Primary care management of alcohol use disorder and at-risk drinking: Part 1: screening and assessment.

OBJECTIVE To provide primary care physicians with evidence-based information and advice on the screening and assessment of at-risk drinking and alcohol use disorder (AUD). A companion article outlines the management of at-risk drinking and AUD. SOURCES OF INFORMATION We conducted a nonsystematic literature review, using search terms on primary care, AUD, alcohol dependence, alcohol abuse, alcohol misuse, unhealthy drinking, and primary care screening, identification, and assessment. MAIN MESSAGE Family physicians should screen all patients at least yearly for unhealthy drinking with a validated screening test. Screen patients who present with medical or psychosocial problems that might be related to alcohol use. Determine if patients who have positive screening results are at-risk drinkers or have AUD. If patients have AUD, categorize it as mild, moderate, or severe using the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, criteria. Share this diagnosis with the patient and offer assistance. Do a further assessment for patients with AUD. Screen for other substance use, concurrent disorders, and trauma. Determine whether there is a need to report to child protection services or the Ministry of Transportation. Determine the need for medical management of alcohol withdrawal. Conduct a brief physical examination and order laboratory tests to assess complete blood count and liver transaminase levels, including γ-glutamyl transpeptidase. CONCLUSION Primary care is well suited to screening and assessment of alcohol misuse.