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Alcohol Assessment and Intervention - Adult/Pediatric - Inpatient/Ambulatory

Alcohol Assessment and Intervention - Adult/Pediatric - Inpatient/Ambulatory - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Clinical Practice Guidelines, Alcohol and Tobacco


Alcohol Use – Adult/Pediatric – Inpatient/Ambulatory
Guideline Summary
Target Population: Non-pregnant adolescent (10-17 years) and adult (18 years and older) patients without a current diagnosis of alcohol use disorder.
Link to Full Guideline: Alcohol Use: Assessment and Intervention—Adult/Pediatric—Inpatient/Ambulatory
ADOLESCENT Alcohol Screening and Intervention Algorithm
Screen for alcohol misuse
using CRAFFT 2.0, Part A: 3 Question Pre-Screen
Ask all six
CRAFFT
questions
Patient Response
“0” for all questions?
Complete CAR
question of
CRAFFT Assessment
Patient
Response
“Yes”?
Screening complete
Yes No
Provide patient
education
regarding safe
driving habits.
2 or more YES
answers?
Provide brief
intervention
Yes
Give positive
reinforcement,
encourage to continue
to not use
No
Provide brief intervention and Refer to specialist
in alcohol/drug related issues*
*Addiction Medicine consult suggested for inpatients.
AUD diagnosis and/or referral for additional outpatient
treatment may be made by consulting service.
Follow up with Primary
Care in about 4 weeks
Follow up with Primary Care in
about 2-8 weeks
Did patient begin
treatment with
referred services?
Consider pharmacotherapy
and/or behavioral
management in Primary Care
Follow up per PCP
discretion
No
Yes
Yes
No
Screen for alcohol misuse
using the AUDIT-C
AUDIT-C
Score
0-2
Men over 65 years
and all women
8-12
Men and women
Screening complete
Provide brief
intervention (BI)
ADULT Alcohol Screening and Intervention Algorithm
Give positive reinforcement.
Advise to continue to drink below
recommended limits*:
Men age 65 years or younger: ≤4
standard drinks per day; ≤ 14 per week
Men over 65 year and all women: ≤ 3
drinks per day; ≤ 7 drinks per week
*Abstinence should be recommended to
some patients in certain clinical
situations (e.g., pregnancy, warfarin)
0-3
Men age 65 years
or younger
3-7
Men over 65 years
and all women
4-7
Men age 65 years
or younger
Low Risk
High Risk
Refer to specialist in alcohol/drug
related issues*
*Addiction Medicine consult suggested for
inpatients.
AUD diagnosis and/or referral for additional
outpatient treatment may be made by
consulting service.
Likely Alcohol Use Disorder
Follow up with Primary
Care in about 4 weeks
Follow up with Primary Care in
about 2-8 weeks
Did patient begin
treatment with
referred services?
Consider pharmacotherapy
and/or behavioral
management in Primary Care
Follow up per PCP
discretion
No
Yes
Brief Intervention Strategies
1. Direct feedback:
“I am concerned about how much you drink and how it is affecting your health.”
2. Discuss how their alcohol use is affecting their health:
“I am concerned about how your alcohol use is affecting our ability to treat your….”
3. Negotiate and set goals:
“What do you think about cutting down to three drinks 2 to 3 times per week?”
4. Behavioral modification strategies:
“There are situations when people lose control of their drinking. Let’s talk about how to avoid these situations.”
5. Self-help directed bibliotherapy : (when available)
“Review this booklet on ways to reduce your alcohol use and bring it with you to our next visit.”
6. Follow-up and reinforcement
“I would like you to return to see me in one month to see how you are doing.”
Screening Frequency for All Patients
Primary Care: All new patients and at least annually; ED or Inpatient: Every admission
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2018CCKM@uwhealth.org