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Screening for UAU within primary care is increasingly used for point\u2010in\u2010time identification of UAU, but it is less clear whether changes in alcohol screening scores effectively capture changes in alcohol\u2010related risk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective cohort study used data from adult primary care patients in a Northwest US health system who had completed two AUDIT\u2010C screens 11\u201324\u2009months apart (T1, T2). Scores were grouped into five categories from no use to very high\u2010risk UAU. Generalized estimating equation models tested whether changes in AUDIT\u2010C categories from T1 to T2 were associated with changes in risk for nonaddiction mental health acute care utilization (emergency department or hospital admission) over 1\u2009year after T1 and T2.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 165,101 patients (61% female; mean age 55), mental health acute care utilization risks were 0.9% after T1 and 0.8% after T2. Compared to those with stable drinking (T1 utilization 0.8%, T2 0.8%), mental health acute care utilization risk decreased for patients with a one\u2010level decrease (T1 1.1%, T2 0.9%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01) or greater than or equal to two\u2010level decrease (T1 2.5%, T2 1.4%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Increases in AUDIT\u2010C categories were not associated with increased risk of mental health acute care utilization.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Changes in AUDIT\u2010C score categories over time, particularly decreases, may reflect real changes in an important risk of UAU. Changes in alcohol screening scores may offer clinicians, health systems, and researchers meaningful information about changes in health risk.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acer.70125","type":"journal-article","created":{"date-parts":[[2025,8,23]],"date-time":"2025-08-23T15:00:51Z","timestamp":1755961251000},"page":"1993-2002","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The association between changes in <scp>AUDIT<\/scp>\u2010C scores and acute mental healthcare utilization over the next year in a primary care population"],"prefix":"10.1111","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3734-6606","authenticated-orcid":false,"given":"Megan L.","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen E.","family":"Jack","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Department of Medicine University of Washington School of Medicine  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4551-7981","authenticated-orcid":false,"given":"Theresa E.","family":"Matson","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malia","family":"Oliver","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer F.","family":"Bobb","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8568-9163","authenticated-orcid":false,"given":"Douglas","family":"Berger","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Department of Medicine University of Washington School of Medicine  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharine A.","family":"Bradley","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8386-3984","authenticated-orcid":false,"given":"Kevin A.","family":"Hallgren","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8,23]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"crossref","unstructured":"Abramson B. 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