Synopsis
Identify alcohol-related risk accurately, distinguish increasing-risk or higher-risk drinking from possible dependence, and deliver proportionate brief intervention, referral and safety planning without relying on laboratory markers or stigma.
- Ask permission, use neutral language and quantify type, strength, measure, frequency, single-occasion peaks, alcohol-free days and recent change rather than asking only whether someone drinks socially.
- A positive AUDIT-C screen, conventionally 5 or more, should lead to the full ten-item UK AUDIT; it does not itself diagnose dependence.
- Full AUDIT scores guide response: 0–7 lower risk, 8–15 increasing risk, 16–19 higher risk and 20 or more possible dependence, always interpreted with clinical judgement.
- Offer a structured five-to-fifteen-minute brief intervention for increasing-risk or higher-risk drinking when dependence is not suspected; use feedback, motivation, practical goals and follow-up.
- Do not use liver tests, mean cell volume or breath alcohol as routine screening tests; normal results do not exclude hazardous use or dependence.
- The UK low-risk message is that it is safest not to regularly exceed 14 units weekly and, if drinking that amount, to spread it over at least three days.
- Pregnancy or planning pregnancy warrants advice that the safest approach is not to drink; advanced liver disease and several other circumstances may also make abstinence the appropriate goal.
- Possible dependence, previous complicated withdrawal, significant comorbidity or failure of brief intervention warrants active referral, not a leaflet-only signpost.
Key red flags
Confusion, impaired consciousness, slow or irregular breathing, cyanosis, persistent vomiting, hypoglycaemia or significant trauma requires urgent physiological assessment and treatment.
Morning tremor, sweating, nausea, anxiety, hallucinations or previous withdrawal seizures suggests physical dependence and makes unsupported abrupt cessation unsafe.
A current suicide plan, self-neglect, domestic abuse, dependent children at risk, severe depression or psychosis requires direct risk and safeguarding action alongside alcohol care.
Jaundice, ascites, haematemesis, melaena, severe abdominal pain, fever or unexplained weight loss may indicate serious alcohol-related physical disease.
Pregnancy, frailty, cognitive impairment, homelessness, poor support or important medical comorbidity lowers the threshold for specialist assessment and supported change.
Investigation priorities
Identify the current risk band and provide a repeatable baseline for intervention.
Management branches
Alcohol use is disclosed, clinically suspected or relevant to a presenting problem.
- Use AUDIT-C when time is limited and complete the full UK AUDIT after a positive short screen.
- Quantify units and pattern, then assess dependence, withdrawal history, comorbidity, current risk and the person's goals.
- Explain the risk band in ordinary language and agree whether the next step is advice, fuller assessment or urgent care.