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Health A-Z

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Harvard Medical School

Diagnosis

Even though alcohol related disorders are very common, only a small minority of individuals recognize the problem and get help. Therefore, screening is very important, whether it is done by primary care physicians or friends and family.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) now recommends that primary care physicians ask a very simple, but specific question How many times in the past year have you had:

  • (Men) 5 or more drinks in a day?

  • (Women) 4 or more drinks in a day?

The goal with this question is to get a quick idea whether or not the person is at increased risk for developing alcohol-related problems. The limits are different for women and men because of known differences in how alcohol is absorbed, distributed and eliminated from the body. Thus, the risk goes up for men who drink more than 4 standard drinks in a day (or more than 14 in a week); while for women, the limit is lower 3 drinks in a day (and 7 drinks in a week).

Almost always, people feel nervous or defensive about their drinking, which is one reason this very common problem so often goes undetected or unaddressed. The NIAAA therefore recommends that physicians make a point of using their time with patients to educate them about drinking and its dangers.

As a screening test, the single question about drinking patterns is as good as slightly more detailed ones, such as the CAGE test. CAGE questions may be easier for concerned family members and friends to ask, since they may hesitate to ask direct questions about quantity.

The word "CAGE" is a device for remembering the questions (see the highlighted words):

  • Do you worry that you might need to CUT down on drinking?

  • Do you feel ANNOYED because other people have criticized your drinking?

  • Do you feel GUILTY about drinking?

  • Do you need a morning EYE OPENER drink to steady your nerves or to fight a hangover?

Another screening questionnaire used by physicians is the 10-question AUDIT (Alcohol Use Disorders Identification Test) developed by the World Health Organization.

Doctors often also ask whether a person has alcohol-related problems at work, at home or with the law, such as getting into fights or driving while intoxicated. The doctor may ask about physical symptoms of alcoholism. As embarrassing as the answers may be, the doctor should view drinking problems as an understandable human predicament and not a reason for their patients to feel ashamed.

A physical examination can reveal signs of poor nutrition and alcohol-related liver or nerve damage. Blood tests can check for anemia, vitamin deficiencies and abnormal levels of liver chemicals.

The NIAAA has a very helpful set of resources for the general public and for clinicians. They are all easily available online at www.niaaa.nih.gov.

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From Health A-Z, Harvard Health Publications. Copyright 2007 by the President and Fellows of Harvard College. All rights reserved. Written permission is required to reproduce, in any manner, in whole or in part, the material contained herein. To make a reprint request, contact Harvard Health Publications. Used with permission of StayWell.

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