Alcohol use disorder: How best to screen and intervene

The Journal of Family Practice. 2019 January;68(1):35-39

January 28, 2019|Family Medicine

Jaividhya Dasarathy, MD, FAAFP;Juan Young, MD;Aarti Chhatlani, MD;Michael Raddock, MD;Rajesh Tampi, MD, MS, DFAPA

The USPSTF recommends the AUDIT, the AUDIT-C, or the single-question NIAAA screen. The CAGE screening tool has low sensitivity at lower levels of alcohol intake.

THE CASE

Ms. E was open to the idea of decreasing her alcohol use and agreed that she was depressed. Her lab tests at follow-up were normal other than an elevated AST/ALT of 90/80 U/L. She received brief counseling from her family physician combined with cognitive behavioral therapy by a psychologist colleague. A subsequent ultrasound of her liver showed mild hepatomegaly and moderate-to-severe steatosis with nodularity of the liver, raising the possibility of cirrhosis.

The NIAAA single-question screen asks how many times in the past year the patient had ≥4 drinks (women) or ≥5 drinks (men) in a day.

She continued to get counseling for her AUD and for her comorbid depression in addition to taking a selective serotonin reuptake inhibitor. She is now in early remission for her alcohol use.

CORRESPONDENCE
Jaividhya Dasarathy, MD, Department of Family Medicine, Metro Health Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109; jdasarathy@metrohealth.org.

References

Download Article