Diagnosing Alcohol Use Disorder – Screening Test and Assessments

Alcohol use disorder (AUD) is a condition present among millions of Americans (over 15 million, according to the data from 2019) and ranges from mild to severe. Determining that a person has a problem, rather than that they just have an occasional drink, can be hard because the drinking culture is very widespread.1

CDC estimates that as many as 37 million Americans binge drink at least once a week, which makes it so common that a problem could go unnoticed. Although the majority of people who drink alcohol do not have AUD, it is important to diagnose alcohol use disorder when there is one.2

Diagnosis of Alcoholism 

Diagnosis of alcoholism is made by a medical professional, but anyone can notice the first symptoms – friends, family, coworkers, a partner, or even the person who is suffering from AUD. There are a few ways to determine what the problem is and how severe it is, including psychological and physical tests, laboratory examinations (through blood) and self-assessment questionnaires.3

Alcoholism diagnosis is crucial since it is the first step towards recovery. It specifies what the issue is and with the diagnosis comes the suggestion for recovery. Once the doctors understand the severity of AUD, they can make a plan for your recovery and adjust it to your real needs, preventing overdose. That is why the diagnosis is vital in this first phase.3

What Are the Methods To Test for Diagnosing Alcohol Use Disorder? 

There is no universal way to assess the state of AUD in a person. It is common to use various methods during the diagnosing process in order to get the whole picture and make a proper assessment. The check-up ought to include:4

• Drinking history.
• Screening tests.
• Psychological examination.
• Physical examination.
• The necessary laboratory assessment.

History is an important element of any diagnosis. In order to be complete, many aspects of the patient’s life and habits should be examined, starting from their alcohol and/or other drug intake – when it began, how often it is consumed and how much was consumed in the previous 24 hours. History includes discussions about other health complications which are the result of drinking, as well as possible withdrawal symptoms. It is important to mention the current health state and any medications that you might be using.4

Screening and psychological tests will focus on the appearance and behavior of a patient, their train of thought, mood they are in and how it changes when drinking; perception (and possible hallucinations), orientation, memory etc.4 There will also be a self-assessment test, although it is advised to do it even on your own at home. The questions that can be posed are:1

• Were there times when you ended up drinking more, or longer, than you intended?
• Did you try to quit drinking, but couldn’t?
• Do you spend a lot of time drinking? 
• Do you sometimes want a drink so badly you can’t think of anything else?
• Do you find that drinking or being sick from drinking interferes with your everyday life? And do you still continue?
• Have you given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
• Did you get into dangerous situations where you or somebody else could have been harmed because of your drinking?
• Have you continued to drink even though it was making you feel depressed or anxious or adding to another health problem?
• Have you had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?
• Have you had withdrawal symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, or a seizure? Or hallucinations?

Physical and laboratory assessments will determine if medication is needed and how much, if any, damage to the patient’s body was done.4

What Are Alcohol Use Screening Tests? 

Tests for diagnosing alcohol use disorder are, as we mentioned, numerous, but they normally start with a conversation, i.e. screening tests where the patient answers various questions so that their alcoholism state can be assessed. Some of the possible questions are listed above.

It is important to have standardized questionnaires, because they can be applicable to all patients and the results of all patients can be compared on the same level. One of the most prominent screening tests is AUDIT – the Alcohol Use Disorders Identification Test.6 It has been standardly used during alcoholism diagnosis since 1989 and examines 3 main aspects:6

• Alcohol intake.
• Dependence on alcohol (if any).
• Alcohol-related harm (if any).

The WHO has created this test with a view to assessing the overall state of the aforementioned and set the alcohol diagnosis criteria.5 They have provided both a version for the clinician, as well as the self-report (they include the same questions but the instructions are different). The clinician’s version is as follows:5

1. How often do you have a drink containing alcohol?

• (0) Never [Skip to Qs 9-10].
• (1) Monthly or less.
• (2) 2 to 4 times a month.
• (3) 2 to 3 times a week.
• (4) 4 or more times a week.

2. How many drinks containing alcohol do you have on a typical day when you are drinking?

• (0) 1 or 2.
• (1) 3 or 4.
• (2) 5 or 6.
• (3) 7, 8, or 9.
• (4) 10 or more.

3. How often do you have six or more drinks on one occasion?

• (0) Never.
• (1) Less than monthly.
• (2) Monthly.
• (3) Weekly.
• (4) Daily or almost daily. (Skip to Questions 9 and 10 if Total Score for Questions 2 and 3 = 0)

4. How often during the last year have you found that you were not able to stop drinking once you had started?

• (0) Never.
• (1) Less than monthly.
• (2) Monthly.
• (3) Weekly.
• (4) Daily or almost daily.

5. How often during the last year have you failed to do what was normally expected from you because of drinking?

• (0) Never.
• (1) Less than monthly.
• (2) Monthly.
• (3) Weekly.
• (4) Daily or almost daily.

6. How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?

• (0) Never.
• (1) Less than monthly.
• (2) Monthly.
• (3) Weekly.
• (4) Daily or almost daily.

7. How often during the last year have you had a feeling of guilt or remorse after drinking?

• (0) Never.
• (1) Less than monthly.
• (2) Monthly.
• (3) Weekly.
• (4) Daily or almost daily.

8. How often during the last year have you been unable to remember what happened the night before because you had been drinking?

• (0) Never.
• (1) Less than monthly.
• (2) Monthly.
• (3) Weekly.
• (4) Daily or almost daily.

9. Have you or someone else been injured as a result of your drinking?

• (0) No.
• (1) Yes, but not in the last year.
• (2) Yes, during the last year.

10. Has a relative or friend or a doctor or another health worker been concerned about your drinking or suggested you cut down?

• (0) No.
• (1) Yes, but not in the last year.
• (2) Yes, during the last year.

A score lower than 8 is normal, of 8 or more indicates AUD and a consultation on the treatment plan should follow, and over 15 is a situation in which instant intervention is needed (e.g. detoxification) with a referral to a specialist.7

How To Conduct A Physical Examination For Diagnosing AUD? 

Another type of test for diagnosing AUD is a physical examination. It is normally done after a conversation with the patient and with clear instructions about what is going to be done. Prior to the exam, the blood alcohol level should be measured so as to assess the base for the symptoms – for example, withdrawal symptoms could be absent due to intoxication or vice versa.4

The physical exam looks at the current intoxication or withdrawal, presence of AUD and potential medical conditions which are the result of AUD. Special attention is paid to:4

• Anemia or bruising.
• Injuries.
• Cardiac enlargement.
• Abdominal pain.
• Liver dysfunction.
• Hypertension.
• Alcoholic facies.
• Slurred speech.

Withdrawal is another indicator of AUD, which occurs when some time passes and there is no intake of alcohol. It includes symptoms such as anxiety, agitation, tremors, hallucinations, and in severe cases, seizures and delirium tremens. These symptoms are also assessed in a physical examination.8

All of these can be serious consequences and symptoms of AUD, and, in case both the screening, the psychological assessments and the alcohol level indicate so, a diagnosis of alcoholism can be made.4

How Is Psychological Assessment of Alcoholism Conducted? 

Psychological evaluation is an equally important step in the process of diagnosing AUD. Thorough testing should be performed so as not to mistake the symptoms of other disorders with AUD. Some aspects which need to be examined are:4

• Appearance and behavior.
• Form of thought.
• Content of thought.
• (Dis)orientation.
• Mood and affect (anxiety, depression, lability).
• Perception.
• Perception (hallucinations).
• Cognition (consciousness, abstract thinking).
• Insight.

Departing from normal behavior in these aspects can be a sign of many different disorders, which is why there are other tests combined with the mental assessment. However, there are also 2 famous and standardized screenings and tests for diagnosing AUD – CAGE and MAST.9

The CAGE test is a four-question test and it is an acronym for the questions:9

• Have you ever felt you should CUT down on your drinking?
• Have people ANNOYED you by criticizing your drinking?
• Have you ever felt bad or GUILTY about your drinking?
• Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (i.e., as an EYE-OPENER)?

Two or more positive answers indicate a possible AUD. This test is not 100% accurate, but it sets a good basis for further examination. The other test is MAST – Michigan Alcoholism Screening Test – which has 25 questions. They are similar to the CAGE ones, but more specific and the test is considered reliable in both clinical and non-clinical settings.9

Both MAST and CAGE have proved to be useful tools in screening for AUD and diagnosing alcoholism in high-risk patients and regular communities.10

Laboratory Assessment For AUD 

Another way of both assessing the patient’s health and checking the information provided by them is through laboratory testing, primarily blood tests, but also urine ones. Blood count will show the state of hemoglobin and red blood cells, whose abnormalities could point to AUD. Low potassium or magnesium are also common indicators of AUD.4

Levels of GGT, MCV and CDT (liver biomarkers) are very important criteria for diagnosing AUD, too. An elevated CDT combined with GGT above normal indicates a possible alcohol dependence and CDT combined with GGT below normal is a sign of alcohol abuse. MCV’s sensitivity to alcohol dependence is lower, but goes up to 85%. The most reliable marker of the 3 is CDT.11

Urine analysis is a particularly sensitive one. By supplying a urine sample, you get the level of alcohol results within 24 hours. Time of detection is 1-2 days, since the blood alcohol decreases ~0.02 gm% per hour.12

Which Alcoholism Diagnosis Method Should I Take? 

Tests for diagnosing AUD are numerous, and all of them have their strengths and weaknesses, but a comprehensive assessment will include all or the majority of them, because they tend to complete each other. The main tests are:4

• Taking history – vital for determining predispositions for AUD and drinking habits.
• Screening tests – AUDIT, MAST, CAGE etc. will provide a self-evaluation and give answers to some crucial questions.
• Psychological exam – determines the effect the potential AUD has had on the psyche (form of thought, perception etc.).
• Physical exam – examines the physical wellbeing, necessary especially with severe AUD to establish what systems in the body have already been affected by drinking.
• Laboratory exam – gives a straightforward answer on how much alcohol there is in your blood.

What Should I Do Next After an AUD Diagnosis? 

If the AUD diagnosis criteria show that you do have AUD, it is important to take further steps towards recovery. It is likely that the doctor will already provide you with a treatment plan once you get the alcoholism diagnosis, but there are plenty of options for treatment. Some of them are:3

• Behavioral treatment. These sessions are aimed at changing your drinking habits through counseling.
• Medications. In some cases of moderate or severe AUD, medications will be necessary to ensure a safe recovery. Medications need to be prescribed by a medical professional and are non-addictive.
• Mutual-support groups. The 12-step AA meetings are support groups for addicts which provide a safe space for conversation and assistance. They are not considered treatment on their own, but are a great addition to other treatment plans.

Whether it is inpatient or outpatient, treatment for AUD works. There are many treatment centers to visit and if you need additional information, you can always call any of the alcohol hotlines which are free and available 24/7 and whose admissions navigator will verify your insurance and answer your questions about the facilities near you, since in some, admission is possible on that same day. Call for help today.

Frequently Asked Questions