Alcohol Assessment

The first – and most important – step to receiving treatment for alcoholism is recognising that you have an alcohol abuse problem. Many people are unable to escape their addiction because they are in denial about its true nature and extent. If you want to live a healthy, fulfilling life, free from alcohol dependence, getting the right treatment is vital.

How do you know if you need to curtail your drinking – or need to quit altogether – or are on the verge of dependence? There are many signs and symptoms to observe. This applies not only to you but to loved ones or friends you care about. In addition, you can perform simple dependence tests to determine if you are addicted to alcohol.

Are you Drinking too Much?

People addicted to alcohol (or, indeed, other substances) are at risk – from health issues to disrupting certain aspects of life such as work, relationships, personal responsibilities and other things that help them function normally in society. Alcohol dependence has the potential to jeopardise all these things and, in the end, to ruin hitherto-wonderful lives.

Recognising the signs early on can save you from a life of regret. Even if you’re already drinking too much, it’s not too late to stop. There are solutions to help you get back on the wagon.

First, here are some signs to tell you if you are drinking too much.

Waking up at night to use the bathroom more often than usual

If you find yourself waking up to urinate more than once during the night, it could be a sign that you have consumed too much alcohol. The human body has an anti-diuretic hormone that regulates the amount of urine in the body. Normally, this hormone induces the kidney to make the urine more concentrated, so that less volume is produced. At night, this hormone is produced in higher quantities, so you don’t need to go to the toilet as much. However, alcohol supresses the production of anti-diuretic hormones, thus making your body produce more urine.

Dry eyes

Alcohol tends to dehydrate the whole body, including the eyes. When you drink too much, the eyes become sticky. In 2012, a study was published in the Journal of Ophthalmologywhich revealed that people who were given a dose of pure alcohol (according to their weight) experienced more dry patches on their eyes the next morning than those who didn’t drink.

You look forward to your 6pm drink

If the thought of shots or a glass of wine gets you through a difficult day, you should probably consider it a sign of a serious problem. This is particularly for people who work in nine to five jobs, where drinking at work is considered unprofessional. It may not seem like a problem, because you don’t feel the urge to drink immediately. However, thinking about it all day is just as bad.

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You are topping up more than the usual amount

As your brain becomes used to the effect of alcohol on its pleasure centres, it adapts to accommodate the chemical experience. The end result is the development of the ability to consume more alcohol than you used to. If you find yourself regularly requesting a top-up, your tolerance for alcohol may have increased.

Your friends and family are concerned

If you’ve been told more than once by a friend or loved one that your drinking habits are a cause for concern, it may be time to do something about it. Often, we fail to see what others can from the outside, and this state of denial is the reason many people find themselves locked into a habit. See an expert for advice on how to taper the quantity you consume.

Sleep patterns are worse

Too much alcohol interferes with sleep patterns. Recent research showed that 60% of alcoholics are insomniacs. They get little REM sleep, as well as slow-wave sleep (the deepest part of sleep). Long-term drinking affects neurotransmitters in the brain, including gamma-aminobutyric acid (GABA), which is known for calming brain activity. An inactive GABA system reduces sleep activity.

Impaired memory and blackouts

Alcohol naturally impacts the cognitive areas of the brain. In excess quantities, it can affect your ability to recall short-term memory. Mostly, this can be traced to poor sleep patterns. Because the brain develops as you sleep, failure to do so may affect its memory recall functions. Likewise, blackouts are a common phenomenon related to excess alcohol consumption. Many heavy drinkers lose track of the previous night after they sober up.

Lingering feelings of depression

Alcohol may boost your mood and cause fleeting feelings of euphoria, but it only lasts as long as the substance remains in your system. When the effect wears off, you may start feeling unhappy or depressed. Such mood swings can cause you to seek alcohol. If they persist long enough to make you get a drink, it becomes a craving.

If you recognise two or more of these signs, then you need to assess yourself more comprehensively. An alcohol addiction counsellor or physician can help you do this in a professional way.

What Happens during an Alcohol Assessment?

There are many reasons to undergo an alcohol assessment. Whether you’re doing so for personal reasons, because of a work/court order or simply helping a loved one, the procedure is basically the same. Going through this process (especially when facing potentially severe consequences) can feel stressful and overwhelming. It’s therefore important to know exactly what you can expect in an alcohol assessment test.

The purpose of an alcohol assessment test is to get an independent evaluation and learn more about the concentration of alcohol you are consuming, the effect it has on your life, and how it has essentially affected your family life, work, relationships, school and general well-being.

An assessment gathers information about your alcohol usage history, any previous treatment you may have received, risk of future usage or problem behaviour, your current dwelling environment, mental health status, support groups and the consequences of your alcohol consumption. This may include legal cases, employment problems and relationship issues.

The objective of an alcohol assessment is not only to understand the chemicals you are using (or the quantity) , but also how this consumption impacted – or still impacts – your life. Besides doing so voluntarily, alcohol assessment tests may be requested by a court following an accident, or even a new employer, current employers or family members.

Alcohol Screening Tools

When it comes to alcohol assessment, there are various screening tools to determine a person’s level of dependence on the substance. Doctors routinely screen patients for various conditions. Screening is a term used to describe the clinical process of assessing a patient for specific ailments, such as alcohol abuse or dependence.

The following are types of screening tools:

AUDIT: Alcohol Use Disorders Identification Test

AUDIT is used to access whether you are alcohol dependent or not. It is a comprehensive questionnaire that aims to discover the type and quantity of alcohol you consume and how often you drink, within a given period. It also examines issues such as the impact of your drinking habit on yourself and people around you.

SADQ: Severity of Alcohol Dependence Questionnaire

SADQ is used when alcohol dependence has been confirmed. It evaluates the severity of dependence and how a physician can begin treatment, based on this assessment. Like AUDIT, SADQ is also a questionnaire, but its questions are tailored towards issues associated with heavy drinking. After screening, the assessor will use the score to recommend detox.

CIWA-Ar: The Revised Clinical Institute Withdrawal Assessment for Alcohol scale assessment

CIWA-Ar is a screening tool for assessing how severe alcohol withdrawal might be during detox. Based on the level of alcohol dependence, some people exhibit mild to severe withdrawal symptoms. This screening tool helps doctors know what to expect and to prepare adequately, ahead of withdrawal treatment. The score suggests the type of medication and required dosage to be administered during detoxification.

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Screening Tools for Young People

A screening tool for young people is specifically tailored to help them identify their alcohol use habits. It also allows you to explore what is going on and the support you might need.

Two such tools are:

  • AUDIT-C
  • CRAFFT

AUDIT-C screening tool is useful for recognising your drinking pattern. The tool can explore the alcohol habits of people as young as 12 years and older, depending on their level of maturity. The tool uses five as the yardstick for determining how serious the situation is.

For scores under five, the assessor will provide alcohol education and maintain universal or low-level support. If it is above five, a trained intervention expert will advise you accordingly or suggest immediate treatment solutions.

If your score is high, consider getting counselling from a therapist with Tier 2 and Tier 3 intervention experience.

CRAFFT is a screening tool that focuses on the risks a young person takes whilst under the influence of alcohol. So, if you are a ‘daredevil’ at parties, CRAFFT will identify these traits and help a counsellor plan a course of treatment or advice going forward.

If you answer ‘Yes’ to two or more statements on the test, a Tier 2 intervention specialist will be recommended for more in-depth assessment and risk reduction procedures.

It’s one of the most popular evaluation tools for establishing alcohol (and drug) risks and is currently endorsed by the National Institute of Clinical Excellence (NICE).

Other Useful Screening Tools

There are many alcohol screening tools for checking your dependence levels or tendency to become dependent. Alcoholism is a serious problem that can ruin your life. Undergoing a screening test is a reliable way to identify your status and act immediately.

Screening is not always questionnaire-based only. In fact, proper clinical screening techniques involve monitoring breathing, as well as blood and urine tests. A physician can use these results to classify your alcohol use status. Most clinical screening methods consist of three sections:

  • Pre-screen questions to gauge the need for in-depth screening
  • Checklist for risk and protective factors
  • Main screening tool: a short series of questions with a scoring system to guide diagnosis and final clinical analysis

Other common screening tools used by experts include the CAGE and MAST tests. Each one includes a unique scoring system and a guide for what to do, based on the final score.

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The CAGE Test

The CAGE questionnaire is a commonly used screening test for problem drinkers and people with potential for alcohol dependence. The name is derived from an acronym of four questions based on its underlying principle.

You can answer a CAGE test in less than a minute, and it is utilised in primary care and other situations where a quick test is required. For people who need immediate results, CAGE presents a reliable alternative to in-depth interviews for alcohol-dependent individuals.

The CAGE questionnaire is not designed for a specific population category, which means it is effective for teens as well as young and older adults. The objective of the test is simply to identify excessive drinkers, as well as those who need treatment and care. The test is based on four questions:

  • Have you ever felt the need to Cut down your drinking?
  • Have you ever been Annoyed by people’s criticism of your drinking habit?
  • Have you ever felt Guilty about your drinking behaviour?
  • Have your ever felt like you needed a drink (Eye-opener) first thing in the morning to calm your nerves or cure a hangover?

While the CAGE questionnaire is a reliable and veritable assessment, its effectiveness is limited to alcohol abuse. Therefore, it is not valid for diagnosing other substance use disorders. However, some modified versions of the questionnaire have been developed for identifying other forms of substance abuse.

The History and Methodology of the CAGE Test

Amongst other methods, the CAGE questionnaire is extensively approved for diagnosing alcohol dependence. It has been described as a screening technique with significant levels of specificity and sensitivity. The test has been validated through receiver operating characteristic analysis, because of its effectiveness in screening problem drinking behaviour.

The CAGE Test was first designed by Dr. John Ewing at the North Carolina Memorial Hospital in 1968. He used it to solve the problem of the scarcity of measures in screening problem drinking behaviour.

In the original study (performed in a general hospital), about 130 patients were randomly chosen to take part in a comprehensive interview. The test set apart four questions that form the basis of its principles today. On its initial run, CAGE successfully identified 16 alcoholics from the sample group.

CAGE Questionnaire Scoring

Each answer to the four alcohol assessment questions is scored on 0 or 1 point. From the answers, assessors can gauge the percentage probability of alcohol dependence, ranging from 0% to 95%. Higher scores show a potential for problem drinking.

Although a score of two or higher is deemed clinically significant, some medical experts suggest a score of one should still receive further consideration. According to JAMA, “Having a score of two to three is an indication of high index suspicion, while a score of four is a definite diagnosis for alcoholism.”

However, the CAGE questionnaire is only a first-phase alcoholism diagnosis. Regardless of the score, it is not a standalone diagnostic tool or official diagnosis. This should only be issued by a licensed professional. If you have a CAGE score of one or higher, it’s advisable to consider more alternatives for assessment.

Clinical Significance of the CAGE Test

The online CAGE test may be short, but research has shown that it is effective in revealing nine out of ten (93%) alcohol-dependent people. The CAGE questionnaire – which doesn’t take longer than a minute to complete – is considered a useful tool for identifying high-risk individuals. It can also be used as a self-assessment tool in determining the need for continuation and assistance.

Since its introduction in the 1960s, thousands of alcohol addiction experts have used CAGE tests as a basis for screening men and women struggling with alcohol dependence. The test is one of the most widely used methods; it is a valid, proven and reliable alcohol assessment tool with high specificity and sensitivity.

When you take a CAGE test online, make sure you respond truthfully to the questions. It’s the only way the test can prove whether further evaluation is necessary.

Why the CAGE Test Works

Alcoholism is a disease of the mind and body, even though it’s hard for some people to admit it. It is often easier to handle the full diagnosis of your condition when it starts on a small scale, such as the verdict from an online alcohol quiz.

All four questions in a CAGE test have been carefully developed to address pertinent issues associated with problem drinking. The questions also foster self-reflection from test-takers, whilst provoking the consideration of external elements, such as familial love and the support of friends who want to see you get better.

Mostly, people drink too much alcohol to the extent they are unable to determine the severity of their drinking habit, until they need to answer questions about it. The CAGE test offers a simplified way to do this, so that they can start treatment before it’s too late.

MUST Alcohol Assessment

The Michigan Alcohol Screening Test (otherwise known as the MAST alcohol screening test) is a self-evaluation questionnaire, designed to test the presence and level of alcohol dependence.

MAST is one of the oldest and most commonly used tools for detecting alcoholism. Since its introduction, many people have developed variations of the test. The popular version consists of 22 self-scoring test questions on alcohol drinking behaviour.

When you take the test, make sure your answers best suit the question being asked. A genuine website will keep your answers confidential, so don’t hesitate to be honest. MAST shouldn’t be considered a final diagnosis, but a first step in deciding whether your drinking habits need to be reviewed further.

History of the Michigan Alcohol Screening Test

In 1971, the MAST alcohol assessment was initially developed as a 25-question test for the general population. It can be taken as a self-test or given as an interview by a qualified intervention specialist. Since its inception, it has successfully identified alcohol-dependent individuals with 98% accuracy.

The MAST test has several variations including an abridged version with 22 questions that is available on many websites. The MAST-G has 24 questions and the Short MAST-G is only 10 questions long, designed mainly for geriatric patients. There is also a 10-question Brief MAST screening and a 13-question Short-MAST. These summarised versions of MAST tests were developed to provide a quick and accurate solution for determining alcohol dependence.

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About the MAST Test Questions

While other alcohol test questions consider the timeframe of your drinking habits, MAST focuses mainly on your previous drinking and alcohol-related events. It only includes few questions about your present alcohol consumption habits and the potential for dependence.

However, because of this, MAST is less reliable in discovering early signs of problem drinking, although the version with more questions offers many benefits that the short question variants don’t. For instance, it allows you to answer more open-ended questions and encourages communication between you and the physician or counsellor.

MAST typically addresses self-evaluation questions about occupational, societal and family problems associated with excess alcohol consumption.

MAST Alcohol Test Scoring

All MAST alcohol screening tests are evaluated on a scale of points. Each answer is awarded a point and all points are summed up afterwards. Scores between 0 – 2 indicate you have no drinking problems, while scores of 3 – 5 show the potential to have a drinking problem. If you register a point total of six and above, then there is a high probability of alcoholism.

Please note that the results of a MAST alcohol screening (or any other alcohol assessment) shouldn’t be regarded as an official diagnosis. Simply put, the result of this quiz should help you answer the question, “Are you an alcoholic?” if somebody asks you.

Self-Assessment

You can perform an alcohol assessment test on yourself by answering the following questions associated with your drinking habit. This is an Alcohol Use Disorders Identification Test (AUDIT) for determining how hazardous or harmful your drinking habit is.

This is merely a glimpse of the questions you will be asked. There are no results at the end.

  • How often do you have a drink containing alcohol?
  • How many alcoholic drinks do you consume in a typical drinking day?
  • How regularly do you take more than six drinks in a single occasion?
  • How often do you not remember the events of the previous night after drinking?
  • How often in the last year have you failed to complete your normal responsibilities because of drinking?
  • How often in the past twelve months were you unable to stop drinking alcohol?
  • How often do you feel guilty about drinking?
  • Has a doctor or qualified counsellor expressed concern about your drinking problem or asked you to cut down?
  • Have your or somebody you know been injured because of drinking?
  • How often do you drink before 12pm?

By answering these questions truthfully, you should be able to determine how harmful your drinking habit is to you or others around you.

Risk of Drinking Patterns

Every person who consumes alcohol has a pattern, depending on their intake, the quantity and how often they drink. If you want to gauge your drinking habit, it’s important to know how safe or risky your drinking pattern is. This is the idea behind most self-assessment tests, like the one above.

Firstly, what do you drink? While some beverages contain high alcohol content, others contain little. Also, do you mix multiple alcoholic drinks? What about consuming alongside substances such as benzodiazepines, cocaine or marijuana? This pattern of drinking increases the risk of alcoholism.

Another thing to watch out for is the quantity of alcohol you take each time, as well as the duration of your drinking (hourly, daily or weekly for example).The more moderate your drinking pattern, the less risky it is.

Neglect of Responsibilities

Some people’s drinking habits cause them to forget or neglect their normal responsibilities. For example, do you get so drunk that you’re unable to attend you child’s school play? Does your drinking habit make you deliver less than expected at school or work?

Even simple tasks like helping your partner pick up the dry-cleaning can feel like an impossible chore when your cognitive functions are impaired by excess alcohol. In severe cases, things you used to love doing tend to take a back seat in your life. A person who used to enjoy playing football might shirk a game if it means they wouldn’t be able to drink.

Loss of Control

Alcoholcan cause you to lose control of your motor functions or mental abilities. When you drink excessively, alcohol interferes with the communication pathways in the brain. The gamma aminobutyric acid system in the brain is disrupted, affecting your mood and behaviour. This makes it harder to think clearly or make coordinated movements.

Poor motor coordination can lead to staggering, slurred speech and numbness to pain. In severe cases, alcohol can cause blackouts and the individual will lose control or awareness of their environment.

Problematic Usage

Many people claim to be able to hold their liquor. While it may seem commendable, it is technically very risky. Being able to hold your liquor means you have a high tolerance for alcohol. Tolerance is a gateway to dependence.

Problematic usage is consuming alcohol in ways that could be dangerous to your health or overall lifestyle. For instance, mixing multiple alcoholic beverages or consuming more than six cans of beer at a time is considered problematic.

Other examples of problematic usage are mixing benzodiazepines or smoking marijuana whilst drinking. These substances make you numb to the effect of alcohol, so you end up drinking more than you should. Drink-driving is a very dangerous example of problematic usage and must never be done. Avoid alcohol when performing tasks that require cognition.

Withdrawal

Continuous drinking can change the structure of your brain and adapt it to excess alcohol. When this happens, the euphoric effect won’t be felt as quickly as before. This means you have developed tolerance to alcohol. Naturally, you’ll drink more to experience the desired ‘high’ feeling. As you drink more over an extended period, tolerance will give in to dependence and soon you will be unable to function normally without drinking alcohol.

Addiction occurs when you develop a physical or psychological dependence on alcohol. This means that without it, you’ll experience unbearable symptoms that will force you to drink again.

Withdrawal symptoms may be physical or psychological:

  • Stage 1: Insomnia, anxiety, nausea, abdominal pains (eight hours after your last drink).
  • Stage 2: High body temperature, elevated heartbeat, hypertension and confusion (24 -72 hours after your last drink).
  • Stage 3: Fever, hallucinations, agitation and seizure (72 hours after your last drink).

During detox, you will experience withdrawal, so ensure you do so with a qualified physician present to avoid any problems.


FAQs

Is the Way or QuantityI Drink Harmful to my Health?

Possibly. Your drinking pattern can be risky to your health. For example, going above moderate alcohol quantity (one to two drinks per day) can increase the chances of intoxication and tolerance. Mixing alcohol with other intoxicating substances also increases the chanceof liver cirrhosis.

Should I cut Down on my Drinking?

Naturally, the less you drink the healthier you’ll be. If you consume more than seven drinks per week, you can curtail the amount. Drinking everyday only increases your chances of building tolerance and dependence.

What Exactly is an Alcohol Assessment?

An alcohol assessment is a self-evaluation test to help you determine how risky your drinking habit may be or your potential for alcohol dependence. While it’s not an official diagnosis, it helps you to gauge your drinking and reduce it accordingly.

What kind of Questions will I be Asked in an Alcohol Assessment?

The questions are mainly to determine your alcohol drinking habits and whether they are a risk to you or people around you. For example, you may be asked “How much do you drink in a day?” or “Do you feel guilty after drinking?”

Why do I Need to Complete an Alcohol Assessment?

There are many reasons to perform an alcohol assessment. You could be doing so for personal reasons (to cut your drinking for example) or it could be a requirement for a new job.

A court may also require you to take an assessment test to determine a legal course of action. Whatever the reason, it’s always good to know where you stand.

What are Some of the Recommendations that Might be Made?

Avoid lying in your assessment. Answer the questions as honestly as possible to get a true representation of your drinking behaviour. Don’t regard it as an official diagnosis, but a gauge for further decisions.

Who will Find out the Results of my Alcohol Assessment?

If it is a personal test, only you will have access to the results, provided you are using a reliable centre. Let them know your privacy preferences. Test results requested by your employer or a court will go to the authorities in those institutions that require them. Rest assured, they won’t be exposed to people who have no business knowing. Many free online tests have little or no data security and self-assessing in this way should not be considered confidential.

How Much does an Alcohol Assessment Test Cost?

This will depend on the service you use, but the cost of a standard drug test and screening can go be as little as £50. However, some more complex tests may cost up to £200. Courts may require more in-depth tests.

Will a Court Accept an Online Alcohol Assessment?

This is very rare. Most courts need an assessment to make a judgement decision. For example, to test whether someone has complied with the terms of their parole, they will need a comprehensive test and an online assessment does not count.

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