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
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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):
> 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)
Does the person meet ICD-10 criteria? 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 (www.integration.samhsa.gov/images/res/tool_auditc.pdf) has a sensitivity of 86% and a specificity of 72%.