What to Expect in an Alcohol Use Disorder Assessment

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Deciding to seek help for compulsive alcohol use can be a difficult decision. It can leave you with a lot of questions about what to expect and what to do. After deciding to get help, the first step will likely be an assessment for alcohol use disorder, which will evaluate your alcohol use, as well as your mental health, physical health, family history, and more. Once you receive an evaluation, you may receive a referral to alcohol addiction treatment.

Assessment Tools for Alcohol Use Disorders

Testing for alcohol use disorder includes a thorough assessment of your symptoms and alcohol use. There are a number of screening tools for alcohol use disorders that are available to your provider. These include but are not limited to:^1,2,3,4,5,6

The CAGE questionnaire
Fast Alcohol Screening Test (FAST)
Alcohol Use Disorders Identification Test (AUDIT)
Michigan Alcohol Screening Test (MAST)
Adult Substance Abuse Subtle Screening Inventory (SASSI)
Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar)

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The CAGE Questionnaire

The CAGE questionnaire is composed of four questions. These questions include:¹

Has anyone suggested you should cut down your alcohol use?
Have you ever been annoyed by others’ criticism of your alcohol use?
Have you ever felt guilty about your alcohol use?
Have you ever needed an eye-opener (i.e., drink upon waking)?

The Fast Alcohol Screening Test (FAST)

The Fast Alcohol Screening Test (FAST) was adopted from the Alcohol Use Disorder Identification Test as a shorter and faster way to screen for alcohol use disorders.² The FAST includes questions about:²

The number of drinks you consume during one occasion
If you have ever had an inability to remember after alcohol use
If you have ever failed to meet important obligations due to drinking
If anyone (e.g., loved one, medical provider) has ever encouraged you to cut down or stop alcohol use

Alcohol Use Disorder Identification Test (AUDIT)

The Alcohol Use Disorder Identification Test was developed by several individuals and the World Health Organization.³ This assessment for alcohol use disorder was designed to help identify excessive drinking and alcohol dependency. It also helps provide a framework for intervention to either help reduce or discontinue the use of alcohol.³ The AUDIT tool uses an alcohol use disorder assessment scale, whereby the total score of the tool will inform decisions on the next course of treatment.

The AUDIT examines many forms of excessive drinking, including:³

High level of alcohol use
Repeated use of alcohol until the point of intoxication
Alcohol use that causes physical or mental health harm
Alcohol use that has resulted in dependency and/or addiction

The AUDIT has three core domains:³

Hazardous Alcohol Use (i.e., pattern of alcohol use that increases the likelihood you experience harmful consequences)
Dependency Symptoms (i.e., a cluster of physiological, behavioral, and cognitive symptoms that develop after repeat alcohol use)
Harmful Alcohol Use (i.e., alcohol use that results in negative physical and mental health consequences)

The AUDIT has 10 test items, and responses to these items are scored independently from 0 to 4. Test items include:³

Frequency of alcohol use
Typical quantity of alcohol used
Frequency of heavy alcohol use
Impaired control over alcohol use
Increased salience of alcohol use
Use of alcohol upon waking
Feelings of guilt after alcohol use
Experiencing blackouts attributed to alcohol use
Injuries sustained due to alcohol use
Other individuals are concerned about your alcohol use

Once all 10 items are scored, they are then added together to result in a total score.3 This total score is used to inform decisions surrounding potential alcohol addiction treatment.³ The scoring is as follows:³

Zone I: Scores between 0 and 7: Providers give education about alcohol and alcohol usage.
Zone II: Scores between 8 and 15: Providers give education about alcohol and alcohol usage.
Zone III: Scores between 16 and 19: Providers give advice about alcohol usage.
Zone IV: Scores between 20 and 40: Providers refer to you to a follow-up with a specialist who can further assess for alcohol use disorder and treatment.

Michigan Alcohol Screening Test (MAST)

The Michigan Alcohol Screening Test (MAST) is a yes/no 25-question tool that is used to help identify alcohol use disorder.⁴ Questions include:⁴

Enjoyment of alcohol use
Awareness of your alcohol use compared to others
Inability to remember things the day after alcohol use
If anyone has complained about your alcohol use
If it is hard to stop after one drink
Guilt after alcohol use
Alcohol use has caused problems (e.g., physical fights or arguments)
If your work has been impacted due to alcohol use
If you have ever experienced withdrawal symptoms after heavy drinking
If you have ever been hospitalized due to your alcohol use
If you have ever had any legal problems due to your alcohol use

Adult Substance Abuse Subtle Screening Inventory (SASSI)

The Adult Substance Abuse Subtle Screening Inventory (SASSI) is a tool used to identify a high or low probability of having a substance use disorder in the past and/or at present.⁵ The tool also highlights any defensiveness or unwillingness to acknowledge potential consequences the test taker is experiencing due to their substance use.⁵

Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar)

The Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar) is not an assessment for alcohol use disorder, but rather, a tool used to examine your level of withdrawal.⁶ It includes questions regarding your orientation to the day and time of symptoms, such as:⁶

Nausea and vomiting
Headache
Experiencing a tremor
Sweating
Anxiety
Agitation
Tactile disturbances (e.g., feeling as if bugs are crawling on you)
Auditory disturbances (i.e., hearing things that others do not)
Visual disturbances (i.e., seeing things that others do not)

Each test item has its own scoring system, each of which is then added together.⁶ Individuals scoring less than 10 typically do not require additional medications for withdrawal symptoms.⁶

What Else Does an Alcohol Use Disorder Assessment Include?

In addition to the screening and testing tools, the provider will conduct a clinical interview. This interview will likely include:⁸

Demographic information
Developmental history
Employment history
Legal history
Substance use history
Medical history
Mental health history
Familial and social support

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What Happens After the Tests and Interview?

Once the assessment tools for alcohol use disorder are compiled and scored, and the interview has been conducted, the provider will discuss the results with you. Depending on the results of these scores, the provider may refer you treatment options, such as:

Substance misuse counseling
Detoxification services
Inpatient rehabilitation services
Partial hospitalization programs
Intensive outpatient programs

What Else Should I Know About the Alcohol Use Disorder Assessment Process?

Therapists understand that talking about your alcohol use can bring up intense emotions including but not limited to:

Guilt
Shame
Embarrassment
Anxiety
Sadness
Anger
Resentment

Medical providers and therapists are mandated reporters, meaning although your confidentiality is of the utmost importance, if you are in danger of harming yourself or someone else, the provider must inform the appropriate agencies. This alone can cause some additional anxiety and it’s important to explore limits of confidentiality with your provider.

Although it can be difficult, be honest with your assessment provider so they can make informed recommendations that will be best suited for you and your needs, both physically and mentally.

If you are interested in learning more about your alcohol abuse treatment options, please call 800-948-8417 Who Answers? to speak to a treatment support specialist who can provide you with information about rehab.

Resources

Ewing, J. (1984). Detecting alcoholism. JAMA, 252(14).
Hodgson, R., Alwyn, T., John, B., Thom, B., & Smith, A. (2002). The fast alcohol screening test. Alcohol and Alcoholism, 37(1), 61-66.
Babor, T. F., Higgins-Biddle, J. C., Saunders, J., & Monteiro, M. G. (2001). The alcohol use disorders identification test: Guidelines for use in primary care (2^nd edition).
Selzer, M.L. (1971). The Michigan Alcoholism Screening Test (MAST): The quest for a new diagnostic instrument.American Journal of Psychiatry, 127(12), 1653-1658.
The SASSI Institute. (2021) Adult substance abuse subtle screening inventory-4 (SASSI-4).
Sullivan, J. T., Sykora, K., Schneiderman, J., Naranjo, C. A., & Sellers, E. M. (1989). Assessment of alcohol withdrawal: The revised Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-Ar). British Journal of Addiction, 84(11), 1353-1357, 1989.
National Institute on Alcohol Abuse and Alcoholism. (2005). What is a standard drink?
National Institute on Drug Abuse. (2020). Principles of drug addiction treatment: A research-based guide (Third edition).