Alcoholic liver disease screening

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: M. Khurram Afzal, MD [2]


All patients who present with elevated liver enzymes, signs of liver disease or increased frequency of accidental trauma should be screened for alcohol abuse. Most individuals who consume heavy amounts of alcohol tend to deny it, hence there must be a strong suspicion under these circumstances. Physicians must have a low threshold to screen for alcohol abuse.


  • Patient should be asked about daily or weekly alcohol consumption.[1]
  • Patient should be asked about the CAGE questions (sensitivity ≥ 70% and Specificity > 90%):[1]
    • Have you ever felt the need to cut down on your drinking?
    • Are you easily annoyed by criticism of your drinking?
    • Have you ever felt guilty about you drinking?
    • Have you ever needed an eye opener?
  • Two positive CAGE answers indicate dependence on alcohol.
  • Alcohol use disorders identification test (AUDIT-C) should also be implemented to detect alcohol abuse:[2]
    • Men should score ≥ four points (Sensitivity = 86% and Specificity = 89%).
    • Women should score ≥ three points (Sensitivity = 73% and Specificity = 91%).


  1. 1.0 1.1 Willenbring ML, Massey SH, Gardner MB (2009). "Helping patients who drink too much: an evidence-based guide for primary care clinicians". Am Fam Physician. 80 (1): 44–50. PMID 19621845.
  2. Bradley KA, DeBenedetti AF, Volk RJ, Williams EC, Frank D, Kivlahan DR (2007). "AUDIT-C as a brief screen for alcohol misuse in primary care". Alcohol. Clin. Exp. Res. 31 (7): 1208–17. doi:10.1111/j.1530-0277.2007.00403.x. PMID 17451397.

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