Screening

Several instruments and interviewing techniques enable the clinician to screen for an alcohol use disorder. Interview techniques include the CAGE (Ewing, 1984) and the TWEAK (Russell et al., 1991). CAGE is a mnemonic device: (Cut down: "Has anyone ever recommended that you cut back or stop drinking?" Annoyed: "Have you ever felt annoyed or angry if someone comments on your drinking?" Guilt: "Have there been times when you've felt guilty about or regretted things that occurred because of drinking?" Eye-Opener: "Have you ever used alcohol to help you get started in the morning, to steady your nerves?"). Positive answers to three of these four questions strongly suggest alcoholism. "TWEAK," a similar mnemonic device is more useful than the CAGE in interviews with women. T assesses tolerance: "How many drinks can you hold or how many drinks does it take to get high? (If it takes more than two drinks to get "high" or six drinks to feel drunk, tolerance can be assumed to be present). W: "Have close friends or relatives worried about your drinking?" Eye-Opener: "Do you sometimes take a drink in the morning to wake up?" Amnesia: "Has a friend or family member ever told you things you said or did while you were drinking that you could not remember?" K (cut): "Do you sometimes feel the need to cut down on your drinking?" Positive answers to three or more points suggest alcoholism.

Laboratory tests are useful for detecting heavy drinking. Serum gamma-glutamyltransferase (GGT) has been established as a sensitive test of early liver dysfunction. GGT has a sensitivity of 50% and a specificity of 80% (Bean & Daniel, 1996), meaning that 50% of patients with drinking problems will be missed by the GGT. However, 80% of people with an elevated GGT do have an alcohol problem (therefore, 20% of people with elevated GGTs are normal drinkers).

Another useful screening test is increased erythrocyte mean corpuscular volume (MCV), which was elevated in 26% of the patients in a Mayo Clinic study. In both male and female alcoholics, the combinations of elevated GGT and MCV identified 90% of alcoholic patients (Skinner, 1981). Other tests that may be elevated are triglycerides, serum alkaline phosphates, serum biliru-bin, and uric acid.

A relatively new test with clinical utility is carbohydrate-deficient transferrin (CDT). Consuming more than 60 grams (5 drinks) of alcohol per day will increase CDT. Normal CDT levels can be expected to return after 2-4 weeks of abstinence (Allen & Anthnelli, 2003).

Alcohol No More

Alcohol No More

Do you love a drink from time to time? A lot of us do, often when socializing with acquaintances and loved ones. Drinking may be beneficial or harmful, depending upon your age and health status, and, naturally, how much you drink.

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