Levels of Screening and Brief Intervention

Screening Level	When to Use This Level	Screening Technique
1	If only one question is possible	On any single occasion during the past 3 months, have you had more than 5 drinks containing alcohol? (Taj et al. 1998).
2	With all patients who report drinking alcohol, if time allows, or for patients who respond “yes” to a level 1 screening question	On average, how many days per week do you drink alcohol? On a typical day when you drink, how many drinks do you have? What is the maximum number of drinks you had on any given day in the past month? (NIAAA 1995, 2003).
3	If level 2 screening reveals that the patient may be at risk for alcohol-related problems (i.e., for men whose alcohol consumption exceeds 14 standard drinks per week or 4 drinks per day, or for women whose consumption exceeds 7 standard drinks per week or 3 drinks per day), or if the clinician suspects that the patient is minimizing his or her alcohol use	The 10-question Alcohol Use Disorders Identification Test (AUDIT) (Saunders et al. 1993).
Brief Intervention Level	When to Use This Level	Brief Intervention Technique
1	If screening results determine that intervention is necessary but time is limited	Simply state concern that the patient’s drinking exceeds recommended limits and could lead to alcohol-related problems. Recommend that the patient minimize or stop drinking (WHOBISG 1996).
2	If referral to a specialist is not necessary; if abstinence is not necessarily the goal	Project TrEAT (Trial for Early Alcohol Treatment) protocol: two brief face-to-face sessions scheduled 1 month apart, with a followup telephone call 2 weeks after each session (Fleming et al. 2002).
3	If the patient has symptoms of alcohol abuse or dependence; if abstinence is the primary goal	Motivational enhancement, referral to a specialist.