How should I assess the severity of alcohol dependence in a patient presenting with harmful drinking behaviors?

To assess the severity of alcohol dependence in a patient presenting with harmful drinking behaviors, start with a brief triage assessment that includes evaluating the pattern and severity of alcohol misuse using validated tools such as the Alcohol Use Disorders Identification Test (AUDIT) and the Severity of Alcohol Dependence Questionnaire (SADQ) or Leeds Dependence Questionnaire (LDQ).

Consider the need for urgent treatment including assisted withdrawal and assess any associated risks to the patient or others.

Conduct a comprehensive assessment if the AUDIT score is above 15, covering historical and recent drinking patterns (using tools like a retrospective drinking diary), dependence severity (using SADQ or LDQ), alcohol-related problems (using the Alcohol Problems Questionnaire, APQ), other substance misuse, physical and psychological health, social problems, cognitive function (e.g., Mini-Mental State Examination), and readiness to change.

Adjust assessment criteria for specific populations such as women, older adults, young people, and those with liver disease.

Use the Clinical Institute Withdrawal Assessment for Alcohol Scale, revised (CIWA-Ar) to quantify withdrawal severity if withdrawal symptoms are present.

Assess comorbid mental health problems as part of the comprehensive assessment to inform the overall care plan.

Blood tests may be considered to identify physical health needs but are not routinely used for diagnosis.