Substance Use: Alcohol

Substance Use: Alcohol

Substance use

Definition: Use of different legal and illegal substances such as alcohol, cannabis, cocaine, 3,4-methylenedioxymethamphetamine (MDMA), methamphetamine, lysergic acid diethylamide (LSD), heroin and others. The use of these substances is considered problematic if the consequences of use have a harmful and negative impact to the person, their family, close relatives or social environment. In people with HIV, substance use may interfere with adherence to ART, is associated with poorer outcomes and can trigger mental health disorders.

Alcohol use in people with HIV

Untreated alcohol use disorder (AUD) is associated with worse outcomes along the HIV care continuum and increased risk of morbidity. Further, people with HIV may experience mortality and physiologic injury at lower levels of alcohol consumption compared with people without HIV.

Screening for alcohol use

Who? How to screen? How to diagnose alcohol use dependence?

Recommend screening people with HIV at least once a year (in view of the high prevalence of problematic alcohol use)

Populations at particularly high risk

Ask: Do you ever consume alcoholic drinks?

If yes: explore with the Alcohol Use Disorders Identification Test-Concise (AUDIT-C), which is a brief alcohol screening instrument that identifies persons who are hazardous drinkers or have active alcohol use disorders (including alcohol abuse or dependence):

  1. Within the past year, how often did you have a drink of alcohol?
    0) Never
    1) Monthly (e.g., on special or rare occasions)
    2) 2-4 times a month
    3) 2-3 times a week
    4) 4 or more times a week
  2. Within the past year, how many standard drinks containing alcohol did you have on a typical day?
    0) 1 or 2
    1) 3 or 4
    2) 5 or 6
    3) 7 to 9
    4) 10 or more
  3. Within the past year, how often did you have six or more drinks on one occasion?
    0) Never
    1) Less than monthly
    2) Monthly
    3) Weekly
    4) Daily or almost daily

> Alcohol use at risk if score is ≥ 5 (men) or ≥ 4 (women)

Explore whether three or more of the following characteristics appear simultaneously, or have been present in the last 12 months (ICD-10 criteria)

  1. Intense desire or compulsion to consume
  2. Decreased ability to control:
    • difficulties in controlling the onset of consumption
    • difficulties in ending intake and controlling the amount
  3. Withdrawal symptomatology
  4. Tolerance or neuroadaptation
  5. Progressive abandonment of activities
  6. Persistence in consumption despite the harmful consequences

Does the person meet ICD-10 criteria?
• NO: risky / harmful consumption
• YES: alcohol dependence - refer the patient to the addiction unit

For risky consumption or where alcohol services are not available, initiate brief intervention or motivational interviewing

The Alcohol Use Disorders Identification Test (AUDIT) is a validated screening test to screen for unhealthy drinking.

The shorter 3-question version AUDIT-C ( has a sensitivity of 86% and a specificity of 72%.