Four levels of risk are shown in Box 6.
Zone I refers to low risk drinking or abstinence.
The second level, Zone II, consists
of alcohol use in excess of low-risk guidelines5,
and is generally indicated when the
AUDIT score is between 8 and 15. A brief
intervention using simple advice and patient
education materials is the most appropriate
course of action for these patients. The
third level, Zone III, is suggested by AUDIT
scores in the range of 16 to 19. Harmful
and hazardous drinking can be managed
by a combination of simple advice, brief
counseling and continued monitoring,
with further diagnostic evaluation indicated
if the patient fails to respond or is suspected
of possible alcohol dependence. The fourth
risk level is suggested by AUDIT scores in
excess of 20. These patients should be
referred to a specialist for diagnostic evaluation
and possible treatment for alcohol
dependence. If these services are not available,
these patients can be managed in
primary care, especially when mutual help
organizations are able to provide community-based
support. Using a stepped-care
approach, patients can be managed first at
the lowest level of intervention suggested
by their AUDIT score. If they do not respond
to the initial intervention, they should be
referred to the next level of care.