Why these two questions are key to detecting alcohol problems

How often do you drink six or more alcoholic beverages in one sitting? Have you ever consumed alcohol first thing in the morning to steady your nerves? These two questions, which recently went viral on the internet, stem from a 2014 report by the University of Leicester. While the report was published 10 years ago, doctors still consider the questions highly effective in diagnosing alcohol addiction. According to the study, these questions are used by primary healthcare professionals to assess addiction with an accuracy rate of 87%.

Jordi Sánchez, a hepatologist at Parc Taulí Hospital in Sabadell, believes that these two questions are crucial. On the one hand, “they detect the problems of people who binge-drink and consume several drinks in a short period of time, a trend that is increasingly on the rise among the young population,” says Sánchez, who explains that red flags are raised when a man has five strong alcoholic drinks within a couple of hours, or when a woman has four.

On the other hand, the second question targets individuals who rely on alcohol to relax, “which denotes a certain level of dependence,” says Sánchez. “We often ask patients admitted to hospital if they wake up in the mornings with tremors and the urge to drink to calm down or with withdrawal symptoms,” explains the specialist, who regularly treats patients with hepatitis and alcoholic cirrhosis.

The study examined 17 individuals who had been asked these two questions by their doctors. The results showed that asking about the frequency of drinking six or more alcoholic drinks in one sitting identified alcoholism with 54% accuracy. “Anyone who regularly admits to doing this is likely to have a problem,” the publication notes.

However, when the second question was added — asking if someone has ever consumed alcohol first thing in the morning to steady their nerves — the accuracy of the diagnosis increased to 87%. This question, part of the CAGE test used to detect alcohol use disorder in adults, is particularly effective in revealing significant dependence.

Gloria Sánchez Antolín, head of the Hepatology Unit at Río Ortega Hospital in Valladolid, agrees that these two questions are highly effective. “Because they’re open, they ensure that the patient does not feel judged and can be referred from primary care to hepatologists and mental health experts,” she explains.

Sánchez also notes the rising trend among young people of drinking before going out, often to help them relax before socializing, leading to an increase in related behavioral problems.

In countries like Spain, where alcohol is deeply ingrained in the culture, this issue is particularly pronounced. “Our society is closely tied to vineyards; we are the largest exporters of wine, which makes it easier for people to afford alcohol,” Sánchez points out. According to the Spanish Ministry of Health, over 15,000 people die annually due to alcohol-related issues. The line between social drinking and alcohol dependence is often thin and easily overlooked.

The latest Survey on Alcohol and Drugs in Spain shows that 9% of the population aged 15 to 64 drank alcohol daily in the 30 days prior to the survey. Additionally, 6.4% of respondents admitted to being drunk in the last month (8.5% of men and 4.2% of women), while 15.4% engaged in binge-drinking (20.3% of men and 10.4% of women). Men, in particular, are consuming alcohol at worrying levels, averaging between 30 and 40 grams of alcohol daily, while women drink 10 grams less.

Sánchez Antolín notes that higher consumption leads to higher tolerance. “Years ago, it was thought that a glass of wine a day was beneficial for vascular health, but we now know that no amount of alcohol can be recommended,” she says. The specialist admits that it is difficult to control alcohol consumption in a country that “culturally normalizes going out to have a few wines or having a glass of brandy for breakfast during the work day.” Each liver has a different level of resistance to alcohol, so it’s hard to predict when liver damage might occur.

Other effective screening tools include the AUDIT alcohol addiction test, commonly used in Spanish psychiatric consultations. This 10-question questionnaire evaluates harmful consumption and symptoms of dependence, asking questions like, “How often in the past year have you been unable to remember what happened the night before because you were drinking?” and “Have you experienced regret or guilt after drinking?”

Sánchez Antolín also highlights laboratory tests that can detect liver damage through simple blood tests and urine samples. “Alcohol-related problems can cause both neuronal and psychological damage,” she warns. The doctor advocates for increased funding in primary care to improve early detection, as many patients find it difficult to acknowledge they have a problem with alcohol, “especially women due to cultural reasons,” says Sánchez Antolín.

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