Fig. 1.

Decision tree of four strategies to screen for unhealthy alcohol use in primary care. (A) A clinician can screen a primary care patient once for unhealthy alcohol by one of four strategies. (B) Once a patient tests positive by a screening test, he or she moves into the full assessment phase. In the full assessment, clinicians ask questions to determine if the test result is a true or false positive and determine if there is an alcohol disorder. Then, there is a probability that the clinician delivers a treatment (brief intervention for at-risk drinking or abuse) or refers to specialty alcohol treatment for alcohol dependence. Finally, there is a chance that the treatment succeeds, placing the unhealthy drinker into a safer health state. Patients then enter the Markov model in one of six health states (see Fig. 2).