Use when screening for alcohol or drug use concerns (heavy drinking, cravings, loss of control, withdrawal symptoms, functional impairment), assessing substance use severity, determining level of care, or patient reports substance-related problems. Provides AUDIT-C (alcohol brief) and DAST-10 (drugs comprehensive) assessments.
This skill helps administer and interpret validated substance use screening instruments. The AUDIT-C assesses alcohol use patterns, while the DAST-10 screens for drug use problems.
Clinical Context: These tools help identify problematic substance use, assess severity, and support clinical decision-making about further evaluation or intervention. They are support tools that supplement, not replace, comprehensive substance use assessment.
IMPORTANT: Screen for BOTH alcohol (AUDIT-C) and drugs (DAST-10). They often co-occur and require different assessment and treatment approaches.
| Assessment | Items | Time | Substance | Cutoff | When to Use |
|---|---|---|---|---|---|
| AUDIT-C | 3 | < 1 min | Alcohol only |
| Men ≥4, Women ≥3 |
| Universal screening, primary care |
| DAST-10 | 10 | 2-3 min | Drugs (not alcohol) | ≥3 | Universal screening, any clinical setting |
| Full AUDIT | 10 | 3-5 min | Alcohol only | ≥8 | After positive AUDIT-C, comprehensive assessment |
Recommended approach: Use AUDIT-C + DAST-10 together for complete substance use screening. See references/screening-comparison.md for detailed guidance.
digraph assessment_selection {
rankdir=TB;
node [shape=box, style=rounded];
start [label="Substance Use\nScreening", shape=ellipse];
both [label="SCREEN BOTH:\nAUDIT-C (alcohol)\n+\nDAST-10 (drugs)", style="filled", fillcolor=lightblue];
audit_result [label="AUDIT-C\nPositive?", shape=diamond];
dast_result [label="DAST-10\nPositive?", shape=diamond];
alcohol_only [label="Alcohol Use\nIssue Only", style="filled", fillcolor=yellow];
drugs_only [label="Drug Use\nIssue Only", style="filled", fillcolor=yellow];
both_positive [label="Both Alcohol\nAND Drugs", style="filled", fillcolor=orange];
neither [label="Negative\nScreens\nRoutine f/u", style="filled", fillcolor=lightgreen];
full_audit [label="Consider\nFull AUDIT\n(if AUDIT-C ≥6)", shape=box];
intervention [label="Brief\nIntervention\nor\nReferral", style="filled", fillcolor=lightblue];
start -> both;
both -> audit_result;
audit_result -> dast_result [label="yes"];
audit_result -> dast_result [label="no"];
dast_result -> both_positive [label="AUDIT yes\nDAST yes"];
dast_result -> alcohol_only [label="AUDIT yes\nDAST no"];
dast_result -> drugs_only [label="AUDIT no\nDAST yes"];
dast_result -> neither [label="both no"];
alcohol_only -> full_audit;
drugs_only -> intervention;
both_positive -> intervention;
full_audit -> intervention;
}
Use this mode when the clinician says "start" or "administer" AUDIT-C and/or DAST-10.
Example requests: "Screen for alcohol use", "Administer DAST-10", "Score AUDIT-C", "Interpret substance screening"
Men:
Women:
For detailed severity interpretations and treatment recommendations, see references/severity-levels.md
Complete details: assets/audit-c.md
Items (0-4 each): 1) Drinking frequency, 2) Drinks per day, 3) Binge drinking frequency
Scoring: Total 0-12. Men ≥4, Women ≥3 = positive. Standard drink: 12oz beer, 5oz wine, 1.5oz spirits.
Next Steps: Below cutoff → annual rescreen. 4-7 (M) or 3-7 (W) → brief intervention, f/u 1-3mo. ≥8 → full AUDIT + referral.
Complete details: assets/dast-10.md
Format: 10 Yes/No questions, past 12 months, excludes alcohol/tobacco. Covers use beyond medical reasons, polysubstance, loss of control, blackouts, guilt, family issues, illegal activities, withdrawal, medical complications. Item 3 reverse scored.
Scoring: Total 0-10. 1 point per "Yes" (except Item 3). ≥3 = problematic use.
Next Steps: 0-2 → monitor. ≥3 → detailed history (substances, frequency, route). Opioids → MAT discussion. Injection use → infectious disease screening.
digraph severity_intervention {
rankdir=TB;
node [shape=box, style=rounded];
audit [label="AUDIT-C\nScore", shape=ellipse];
dast [label="DAST-10\nScore", shape=ellipse];
audit_low [label="0-3 (Men)\n0-2 (Women)", shape=box];
audit_haz [label="4-5 (Men)\n3-4 (Women)", shape=box];
audit_harmful [label="6-7 (Men)\n5-7 (Women)", shape=box];
audit_severe [label="≥8", shape=box];
dast_low [label="0-2", shape=box];
dast_mod [label="3-5", shape=box];
dast_sub [label="6-8", shape=box];
dast_severe [label="9-10", shape=box];
tx_none [label="Annual\nRescreening", style="filled", fillcolor=lightgreen];
tx_brief [label="Brief\nIntervention\n(5-15 min)", style="filled", fillcolor=yellow];
tx_bi_refer [label="Brief Intervention\n+ Full AUDIT\n+ Consider Referral", style="filled", fillcolor=orange];
tx_specialty [label="Specialty\nAddiction\nTreatment", style="filled", fillcolor=red, fontcolor=white];
tx_monitor [label="Routine\nMonitoring", style="filled", fillcolor=lightgreen];
tx_assess [label="Comprehensive\nAssessment\nOutpatient Option", style="filled", fillcolor=yellow];
tx_refer [label="Specialty Referral\nMAT if Opioids", style="filled", fillcolor=orange];
tx_immediate [label="Immediate Referral\nHigher LOC", style="filled", fillcolor=red, fontcolor=white];
audit -> audit_low;
audit -> audit_haz;
audit -> audit_harmful;
audit -> audit_severe;
dast -> dast_low;
dast -> dast_mod;
dast -> dast_sub;
dast -> dast_severe;
audit_low -> tx_none;
audit_haz -> tx_brief;
audit_harmful -> tx_bi_refer;
audit_severe -> tx_specialty;
dast_low -> tx_monitor;
dast_mod -> tx_assess;
dast_sub -> tx_refer;
dast_severe -> tx_immediate;
}
For structured clinical decision trees covering screening pathways, treatment selection, withdrawal management, and co-occurring disorders, see references/clinical-decision-trees.md
Substance-Specific: Opioids: MAT immediately (buprenorphine, methadone, naltrexone), naloxone for all. Stimulants: Behavioral therapies, cardiac/psychiatric evaluation. Benzodiazepines: Never abrupt stop (seizure risk), supervised taper required.
Components (5-15 min): Provide feedback (compare to low-risk guidelines), assess readiness, set goals, provide resources, follow-up in 1-3 months. Low-risk limits: Men ≤14/week, ≤4/day; Women ≤7/week, ≤3/day.
Approach: Non-judgmental, confidential. Normalize screening, use non-stigmatizing language.
Immediate Concerns: Acute intoxication/withdrawal → medical evaluation. Alcohol/benzodiazepine withdrawal → supervised detox (seizure risk). Opioids → MAT + naloxone. Injection use → infectious disease screening. Suicidal ideation → crisis intervention per ../../docs/references/crisis-protocols.md.
Crisis Resources: SAMHSA 1-800-662-4357, 988 Lifeline, Text HOME to 741741, Emergency 911
AUDIT-C template: assets/audit-c.md - Include 3 items, score, gender/cutoff, result, risk level, brief intervention, follow-up.
DAST-10 template: assets/dast-10.md - Include 10 items, score, risk level, substances, red flags (injection/opioids/withdrawal), recommendations, safety, naloxone if needed.
Support tool, not diagnostic: Self-report may underestimate use. Requires clinical context interpretation. Cultural factors affect disclosure. Clinical judgment supersedes scores. Use non-judgmental, motivational approach. Avoid stigmatizing language; use "person with substance use disorder," "person in recovery."
Special Populations: Pregnancy (immediate perinatal referral), adolescents (use CRAFFT), older adults (lower cutoffs, medication interactions), chronic pain (assess prescription use).
Comorbidity: High rates of depression (30-50%), anxiety (20-30%), PTSD (30-50%), suicidal ideation. Screen with ../../depression-screening/, ../../anxiety-screening/, ../../trauma-screening/, ../../suicide-screening/. Integrated treatment required.
Related workflows: ../../intake-interview/ (comprehensive intake), ../../treatment-planning/ (substance treatment plans), ../../documentation/ (progress notes). See ../../docs/references/crisis-protocols.md and ../../docs/references/referral-guidelines.md.
Detailed guidance: references/severity-levels.md, references/screening-comparison.md, references/clinical-decision-trees.md
External: https://findtreatment.gov (SAMHSA), https://aa.org, https://na.org, https://smartrecovery.org
AUDIT-C:
DAST-10:
Freely available for clinical and research use