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Assessment and Diagnosis
When risk drinking is suspected, the assessment should include consumption pattern, criteria for alcohol-use disorders (Table 1), alcohol-related health problems (Table S1 in the Supplementary Appendix), and readiness to change drinking.
Evaluation of consumption includes the typical number of days per week on which alcohol is consumed, the number of standard drinks consumed on a typical day, the maximum number of standard drinks consumed on an occasion, and
the number of days per month of heavy drinking (five or more drinks for men and four or more for women). Frequent heavy drinking or high severity scores on screening tools are associated with an alcohol-use disorder. For example, a score of 7 to 9 on the Alcohol Use Disorders Identification Test–Consumption Questions (range, 0 to 12, with higher scores indicating risk drinking) (Table 2) is associated with a likelihood ratio of more than 3 for alcohol dependence.21 In patients
with positive screening results for risk drinking, a report of drinking in physically hazardous situations or drinking more or for longer than intended is 94 to 95% sensitive and 62 to 77% specific for an alcohol-use disorder.22 Brief assessment can also include a symptom checklist (Table 1).
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