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Ask About Alcohol Use

Prescreen: Do you sometimes drink beer, wine, or other alcoholic beverages? Screening complete. Ask the screening question about heavy drinking days: How many times in the past year have you had . . . 5 or more drinks in a day? (for men) 4 or more drinks in a day? (for women) One standard drink is equivalent to 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof spirits — see chart on page 24. If the patient used a written self-report (such as the AUDIT p. 11), START HERE Is screening positive? 1 or more heavy drinking days or AUDIT score of ≥ 8 for men or ≥ 4 for women   Advise staying within these limits: Maximum Drinking Limits For healthy men up to age 65— no more than 4 drinks in a day AND no more than 14 drinks in a week For healthy women (and healthy men over age 65)— no more than 3 drinks in a day AND no more than 7 drinks in a week Recommend lower limits or abstinence as medically indicated; for example, for patients who take medications that interact with alcohol have a health condition exacerbated by alcohol are pregnant (advise abstinence) Express openness to talking about alcohol use and any concerns it may raise Rescreen annually   Your patient is an at-risk drinker. For a more complete picture of the drinking pattern, determine the weekly average: On average, how many days a week do you have an alcoholic drink?   X On a typical drinking day, how many drinks do you have? Weekly average Record heavy drinking days in the past year and the weekly average in the patient's chart (see page 27 for a downloadable baseline progress note).

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