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Alcohol Consumption Screening Tools

Several screening tools have been developed to help clinicians and other professionals
to identify patients that have drinking problems. AUDIT and T-ACE are two of the most
popular of these screening tools. While AUDIT is used to identify patients with drinking
problems in a wide range of settings and target populations, T-ACE can only be used in
pregnant women.

AUDIT Measurement Tool

Alcohol Use Disorder Identification Test (AUDIT) consists of ten questions whose
answers allow the health professional to determine a patient’s drinking habits and the extent
of their alcohol drinking problem (National Institute on Alcohol Abuse and Alcoholism
(NIAAA)). There is a point for each of the ten questions. At the end of the interview session,
the interviewer simply sums up the score to determine the magnitude of the patient’s drinking
problem. A score of 7 and above shows that the patient has a drinking problem that is serious
enough to affect their health (NIAAA). The ten questions that are asked in AUDIT measuring
tool are provided here.

1. How many times have you consumed alcohol or a drink that contains alcohol in the
   past year?
2. How many alcohol drinks have you consumed in a single drinking session in the past
   year?
3. How many times have you consumed more than six alcohol drinks in the past year?
4. How many times have you been unable to stop consuming alcohol in an alcohol-
   consumption session in the past year?
5. How many times in the last year have you failed to keep your duties on time because
   of consuming alcohol?

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6. How many times in the last year have you had to consume alcohol in the morning
   before starting your day after a previous day of heavy alcohol drinking?
7. How many times in the last year have you felt hatred for yourself or guilty after a
   session of alcohol consumption?
8. How many times in the last year have you had difficulties remembering what
   happened the previous night because of the effects of heavy alcohol drinking?
9. Have you been injured or caused injuries to other people because of alcohol
   consumption?
10. Has a friend, relative, family member or medical professional suggested to you that
    you should stop your habit of regular alcohol consumption?
    T-ACE Measurement Tool

Tolerance, Annoyance, Cut Down, and Eye-Opener (T-ACE) is a tool that is used to
determine alcohol-drinking problems in pregnant women (Mental Illness Research Education
and Clinical Center (MIRECC)). In particular, the tool is used to assess the extent to which
alcohol-drinking behaviors of the pregnant woman may affect the embryo or fetus. Heavy
alcohol consumption during pregnancy can have major problems for the child. For instance,
children whose mothers were heavy drinkers during their pregnancy risk developing
permanent physical disabilities. Results of T-ACE test, therefore, help health professionals to
develop intervention measures that reduce the risk of unborn babies developing deformities at
birth. Unlike the AUDIT test that contains ten questions, T-ACE contains four questions.
These questions require ‘yes’ and ‘no’ answers from the respondent. Each ‘yes’ answer has a
score of 1 (MIRECC). A score of more than 2 shows that the mother’s drinking habits are
dangerous enough to cause birth defects to the child (MIRECC). Here are the four questions
that are contained in T-ACE test.

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1. How many alcoholic drinks do you need to take to feel high?
2. Have you annoyed people after consuming alcohol?
3. Have you felt like quitting or cutting down your alcohol drinking?
4. Are there times that you have had to take a drink in the morning in order to get rid of
   a hangover caused by a previous day of drinking or to steady your nerves?
   The last three questions require a simple ‘yes’ or ‘no’ answer. However, in the first
   question, the respondent will choose 0 if they need less than 2 drinks to get high and 1 if they
   need more than 2 drinks to get high.

Strengths and weaknesses of AUDIT and T-ACE

Both AUDIT and T-ACE tools are fairly effective in assessing a patient’s alcohol
dependency. Through a variety of questions, one can determine the frequency of the person’s
drinking, the quantities of alcohol that they take, and the effects of the drinking on their lives.
As for AUDIT, its major strength is that it can be applied to large segments of the population.
The main weakness of both AUDIT and T-ACE is that it they do not factor in specific
characteristics of the respondent that affect how alcohol impacts their bodies. For instance, a
certain level of alcohol consumption may be dangerous for old and sickly people but not for
relatively young people. Men and women also have different alcohol thresholds. Thus,
quantities that may be problematic for women may not be problematic for men. Another
weakness is that the tests do not specify quantities of alcohol consumed per session. Without
knowing how much a person consumes in a drinking session, it is hard to determine the
extent of their problem
A key weakness for T-ACE is lack of reference period. It is important to know
whether the period being considered is a month, half a year, or a year before the interview.
This information is particularly important for T-ACE tests that seek to determine how a

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pregnant woman’s alcohol-drinking may affect their child. For such cases, it is important to
know when the pregnant woman showed certain drinking behaviors. Another major weakness
of T-ACE is that it has very few questions which makes it hard to get precise information
about a person’s drinking problem.

Challenges and Suggestions for Improvement

The main challenge when using AUDIT and T-ACE is that there is no way of
verifying the information that the respondent provides. It is, therefore, easy to suggest a
solution that may not be appropriate for a person’s situation. My suggestion for both
measurement tools is that the questions should be more specific, especially for questions that
are related with quantities of alcohol consumed.
Conclusion

AUDIT and T-ACE are fairly accurate measurement tools used to assess the extent of
a patient’s alcohol-drinking problem. In spite of some of the weaknesses that have been
highlighted in the paper, the two tools provide important information that can be used to
address problems faced by alcoholics.

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References

Mental Illness Research Education and Clinical Center (MIRECC) (n.a). T-ACE Screening
Tool. Retrieved on 1 st July, 2020 from https://www.mirecc.va.gov/visn22/T-
ACE_alcohol_screen.pdf
National Institute on Alcohol Abuse and Alcoholism (NIAAA) (n.a). Screening Tests.
Retrieved on 1 st July, 2020 from https://pubs.niaaa.nih.gov/publications/arh28-2/78-
79.htm#:~:text=Two%20instruments%20in%20particular%2C%20the,very%20specif
ic%20population%E2%80%94pregnant%20women.