What should be the legal age for drinking?

For professionals


Health professionals working in the area of alcohol use are faced in numerous challenges. Professionals in primary health care are strategically placed to identify and treat persons with problem alcohol use at an early stage.

The steps involved to manage persons with problem alcohol use effectively include:

  • Assessment/Screening
  • Establishing diagnosis or level of risk associated with drinking
  • Planning intervention/management



Assessment or screening helps to identify individuals with problem alcohol use. Important areas for assessment include:

  • Pattern of drug use – frequency, quantity and duration
  • Medical and psychiatric problems related to alcohol use
  • Psychosocial factors – support, barriers, expectations
  • Motivation to change drinking patterns
  • Effects of alcohol – intoxification, withdrawal

The tools for assessment is aided by

  • Clinical interview – history, physical examination and mental status examination
  • Screening questionnaires  to assess problem drinking and need for intervention - Alcohol Use Disorders Identification Test (AUDIT)
  • Laboratory investigations – mean corpuscular volume, gamma glutamyl transferase, aspartate transferase/alanine transferase


Establishing diagnosis or level of risk associated with drinking

The level of risk associated with drinking can be inferred from the scores obtained on screening questionnaires.  Risk levels based on Alcohol Use Disorders Identification Test (AUDIT) manual are:

0 -7 – Low risk (the person does not have problems related to alcohol use)

8-15 – Moderate risk (generally indicates hazardous drinking)

16 – 19 – High risk (the person engages in harmful drinking and may also have symptoms of dependence)

20 and above – Very high risk (the person is a dependent user) 

A diagnosis for alcohol use disorders is made on the basis of categories suggested by the classification systems:

International Classification of Diseases (ICD – 10)

Diagnostic Statistical Manual of Mental Disorders (DSM –IVTR)


Planning intervention/management

 The mode of intervention depends on the level of risk associated with drinking and if a diagnosis of alcohol use disorders is made.

  • At low risk levels of alcohol use – person is educated about alcohol use and lower-risk drinking practices
  • Moderate risk – simple advice is given about the potential risks of hazardous drinking and is encouraged to set goals for lower-risk drinking
  • High risk -  Brief intervention is provided using the FRAMES analogy (Feedback about risk level, Responsibility to change, Advice about reducing drinking, Menu of options for change, Empathy, Support self efficacy)
  • Very high risk – They are usually referred to specialists for diagnosis of alcohol use disorders and managed by a combination of pharmacotherapy and psychosocial interventions



Babor, T.F., and Higgins-Biddle. Brief Intervention for Hazardous  and Harmful Drinking: Manual for use in primary care. World Health Organization.

Lal R. Substance Use Disorders: A Manual for physicians. New Delhi: National Drug Dependence Treatment Center, All India Institute of Medical Sciences, 2005.