SESSION 3: Alcohol Screening

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In session 3:
Safe and Unsafe Drinking Levels
Screening
Alcohol Screening & Brief Intervention Flow Chart

Safe and Unsafe Drinking Levels

Low-risk or safe drinking is that level which complies with the advice of health authorities as to the level of daily alcohol consumption that can be consumed without placing the person’s health or that of others at risk. Individual differences and illnesses can affect the level that is safe for an individual at a particular time.

Risky or hazardous drinking are interchangeable terms. It is that level of consumption that has not caused a person any permanent detectable harm but which places them at risk if sustained.

High-risk or harmful or drinking are interchangeable terms. It is that level of consumption that is already causing harm to the person drinking, or to those in his or her family and social network.

Dependent drinking is that pattern and level of consumption where there is a narrowing of drinking repertoire, an increased salience of alcohol (taking a greater priority in the drinker’s life), a subjective compulsion to drink, increased tolerance to alcohol, withdrawal symptoms, drinking to relieve withdrawal, and rapid reinstatement of the drinking patterns after a period of abstinence.

The most common methods to determine these drinking levels in populations such as the veteran community are by screening and assessment techniques.

Screening

Why use screening?

Many factors contribute to the development of alcohol related problems. Not understanding the low-risk guidelines associated with excessive alcohol consumption is a major factor. For veterans, social and environmental influences such as customs and attitudes that favour heavy drinking also play an important part.

The importance of screening is that, given appropriate support and assistance, people who are not alcohol dependent may reduce or stop their consumption. Once alcohol dependence has developed, cessation or changes to consumption are much more difficult and usually require specialised treatment. Although not all veterans who are drinking at risky or high-risk levels will become dependent, no one becomes dependent without having first engaged for some time in consumption at those levels.

Often, risky drinking is undetected and many people may be presenting to primary care settings with signs and symptoms that would not necessarily be linked to their drinking. Screening is a simple way to identify people whose drinking may pose a risk to their health, as well as those who are already experiencing alcohol related problems, including dependence.

Benefits of screening

There are many potential benefits from screening for alcohol consumption in primary care and front-line settings. It provides an opportunity to educate veterans about low-risk consumption and the risks associated with excessive alcohol use. Information about the amount and frequency of the veteran’s alcohol consumption may also inform the assessment of their presenting problem or condition.

It may also alert health workers to the need to advise veterans whose alcohol consumption may adversely affect their use of medications or other aspects of their condition or treatment. It provides the opportunity to take preventative measures that have proven to be effective in reducing alcohol related harm.

The goal of screening

The goal of screening is to identify individuals who are at risk of developing alcohol-related problems.

Because of the potential impact that screening and brief interventions represent, not just for individuals but for groups such as the veteran community, screening should be initiated on a systematic and comprehensive basis. Even the reduction of amounts such as one standard drink in daily consumption levels has been shown to have a significant impact in terms of the overall morbidity rates of populations generally.

Screening instruments and responses

Screening instruments are diagnostic tools allowing clinicians to determine whether further investigation is warranted. Instruments can provide positive or negative screens, and even when a screening tool doesn’t flag any concerns, there are still strategies we might put into place to prevent harm in the future.

If a client returns a negative screen it usually means they are drinking at low-risk levels. In this case, responses designed to prevent or minimise future harm would be appropriate. An example could include education or information about standard drinks contained in the Australian Alcohol Guidelines. The response would aim at maintaining low-risk drinking and dealing with changing circumstances if they occur.

If a client returns a positive screen then it usually means that they are drinking at risky levels and there is a case for some form of intervention. The practitioner should consider a number of approaches that are detailed in the Brief Intervention section of this training manual.

Facts, figures and fascinating information.

"An intelligent man is sometimes forced to get drunk to spend time with his fools." Earnest Hemingway

Alcohol: Bon Scott’s drug of choice!

Alcohol Screening & Brief Intervention Flow Chart

The flow-chart illustrates the process of alcohol screening and brief intervention. The chart traces the steps involved in AUDIT screening; the determination of risk levels; and the role of brief intervention in the management of risk and subsequent referral for those clients judged at-risk.

Alcohol screening and brief intervention flow chart