Assessment Tools Used to Diagnose Alcohol Use Disorders
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a diagnostic tool, provides standardized criteria that healthcare professionals use to formally diagnose substance use and mental health disorders in the United States.1
The information provided in this article is for educational purposes only. Though the answers to some of these questions could be taken as an opportunity to speak more specifically with a doctor or other treatment professional about your drinking, they should not be used to make a definitive self-diagnosis. For official diagnoses, qualified healthcare professionals are in the best position to administer, score, and interpret findings from any alcohol use assessment.
Recognizing Alcohol Misuse
People who misuse substances, including alcohol, may not always recognize that there is a problem.2 Alcohol misuse refers to patterns of drinking that can be harmful to an individual’s health or that may interfere with interpersonal relationships or the ability to work.3 The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines misuse as an excess daily consumption of more than 4 drinks for men and more than 3 drinks for women or a weekly consumption in excess of 14 drinks for men and 7 drinks for women.3
AUDIT Alcohol Screen Assessment
The Alcohol Use Disorders Identification Test (AUDIT) was developed by the World Health Organization to screen for risky alcohol use and alcohol-related problems.5 The original version, developed in the 1980s as an international screening instrument, was modified in 2014 to align with the recommended drinking amounts and definitions of alcohol misuse in the United States (US AUDIT).5,6 In the United States, a drink refers to 1 beer, 1 5-oz. glass of wine, or 1 mixed drink containing 1.5 oz. of alcohol.6
The 10-item AUDIT used today helps a healthcare provider measure different aspects of alcohol use, utilizing questions related to quantity and frequency of use, symptoms of alcohol dependence, and alcohol-related consequences.7,8 The assessment can be done in a self-report format—meaning the patient completes the form—or the clinician can ask the questions, which include:6
- How often do you have a drink containing alcohol?
- How many drinks containing alcohol do you have on a typical day when you are drinking?
- How often do you have 5 (for men) or 4 (for women and men over age 65) or more drinks on one occasion?
- How often during the last year have you found that you were not able to stop drinking once you had started?
- How often during the last year have you failed to do what was normally expected from you because of drinking?
- How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?
- How often during the last year have you had a feeling of guilt or remorse after drinking?
- How often during the last year have you been unable to remember what happened the night before because you had been drinking?
- Have you or someone else been injured because of your drinking?
- Has a relative, friend, doctor, or other health worker been concerned about your drinking or suggested you cut down?
Scoring the AUDIT provides a clinician with results that range from 0–40. Higher scores indicate potential alcohol misuse and related problems.5 However, since the effects of alcohol vary, depending on an individual’s body weight and differences in metabolism, scoring may involve some interpretation on the part of the healthcare provider.5 Scoring ranges suggest the following:5
- 0–7: The individual may benefit from education on levels of low-risk alcohol use and risks associated with heavier alcohol consumption.
- 8–15: A person in this range may benefit from advice on their alcohol use and brief interventions to motivate changes in drinking.
- 6–19: An individual within this range would likely benefit from brief interventions focused on reducing alcohol misuse.
- 20–40: A person in this range requires a brief intervention and referral for diagnostic evaluation and treatment.
Besides the full 10-item AUDIT, healthcare providers may use a shorter version, the AUDIT-Consumption (US AUDIT-C), which includes the first 3 questions of AUDIT to assesses an individual’s frequency and quantity of alcohol consumption.6,7 The AUDIT-C can be quickly administered to determine if further assessment of a patient’s alcohol use is needed.
The CAGE questionnaire is historically a very widely used, though outdated, screening test.9 While it continues to be one of the most popular screening tools, the U.S. Preventive Services Task Force (USPSTF) does not recommend its continued use. The reasoning? The CAGE questionnaire may not successfully capture individuals in the beginning stages of alcohol misuse, who could benefit from early intervention.9
CAGE is an acronym that stands for Cut down, Annoyed, Guilty, Eye-opener. These phrases reference four questions that can be asked by clinicians to help assess the signs and symptoms of alcohol misuse:10
- 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 get rid of a hangover?
Either a healthcare professional verbally administers the CAGE questionnaire, or patients complete it using a self-report version.10 Patients answer each question with a yes or no response, and each “yes” receives 1 point. Results greater than or equal to 2 indicate potential alcohol problems.10
The Michigan Alcohol Screening Test (MAST)
The MAST, a 25-item questionnaire, provides a quick and effective screen for lifetime alcohol use and alcohol-related problems across a variety of patient populations.11
Patients respond to each item using a yes/no format, and every “yes” receives 1 point. If an individual scores a 5 or 6, it is recommended that a healthcare provider complete an additional evaluation.12 A thorough assessment of a patient’s alcohol use is recommended for patients who score a 7 or higher on the MAST.12
Getting Treatment for Alcohol Addiction
If you think you or a loved one might be struggling with alcohol misuse, consider reaching out to your doctor, therapist, or other healthcare provider. A trained healthcare professional may be able to conduct one of these or similar assessments to better determine a diagnosis and recommend treatment options.13
Alcohol treatment can vary in intensity and setting, ranging from outpatient treatment to inpatient care.14 There are a variety of treatment options available for alcohol misuse and alcohol use disorder. Types of treatment include behavioral therapies, medications, and mutual-help groups.13
Evidence-based behavioral therapies focus on helping an individual identify thoughts, emotions, and behaviors that increase the likelihood of alcohol use; learn alternative coping strategies; and change drinking behaviors.13 Additionally, there are three medications approved by the U.S. Food and Drug Administration (FDA) for treating alcohol use disorder. And mutual-help groups, such as Alcoholics Anonymous, can provide social support around changes in drinking behavior and help and individual sustain abstinence.13
Begin your path to recovery today. Call American Addiction Centers (AAC) at if your alcohol use or the use of someone you love has become problematic. Let one of our compassionate admissions navigators answer your questions, explain your options, even verify your insurance for free.