Barriers to a Diagnosis: Even when people with alcoholism experience withdrawal symptoms, they nearly always deny the problem, leaving it up to coworkers, friends, or relatives to recognize the symptoms and to take the first steps toward encouraging treatment. Denial, in fact, may be an important warning signal for alcoholism.
Family members cannot always rely on a physician to make an initial diagnosis. Although 15% to 30% of people who are hospitalized suffer from alcoholism or alcohol dependence, physicians often fail to screen for the problem. In addition, doctors themselves often cannot recognize the symptoms. In one study, alcohol problems were detected by the physician in less than half of patients who had them. Even when physicians identify an alcohol problem, however, they are frequently reluctant to confront the patient with a diagnosis that might lead to treatment for addiction.
Screening Tests for Alcoholism: A physician who suspects alcohol abuse should ask the patient questions about current and past drinking habits to distinguish moderate from heavy, or hazardous, drinking. [See Box Definition of Alcohol Use and Abuse.]
A physician who suspects alcohol abuse or dependency have a number of short screening tests available, which a person can even take on his or her own. Because people with alcoholism often deny their problem or otherwise attempt to hide it, the tests are designed to elicit answers related to problems associated with drinking rather than the amount of liquor consumed or other specific drinking habits.
CAGE Test. The CAGE test is an acronym for the following questions and is the quickest test:
• Attempts to CUT (C) down on drinking.
• ANNOYANCE (A) with criticisms about drinking.
• GUILT (G) about drinking.
• Use of alcohol as an EYE-OPENER (E) in the morning.
This test and another called the Self-Administered Alcoholism Screening Test (SAAST), appear to be most useful in detecting possible alcoholism in white middle-aged males. They are not very accurate for identifying alcohol abuse in older people, white women, and African-and Mexican-Americans.
T-ACE Test. The T-ACE test is a four-question test that appears to be quite accurate in identifying alcoholism in both men and women. It asks the following questions:
• Does it TAKE (T) more than three drinks to make you feel high?
• Have you ever been ANNOYED (A) by people’s criticism of your drinking?
• Are you trying to CUT DOWN (C) on drinking?
• Have you ever used alcohol as an EYE OPENER (E) in the morning?
A positive response to two of these four questions is considered to indicate possible alcohol abuse or dependence.
AUDIT Test. A more effective and important test for most people may be the Alcohol Use Disorders Identification Test (AUDIT), which is the only test specifically designed to identify hazardous or harmful drinking. It asks three questions about amount and frequency of drinking, three questions about alcohol dependence, and four questions about problems related to alcohol consumption.
A Single-Question. One simple question may be as sensitive as the CAGE or Audit test: “When was the last time you had more than five drinks (for men) or four drinks (for women) in one day?” An answer of “within three months” accurately identified about half of people who were problem drinkers. Problem drinking is defined as hazardous drinking within the last month or some alcohol-use disorder during the past year. [See Box Definition of Alcohol Use and Abuse.]
Other Screening Tests. Other short screening tests are the Michigan Alcoholism Screening Test (MAST) and The Alcohol Dependence Scale (ADS).
Ruling Out Other Problems: Some symptoms of alcoholism may be attributed to other disorders, particularly in the elderly, where symptoms of confusion, memory loss, or falling may be attributed to the aging process alone. Heavy drinkers may be more likely to complain to their doctors about so-called somatization symptoms, which are vague ailments such as joint pain, intestinal problems, or general weakness, that have no identifiable physical cause. Such complaints should signal the physician to follow-up with screening tests for alcoholism.
Alcoholism is particularly less likely to be recognized in elderly women. In fact, only 1% of older women who need treatment for alcoholism are diagnosed accurately and treated appropriately. Instead, they are often diagnosed with depression and may even be prescribed anti-anxiety drugs or antidepressants that can have dangerous interactions with alcohol.
Tests for alcohol levels in the blood are not useful for diagnosing alcoholism because they reflect consumption at only one point in time and not long-term usage. Certain blood tests, however may provide biologic markers that suggest medical problems associated with alcoholism or indications of alcohol abuse:
• A test for a factor known as carbohydrate-deficient transferrin (CDT) has been approved as a marker for heavy drinking. It can be helpful in monitoring patients for progress towards abstinence and may also be an indicator for a higher risk for suicide in people with alcoholism.
• Gamma-glutamyltransferase (GGT). This liver enzyme is very sensitive to alcohol and can be elevated after moderate alcohol intake and in chronic alcoholism.
• Aspartate and alanine aminotransaminases (AST,ALT) are tests for enzymes and factors that can help identify liver damage.
• Tests of testosterone levels in men with alcoholism may be low. (This result sometimes persuades men with alcoholism to seek help.)
• A mean corpuscular volume (MCV) blood test is sometimes used to measure the size of red blood cells, which increase with alcohol use over time.