Alcohol consumption — Frequently asked questions (FAQ)
1) What does this algorithm cover?
The algorithm guides early detection and brief intervention for alcohol consumption in adults, from quantification in standard drinks to screening with AUDIT-C and, when indicated, use of the full AUDIT. It integrates severity stratification — low risk, risky drinking, harmful drinking and probable dependence —, defines the intensity of intervention and clarifies referral criteria and follow-up.
2) What is a “standard drink” and how is it calculated?
A standard drink corresponds approximately to 10–12 g of pure alcohol. In clinical practice, it can be estimated as approximately 330 mL of beer (~5%), 100–120 mL of wine (~12%) or 30 mL of spirits (~40%). For greater precision, the formula can be used: g of alcohol = mL × % × 0.789 ÷ 100, then converted to standard drinks by dividing by 10–12.
3) When should I use AUDIT-C and when should I proceed to the full AUDIT?
The AUDIT-C is a brief tool for initial screening. A positive result — usual cut-offs: men ≥5 and women ≥4 — suggests a risky drinking pattern and should prompt use of the full AUDIT for more accurate stratification and intervention planning. Even with a negative AUDIT-C, assessment should be expanded if there are clinical concerns or alcohol-related consequences.
4) How should the total AUDIT score be interpreted?
A common interpretation of AUDIT is: 0–7 — low risk —, 8–15 — risky drinking —, 16–19 — harmful drinking — and ≥20 — probable dependence. Stratification should always be integrated with clinical findings, comorbidities and psychosocial context.
5) What defines “harmful drinking” and why should we not rely only on the score?
Harmful drinking is characterised by the presence of physical, psychological or social harm attributable to alcohol, regardless of the score. An AUDIT score of 16–19 strongly suggests harmful drinking, but an AUDIT score of 8–15 may also correspond to harmful drinking if consequences are already present — for example, worsening hypertension, liver disease, family conflict, absenteeism or falls. In these cases, the intensity of intervention should be greater than standard brief intervention.
6) What is brief intervention and how should it be applied in risky drinking?
Brief intervention is a structured, patient-centred approach, usually lasting only a few minutes, with feedback on risk, goal setting and concrete strategies for change. In risky drinking, clear advice to reduce intake is recommended, with measurable goals — for example, limits per occasion/week —, behavioural strategies — alcohol-free days, avoiding binge drinking, alternating drinks — and reassessment in 4–12 weeks with repeat AUDIT-C or consumption monitoring.
7) How should the intervention be adapted in harmful drinking?
In harmful drinking, the intervention should be more intensive: clarify the consequences attributable to alcohol, define a structured plan — reduction or abstinence depending on risk —, assess medical and psychiatric comorbidities and schedule early follow-up in 2–6 weeks. Psychological or motivational support should be considered, as well as referral if there is repeated failure, significant harm or suspected dependence.
8) What should be included in the approach to “probable dependence”?
With AUDIT ≥20, the priority should be safety and linkage to specialist care. It is essential to assess the risk of withdrawal syndrome, avoid abrupt cessation without medical supervision in cases of high consumption, and arrange priority referral — addiction services, psychiatry or internal medicine depending on context. In parallel, medical/psychiatric comorbidity should be treated and motivational support maintained.
9) What is binge drinking and how does it influence clinical decision-making?
Binge drinking corresponds to heavy drinking on a single occasion — often defined as ≥6 standard drinks on one occasion; some definitions use a lower cut-off in women. This pattern is associated with a higher risk of trauma, violence, acute intoxication and cardiometabolic consequences. Even without a very high total AUDIT score, recurrent binge drinking warrants targeted intervention, strategies to avoid episodes and closer follow-up.
10) Which “red flags” require urgent assessment or immediate referral?
Priority assessment is warranted in suspected moderate/severe withdrawal or previous withdrawal seizures, very high daily intake, suicidal ideation/severe depression, violence or significant social risk, pregnancy with relevant alcohol use, and severe alcohol-related medical complications — for example, pancreatitis, decompensated liver disease or recurrent falls. In these scenarios, the decision should not depend only on the score.
11) When should I reassess and how should response be monitored?
In risky drinking, reassessment is recommended in 4–12 weeks; in harmful drinking, in 2–6 weeks; and in probable dependence, shorter follow-up and/or contact to ensure referral and safety. Monitoring can be performed with repeat AUDIT-C, a record of consumption — standard drinks/week —, assessment of clinical consequences and review of the change plan.
