Screening for high-risk drinking and alcohol use disorder: update of the 2023 national clinical practice guideline

Clinical Snapshot

Key Findings

• P Value: Not applicable - guideline development

• Effect Size: Not applicable - guideline recommendations

• Primary Outcome: Five evidence-based recommendations for simplified alcohol screening

• Nnt Or Sensitivity: Screening algorithm designed to optimize sensitivity for both high-risk drinking and AUD detection

• Confidence Interval: Not applicable - GRADE certainty ratings used

Clinical Application

High - specifically designed to address time constraints as primary implementation barrier Moderate relevance - principles applicable but would need adaptation to Australian alcohol guidelines, RACGP recommendations, and local screening thresholds All patients in Canadian healthcare settings, particularly primary care

Abstract

BACKGROUND: Current screening tools for harmful alcohol consumption have fallen out of step with recent guidance on the health risks of alcohol. To address this gap, the Canadian Research Initiative in Substance Matters updated the screening recommendations for high-risk drinking and alcohol use disorder (AUD) in the 2023 national clinical practice guideline. METHODS: Following a systematic review of literature published between Jan. 1, 2013, and Feb. 24, 2023, that examined screening tools for high-risk drinking and AUD, the updated recommendations were developed by a multidisciplinary national committee, which included people with lived and living experience. We scored the recommendations and certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation tool. We used the Appraisal of Guidelines for Research and Evaluation II instrument and the Guidelines International Network's principles for disclosure of interests and management of conflicts to ensure the update met international standards for transparency, high quality, and methodological rigour. RECOMMENDATIONS: Acknowledging that time constraints are the most commonly reported barrier to universal alcohol screening, we developed 5 recommendations involving a simple screening method, to identify and address both unhealthy alcohol consumption and more serious problems related to alcohol. The recommendations include asking all patients about alcohol consumption and providing educational support to all those who drink above Canada's Guidance on Alcohol and Health's low-risk threshold. We propose a simple screening algorithm to optimize and tailor further intervention, including when to assess for possible AUD. INTERPRETATION: The revised screening recommendations represent a timesaving and pragmatic approach intended to be a resource for universal screening for alcohol risks and problems. The recommendations streamline the process of identifying and addressing the health needs of those who consume alcohol in a hazardous way or may have more serious problems related to alcohol.

References

1. 1.Wood, E., Wong, S. C., Corace, K., Martell, D., Barker, B., de Montigny, C., Hodgins, D. C., Poulin, G., Halpape, K., Le Foll, B., Lim, R., Brosseau, A., Henry, R., Marsh, D. C., Cowan, N., Teed, R., Johnson, C., Brunelle, C., Graham, B., & Rehm, J. (2026). Screening for high-risk drinking and alcohol use disorder: update of the 2023 national clinical practice guideline. CMAJ, Article cmaj.251759. https://doi.org/10.1503/cmaj.251759