Alcohol Use Disorder Screening & Brief Intervention (AUDIT-C)

Algorithm Steps

1. ▶

   Start

   Universal Alcohol Screening

   USPSTF: Screen all adults 18+ years

   1. ●

      Action

      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
      1. ✓

         Outcome

         Negative Screen

         Reinforce healthy choices, rescreen annually

      2. ●

         Action

         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)
         1. ◆

            Decision

            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
            1. ●

               Action

               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
               1. ●

                  Action

                  Follow-Up

                  Monitor progress

                  • Repeat AUDIT-C at visits
                  • LFTs, MCV (biomarkers)
                  • Assess treatment adherence
                  • Address relapses non-judgmentally
                  • Continue supporting recovery
            2. ◆

               Decision

               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
               1. ●

                  Action

                  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
                  1. ●

                     Action

                     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
               2. ⚠

                  Warning

                  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
                  1. ⚠

                     Warning

                     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