Alcohol Use Disorder (AUD)
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines AUD as an “impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences.” AUD is a disease diagnosed based on the severity of symptoms present the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) of Mental Disorders, Fifth Edition.
A multidisciplinary committee of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine define alcoholism as a “primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial. Each of these symptoms may be continuous or periodic.”
Screening for Alcohol Use Disorder
Alcohol Use Disorders Identification Test (AUDIT PDF.
10 question screening tool to assess alcohol consumption, drinking behaviors, and alcohol-related problems. (PDF)
AUDIT C (PDF) PLUS 2-
AUDIT screen combines alcohol and other drugs.
Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS) Tool
Combines screening and brief assessment for commonly used substances, eliminating the need for multiple screening and lengthy assessment tools
Alcohol Symptom Checklist
After positive screen, symptom checklist indicates mild, moderate or severe alcohol use disorder
Alcohol use disorder (AUD) often co-occurs with other mental health disorders, either simultaneously or sequentially. The prevalence of anxiety, depression, and other psychiatric disorders is much higher among persons with AUD compared to the general population. The likelihood of recovery from both conditions is higher if both the AUD and the co-occurring mental health disorder are treated. Medications for AUD and for mild to moderate depressive and anxiety disorders can be started in a primary care setting.
Behavioral Health Provider Toolkit (PDF)
This toolkit is full of resources including:
- Additional Adult, Adolescent and Child behavioral health screening assessments for Anxiety Disorder, Attention Deficit Hyperactivity Disorder and Depressive Disorders
- PHQ-9 reimbursement
- Suicide Prevention Practices
- Medication Management
- Therapy available
Prevalence, Risks, and Consequences of Alcohol Use
in the United States
NIAAA further details that Alcohol is a leading cause of morbidity and mortality, with harms related to both acute and chronic effects of alcohol contributing to about 5 million emergency department visits and more than 140,000 deaths in the U.S. each year.
There is no perfectly safe level of alcohol consumption, as current research points to health risks including cancer and cardiovascular risks even at low levels of consumption, regardless of beverage type.
Alcohol is a carcinogen associated with cancer of the oral cavity, pharynx, larynx, esophagus, colon, rectum, liver, and female breast, with breast cancer risk rising with less than one drink a day.
The whole body is impacted by alcohol use—not just the liver, but also the brain, gut, pancreas, lungs, cardiovascular system, immune system, and more—and may explain, for example, challenges in managing hypertension, atrial fibrillation, diabetes, and recurrent lung infections.
Your patients may be unaware that their alcohol use may be contributing to their medical problems and risks. During brief interventions, you can help patients to see that they can improve their health and reduce risks by cutting back or quitting drinking.
NIAAA recommends adults of legal drinking age can choose not to drink or to drink in moderation by limiting intake to 2 drinks or less in a day for men and 1 drink or less in a day for women when alcohol is consumed. Drinking less is better for health than drinking more.
The good news is that no matter how severe the problem may seem, most people with AUD can benefit from treatment with behavioral therapies, medications, or both.
Medications for Alcohol and Drug Use Disorders
Medications for alcohol use disorders (AUDs) improve response to behavioral treatment, and naltrexone can decrease heavy drinking as well.
The FDA has approved three medications for alcohol use disorders:
Naltrexone- Acamprosate- Disulfiram-
These medications can be prescribed in primary care with medication management focused on assessing use and symptoms, recommending abstinence in a patient-centered manner, medication adherence, and encouraging participation in peer support.
Follow-up can be every 1-2 weeks for 2 months and then monthly when patients are stable.
Care management by a nurse, recommending abstinence and naltrexone, is associated with improved engagement in alcohol-related care and decreased drinking compared to “referral to treatment” in primary care patients not seeking addiction treatment.
For assistance with care coordination, providers can “Let Us Know” by contacting the AmeriHealth Caritas Florida Rapid Response and Outreach team at 1-855-371-8072.