1. A maladaptive pattern of alcohol abuse leading to clinically significant impairment or distress, as
manifested by one or more of the following, occurring within a 12-month period:
Recurrent alcohol use resulting in failure to fulfil major role obligations at work, school, or home
(e.g., repeated absences or poor work performance related to substance use; substance-related
absences, suspensions or expulsions from school; or neglect of children or household).
Recurrent alcohol use in situations in which it is physically hazardous (e.g., driving an automobile
or operating a machine).
Recurrent alcohol-related legal problems (e.g., arrests for alcohol-related disorderly conduct).
Continued alcohol use despite persistent or recurrent social or interpersonal problems caused or
exacerbated by the effects of the alcohol (e.g., arguments with spouse about consequences of
intoxication or physical fights).
2. These symptoms must never have met the criteria for alcohol dependence.

A maladaptive pattern of alcohol use, leading to clinically significant impairment or distress, as manifested by
three or more of the following seven criteria, occurring at any time in the same 12-month period:
1. Tolerance, as defined by either of the following:
A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.
Markedly diminished effect with continued use of the same amount of alcohol.
2. Withdrawal, as defined by either of the following:
The characteristic withdrawal syndrome for alcohol (refer to DSM-IV for further details).
Alcohol is taken to relieve or avoid withdrawal symptoms.
3. Alcohol is often taken in larger amounts or over a longer period than was intended.
4. There is a persistent desire or there are unsuccessful efforts to cut down or control alcohol use.
5. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol or recover from its
effects.
6. Important social, occupational, or recreational activities are given up or reduced because of alcohol
use.
7. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or
psychological problem that is likely to have been caused or exacerbated by the alcohol (e.g., continued
drinking despite recognition that an ulcer was made worse by alcohol consumption).
American Psychiatric Association. 1994. Diagnostic and Statistical Manual of Mental Disorders (4th ed.)
(DSM-IV). Washington, D.C.: APA.

Alcohol dependence is a major problem in the EU.
Alcohol misuse is also an increasing problem in children and young people.

Approach to patient with suspected alcohol
related problem
Be honest and non-judgmental.
Many patients drink in secret and may not want to discuss the issue.
The patient needs to accept that there is a problem before therapy can start.
Detoxification should be discussed.
Information regarding local Alcoholics Anonymous groups should be offered.

Assessment
It is necessary to decide if the patient has an alcohol problem and, if so, whether the patient
is a dependent drinker. The patient has a problem if he or she answers yes to any of the
'CAGE' questions (= C ut down, A nnoyed, G uilty, E ye-opener) and/or scores highly on
the Alcohol Use Disorders Identification Test (AUDIT). Specialist advice should be sought if
they score more than 15 on AUDIT assessment.

The Alcohol Use Disorders Identification Test: Interview Version
Read questions as written.

0 points – Never
1 point – Monthly or less
2 points – 2 to 4 times a MONTH
3 points – 2 to 3 times a WEEK
4 points – 4 or more times a week

1/9

1. How often do you have a drink containing alcohol?
Questioner may skip to Questions 9 and 10 if reply to Question 1 is never, or if both answers
to Q 2 and 3 are 0.

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

0 points – 1 or 2 drinks
1 point – 3 or 4 drinks
2 points – 5 or 6 drinks
3 points – 7 or 8 or 9 drinks 4
points – 10 or more drinks

3. How often do you have six or
more drinks on one occasion?
AUDIT-C Score /12
(complete full questionnaire if score
is 3 or more)

1/9

0 points – Never
1 point – Less than monthly 2 points – Monthly
3 points – Weekly
4 points – Daily or almost daily

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

0 points – Never
1 point – Less than monthly
2 points – Monthly
3 points – Weekly
4 points – 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?

1/9

0 points – Never
1 point – Less than monthly 2 points – Monthly
3 points – Weekly
4 points – 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 points – Never
1 point – Less than monthly
2 points – Monthly
3 points – Weekly
4 points – Daily or almost daily

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

1/9

0 points – Never
1 point – Less than monthly 2 points – Monthly
3 points – Weekly
4 points – Daily or almost daily

1/9

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

0 points – Never
1 point – Less than monthly
2 points – Monthly
3 points – Weekly
4 points – Daily or almost daily

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

0 points – No, never
2 points – Yes, but not in the last year 4
points – 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?
The Alcohol Use Disorders
Identification Test (AUDIT)
Score = /40

1/9

0 points – No, never
2 points – Yes, but not in the last year 4 points – Yes, during the last
year

1/9

Scores of 8 or more are considered an indicator of hazardous and harmful alcohol use.
Dependent drinkers are characterized by:
An overwhelming desire for alcohol.
Drinking out of control.
A need for increasing amounts of alcohol.
Withdrawal symptoms experienced.
Having little interest in other leisure activities.
Continuing to drink even when the harm being done is made clear.
These can be formally assessed using a validated tool such as the Severity of Alcohol
Dependence Questionnaire (SADQ).
A comprehensive assessment should be carried out when a person scores 15 or more on
the AUDIT. This should address a range of potential needs. A clinical interview should
assess:
Alcohol use (consumption, historical and recent patterns of drinking), using validated
clinical tools.
Level of dependence. Alcohol-
related problems.
Other drug misuse (including over-the-counter medication).
Physical health problems.
Psychological and social problems.
Cognitive function – although formal measures of cognitive functioning (eg the Mini Mental
State Examination) are usually only performed if impairment persists after a period of
abstinence or a significant reduction in alcohol intake.
Readiness and belief in ability to change.
If possible, information

AUDIT-C

Questions

Scoring system Your
score 0 1 2 3 4

How often do you have a drink containing
alcohol? Never Monthly
or less
2 – 4
times
per
month
2 – 3
times
per
week
4+
times
per
week

How many units of alcohol do you drink on a
typical day when you are drinking? 1 -2 3 – 4 5 – 6 7 – 8 10+
How often have you had 6 or more units if
female, or 8 or more if male, on a single
occasion in the last year?

Never
Less
than
monthly
Monthly Weekly
Daily
or
almost
daily

Scoring:
A total of 5+ indicates increasing or higher risk drinking.
An overall total score of 5 or above is AUDIT-C positive. SCORE

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

(0.0) Never. 

(0.5) Monthly or less. 

(1.0) Two to four times a month. 

(1.5) Two to three times a week. 

(2.0) Four or more times a week. 

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

(0.0) 1 or 2. 

(0.5) 3 or 4. 

(1.0) 5 or 6. 

(1.5) 7 to 9. 

(2.0) 10 or more. 

3. Have people annoyed you by criticizing your drinking? 

(0.0) No. 

(1.0) Yes. 

4. Have you ever felt bad or guilty about your drinking? 

(0.0) No. 

(1.0) Yes. 

5. Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hang-over? 

(0.0) No. 

(1.0) Yes. 

Five-Shot Questionnaire

Please recall a recent month when you were drinking in a way, which for you was fairly typical of a heavy drinking period 

We want to know more about your drinking during this time and how often you experienced certain feelings. Please circle the number at the start of the answer that applied to you during this typical period of drinking. 

Section 1 

1. A) I wake up feeling sweaty 

O Almost Never 

1 Some-times 

2 Often 

3 Nearly Always 

1. B) My hands shaking first thing in the morning 
2. C) 

O Almost Never 

1 Some-times 

2 Often 

3 Nearly Always 

My whole body shakes violently first thing in the morning, if I don’t have a 

drink 

O Almost Never 

1 Some-times 

2 Often 

3 Nearly Always 

1. D) I wake up absolutely drenched in sweat 

O Almost Never 

1 Some-times 

2 Often 

3 Nearly Always 

1. E) I dread waking up in the morning 

O Almost Never 

1 Some-times 

2 Often 

3 Nearly Always 

1. F) I am frightened of meeting people first thing in the morning 

O Almost Never 

1 Some-times 

2 Often 

3 Nearly Always 

1. G) I feel on the edge of despair when I wake up 

O Almost Never 

1 Some-times 

2 Often 

3 Nearly Always 

1. H) I feel very frightened when I wake up 

O Almost Never 

1 Some-times 

2 Often 

3 Nearly Always 

1. I) I like to have a morning drink 

O Almost Never 

1 Some-times 

2 Often 

3 Nearly Always 

1. J) I always gulp down my morning drink as quickly as possible 

O Almost Never 

1 Some-times 

2 Often 

3 Nearly Always 

1. K) I drink in the morning to get rid of the shakes 

O Almost Never 

1 Some-times 

2 Often 

3 Nearly Always 

1. L) I have a very strong craving for a drink when I wake up 

O Almost Never 

1 Some-times 

2 Often 

3 Nearly Always 

1. M) I drink more than 1/4 bottle of spirits or 4 pints beer or 1 bottle of wine per day 

O Almost Never 

1 Some-times 

2 Often 

3 Nearly Always 

1. N) I drink more than 1/2 bottle of spirits or 8 pints beer or 2 bottles wine per day 

O Almost Never 

1 Some-times 

2 Often 

3 Nearly Always 

1. O) I drink more than 1 bottle of spirits or 15 pints beer or 4 bottles of wine per day 

O Almost Never 

1 Some-times 

2 Often 

3 Nearly Always 

1. P) I drink more than 2 bottles of spirits or 30 pints beer or 8 bottles of wine per day 

O Almost Never 

1 Some-times 

2 Often 

3 Nearly Always 

Section 2 

FOR THE NEXT 4 QUESTIONS: 

Imagine you have been abstinent for a few weeks, then drink heavily for a couple of days. 

1. Q) The morning after would you start to sweat? 

O Not at all 

1 Slightly 

2 Moderately 

3 A lot 

3 I haven’t been abstinent for that long, so it’s hard to say 

1. R) The morning after would your hands shake? 

O Not at all 

1 Slightly 

2 Moderately 

3 A lot 

3 I haven’t been abstinent for that long, so it’s hard to say 

1. S) The morning after would your body shake? 

O Not at all 

1 Slightly 

2 Moderately 

3 A lot 

3 I haven’t been abstinent for that long, so it’s hard to say 

1. T) The morning after would you be craving a drink? 

O Not at all 

1 Slightly 

2 Moderately 

3 A lot 

3 I haven’t been abstinent for that long, so it’s hard to say 

SCORE 

Add up the numbers you’ve circled. 

A score of less than 3 indicates no alcohol dependence 

A score between 4 and 20 indicates mild dependence 

A score between 20 and 30 indicates moderate dependence 

A score of over 30 indicates severe dependence