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

Evan Wood, Shirley C Wong, Kim Corace, David Martell, Bryce Barker, Catherine de Montigny, David C Hodgins, Ginette Poulin, Katelyn Halpape, Bernard Le Foll, Ronald Lim, Ami Brosseau, Robert Henry, David C Marsh, Nicole Cowan, Rand Teed, Cheyenne Johnson, Caroline Brunelle, Brittany Graham, Jürgen Rehm

Journal: CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne 2026;198(17):E655-E665

PMID: 42082413

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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.

Address: Department of Medicine (Wood, Wong), University of British Columbia; British Columbia Centre on Substance Use (Wood, Wong, Johnson), Vancouver, BC; Department of Psychiatry (Corace), University of Ottawa; Ottawa Hospital Research Institute (Corace); Canadian Centre on Substance Use and Addiction (Corace, Barker), Ottawa, Ont.; Department of Family Medicine (Martell), Dalhousie University, Halifax, NS; Addiction Medicine Department (de Montigny), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Department of Psychology (Hodgins), University of Calgary, Calgary, Alta.; Department of Family Medicine (Poulin), Max Rady College, University of Manitoba, Winnipeg, Man.; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; Department of Family and Community Medicine (Le Foll), University of Toronto; Institute for Mental Health Policy Research (Le Foll, Rehm), Centre for Addiction and Mental Health, Toronto, Ont.; University of Calgary (Lim), Calgary, Alta.; Cool Aid Community Health Centre & Victoria Native Friendship Centre (Brosseau), Victoria, BC; Department of Indigenous Studies (Henry), University of Saskatchewan, Saskatoon, Sask.; Northern Ontario School of Medicine (Marsh); Health Sciences North Research Institute (Marsh), Sudbury, Ont.; Vancouver Coastal Health (Cowan), Vancouver, BC; Drug Class Program (Teed), Craven, Sask.; Department of Psychology (Brunelle), University of New Brunswick, Saint John, NB; BC Centre for Disease Control (Graham), Vancouver, BC; Department of Psychiatry (Rehm), University of Toronto, Toronto, Ont. [email protected].; Department of Medicine (Wood, Wong), University of British Columbia; British Columbia Centre on Substance Use (Wood, Wong, Johnson), Vancouver, BC; Department of Psychiatry (Corace), University of Ottawa; Ottawa Hospital Research Institute (Corace); Canadian Centre on Substance Use and Addiction (Corace, Barker), Ottawa, Ont.; Department of Family Medicine (Martell), Dalhousie University, Halifax, NS; Addiction Medicine Department (de Montigny), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Department of Psychology (Hodgins), University of Calgary, Calgary, Alta.; Department of Family Medicine (Poulin), Max Rady College, University of Manitoba, Winnipeg, Man.; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; Department of Family and Community Medicine (Le Foll), University of Toronto; Institute for Mental Health Policy Research (Le Foll, Rehm), Centre for Addiction and Mental Health, Toronto, Ont.; University of Calgary (Lim), Calgary, Alta.; Cool Aid Community Health Centre & Victoria Native Friendship Centre (Brosseau), Victoria, BC; Department of Indigenous Studies (Henry), University of Saskatchewan, Saskatoon, Sask.; Northern Ontario School of Medicine (Marsh); Health Sciences North Research Institute (Marsh), Sudbury, Ont.; Vancouver Coastal Health (Cowan), Vancouver, BC; Drug Class Program (Teed), Craven, Sask.; Department of Psychology (Brunelle), University of New Brunswick, Saint John, NB; BC Centre for Disease Control (Graham), Vancouver, BC; Department of Psychiatry (Rehm), University of Toronto, Toronto, Ont.

DOI: 10.1503/cmaj.251759

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Full Text Sources:

http://www.cmaj.ca/cgi/pmidlookup?view=long&pmid=4...

Medical:

https://medlineplus.gov/alcohol.html

Miscellaneous:

https://assays.cancer.gov/CPTAC-1496

MeSH Terms: Humans, Canada, Mass Screening, Alcoholism, Alcohol Drinking, Alcohol-Related Disorders, Practice Guidelines as Topic