Alcohol Screening and
Brief Intervention
What is alcohol screening and brief intervention (ASBI)?
Alcohol screening and brief intervention (ASBI) is a clinical preventive service, similar in many ways to screenings for high blood pressure or tobacco use. It is recommended by CDC, the US Preventive Services Task Force, NPWH, ACNM, AWHONN, and ACOG.
US Preventive Services Task Force recommends that all adults ages 18 or older should be screened in primary care settings for alcohol misuse. A standardized screening tool, such as the US AUDIT or the single question alcohol screener, is used to assess the client’s drinking patterns (i.e., how frequently they drink alcohol and how much alcohol they drink when they drink).
Clients whose screening indicates that they are drinking above recommended levels are provided feedback about their specific health risks, and then brief education, brief counseling, or a referral for further assessment and treatment depending on their screening score.
Why should NPs, midwives, and nurses routinely ask all their clients about their alcohol use?
Alcohol use, especially excessive alcohol use such as binge drinking, can have adverse health effects, including increased risk for accidents and injuries, heart disease, liver disease, certain types of cancers including breast cancer and liver cancer, weakened immune system, and alcohol use disorders. Any alcohol use during pregnancy can lead to fetal alcohol spectrum disorders.
Binge drinking is defined as consuming 4 or more standard drinks in a 2-3 hour period for women and 5 or more in a 2-3 hour period for men. Heavy drinking for women is 8 or more standard drinks per week; for men, 15 or more standard drinks per week.
Why should you screen for more than just severe or dependent alcohol use?
Asking about alcohol use can provide an opportunity for education about or reinforcement of healthy behaviors, as well as identifying those who may benefit from brief counselling or treatment. Only about 10% of US adults who drink alcohol excessively meet the criteria for severe alcohol use disorders.
In addition, many people may not be aware that there are recommendations for people who do drink alcohol to moderate their use – up to one standard drink per day for women, up to two for men.
What are the key steps in ASBI?
What are the recommended drinking limits?
According to the Dietary Guidelines for Americans 2020-2025, women should limit their alcohol intake to 1 standard drink or less per day; men should limit their consumption to 2 standard drinks or fewer per day. Binge drinking (consuming 4 or more standard drinks in a 2 hour period for women, 5 or more for men) should be avoided.
There are also some people who should not drink any alcohol, including if they are pregnant or might be pregnant, if they are under the legal age to consume alcohol, if they have certain medical conditions, if they are taking certain medications, or if they are recovering from an alcohol use disorder. Importantly, the guidelines do not recommend that non-drinkers start drinking alcohol.
Recommended drinking limits are based on US standard drink sizes. A US standard drink is the equivalent of 12 fl. oz. of beer, 5 fl. oz. of wine, or 1.5 fl. oz. of 80 proof distilled spirits.
There is no safe time, no safe amount, and no safe type of alcohol to drink during pregnancy.
Standard drink sizes
US standard drink sizes for use with a validated screening tool such as the US AUDIT.
Alcohol-Use-Card-Guide ACOG.pdfACOG's risky alcohol use guide
Free for download and use, courtesy of ACOG.
spanish pocketcard.pdfGuía de uso de alcohol de riesgo
Free for download and use, courtesy of ACOG.
What are the recommended validated screening tools?
AUDIT1-3 with AUDIT US and Scoring Instructions.pdfUS AUDIT (English)
Includes scoring and interpretation.
Brief single-question or 3-question alcohol screeners
"How many times in the past year have you had X or more drinks in a day?"
US AUDIT 1-3: First three questions of the US AUDIT
How often do you have a drink containing alcohol?
How many drinks containing alcohol do have on a typical day when you drink?
How often do you have X or more drinks on one occasion
(where X is 4 or more for females, 5 for males)
What resources are there to help NPs, midwives, and nurses routinely ask their clients about their alcohol use?
We have a variety of client engagement tools to help you have a conversation about alcohol use on our client education page, as well as an alcohol screening and brief intervention toolkit and the resources below.
7. BI Guidance.pdfBrief intervention guidance
8. Brief Intervention Techniques for NPs and Midwives.pdfBrief intervention techniques
Links to online training opportunities are available on our Professional Resources page.
Skills demonstration videos can be found in Module 6 of our curriculum.
Resources to Support Implementation of aSBI in Clinics
AlcoholSBIImplementationGuide-P.pdfPlanning and implementing screening and brief intervention for risky alcohol use
Free for download and use, courtesy of the Center of Disease Control and Prevention.
Agency for Healthcare Research and Quality (AHRQ)
Unhealthy Alcohol Use Tools and Resources, including educational posters for exam rooms in English and Spanish, peer-reviewed literature, pocket cards, and other resources.