pregnancy test and highly effective contraception), baclofen (overdose and seizure risk)
- Do not use benzodiazepines for relapse prevention
- Path rejoins step 10Shared downstream outcome
If No16Outcome Negative AUDIT-C: reinforce low-risk drinking, rescreen yearly
Adults: no more than 10 standard drinks a week and no more than 4 on any one day (NHMRC 2020). If reported intake is above these limits, give brief advice to cut down.
Guideline Source
Guidelines for the Treatment of Alcohol Problems (Australian Government, Haber & Riordan, 2021); USPSTF Unhealthy Alcohol Use screening (2018); NHMRC Alcohol Guidelines (2020)
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Adults 18 and over only. Not for acute intoxication, alcohol withdrawal treatment or alcohol-related emergencies: use a withdrawal or emergency protocol.
- Screening and first-line primary care management only. Withdrawal management and specialist AUD treatment need their own protocols.
- AUDIT-C cut-offs vary between sources: this pathway uses men 4 or more and women 3 or more; the Australian guideline chapter 4 uses 5 or more for further assessment.
- Brief intervention and motivational interviewing need training.
- Other drug use is flagged but not managed here.
Contraindicated Populations
pediatricUnder 18 years (use adolescent tools)Acute intoxication or alcohol withdrawal (use a withdrawal protocol)
Applicable Regions
USAUUKEU
AU: Australian standard drink = 10 g alcohol. NHMRC 2020: adults no more than 10 standard drinks a week and no more than 4 on any one day; no alcohol under 18, in pregnancy or when planning pregnancy; not drinking is safest when breastfeeding. Naltrexone is available only as tablets in Australia.
UK: UK low-risk guidance and unit size (1 unit = 8 g) differ from Australia: use local limits.
US: USPSTF grade B (2018; update in progress). US standard drink = 14 g alcohol. Extended-release naltrexone IM injection is FDA-approved but not available in Australia.
Version 2Next review: 2027-09-30
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 Guidelines for the Treatment of Alcohol Problems (Australian Government, Haber & Riordan, 2021); USPSTF Unhealthy Alcohol Use screening (2018); NHMRC Alcohol Guidelines (2020).
What guideline is the Alcohol Use Disorder Screening & Brief Intervention (AUDIT-C) based on?
This algorithm is based on Guidelines for the Treatment of Alcohol Problems (Australian Government, Haber & Riordan, 2021); USPSTF Unhealthy Alcohol Use screening (2018); NHMRC Alcohol Guidelines (2020) (DOI: 10.1001/jama.2018.16789).
What are the limitations of the Alcohol Use Disorder Screening & Brief Intervention (AUDIT-C)?
Known limitations include: Adults 18 and over only. Not for acute intoxication, alcohol withdrawal treatment or alcohol-related emergencies: use a withdrawal or emergency protocol.; Screening and first-line primary care management only. Withdrawal management and specialist AUD treatment need their own protocols.; AUDIT-C cut-offs vary between sources: this pathway uses men 4 or more and women 3 or more; the Australian guideline chapter 4 uses 5 or more for further assessment.; Brief intervention and motivational interviewing need training.; Other drug use is flagged but not managed here.. Individual patient factors may require deviation from these recommendations.
Get AI-Powered Analysis Alongside This Algorithm
In AttendMe.ai, the Alcohol Use Disorder Screening & Brief Intervention (AUDIT-C) appears automatically when your clinical question matches — alongside evidence from 3M+ peer-reviewed articles.
Try AttendMe Free