Primary Care Validation of a Single-Question Alcohol Screening Test

ABSTRACTBACKGROUNDUnhealthy alcohol use is prevalent but under-diagnosed in primary care settings.OBJECTIVETo validate, in primary care, a single-item screening test for unhealthy alcohol use recommended by the National Institute on Alcohol Abuse and Alcoholism (NIAAA).DESIGNCross-sectional study.PARTICIPANTSAdult English-speaking patients recruited from primary care waiting rooms.MEASUREMENTSParticipants were asked the single screening question, “How many times in the past year have you had X or more drinks in a day?”, where X is 5 for men and 4 for women, and a response of >1 is considered positive. Unhealthy alcohol use was defined as the presence of an alcohol use disorder, as determined by a standardized diagnostic interview, or risky consumption, as determined using a validated 30-day calendar method.MAIN RESULTSOf 394 eligible primary care patients, 286 (73%) completed the interview. The single-question screen was 81.8% sensitive (95% confidence interval (CI) 72.5% to 88.5%) and 79.3% specific (95% CI 73.1% to 84.4%) for the detection of unhealthy alcohol use. It was slightly more sensitive (87.9%, 95% CI 72.7% to 95.2%) but was less specific (66.8%, 95% CI 60.8% to 72.3%) for the detection of a current alcohol use disorder. Test characteristics were similar to that of a commonly used three-item screen, and were affected very little by subject demographic characteristics.CONCLUSIONSThe single screening question recommended by the NIAAA accurately identified unhealthy alcohol use in this sample of primary care patients. These findings support the use of this brief screen in primary care.

[1]  D. Kivlahan,et al.  The AUDIT Alcohol Consumption Questions (AUDIT-C) An Effective Brief Screening Test for Problem Drinking , 2010 .

[2]  P. Friedmann,et al.  Screening and intervention for alcohol problems , 2000 .

[3]  D. Kivlahan,et al.  The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. , 1998, Archives of internal medicine.

[4]  Robert J Volk,et al.  AUDIT-C as a brief screen for alcohol misuse in primary care. , 2007, Alcoholism, clinical and experimental research.

[5]  K. Kraemer,et al.  Three questions can detect hazardous drinkers. , 2001, The Journal of family practice.

[6]  U. P. S. T. Force,et al.  Screening and Behavioral Counseling Interventions in Primary Care To Reduce Alcohol Misuse: Recommendation Statement , 2004, Annals of Internal Medicine.

[7]  P. Friedmann,et al.  Screening and intervention for alcohol problems. A national survey of primary care physicians and psychiatrists. , 2000, Journal of general internal medicine.

[8]  Thomas F. Babor,et al.  Alcohol Use Disorders Identification Test , 1995 .

[9]  O. Aasland,et al.  Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption--II. , 1993, Addiction.

[10]  Katrina M. Krause,et al.  Primary care: is there enough time for prevention? , 2003, American journal of public health.

[11]  M. Polen,et al.  Behavioral Counseling Interventions in Primary Care To Reduce Risky/Harmful Alcohol Use by Adults: A Summary of the Evidence for the U.S. Preventive Services Task Force , 2004, Annals of Internal Medicine.

[12]  M. Rubio‐Stipec,et al.  The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): development, reliability and feasibility. , 2002, Addiction.

[13]  B. Turner,et al.  Primary care physicians' views on screening and management of alcohol abuse: inconsistencies with national guidelines. , 1999, The Journal of family practice.

[14]  Fausto Mazzi,et al.  Concordance of the Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health Surveys , 2006, International journal of methods in psychiatric research.

[15]  M. Selzer.  The Michigan alcoholism screening test: the quest for a new diagnostic instrument. , 1971, The American journal of psychiatry.

[16]  H. Kranzler,et al.  The Alcohol Use Disorders Identification Test (AUDIT): validation of a screening instrument for use in medical settings. , 1995, Journal of studies on alcohol.

[17]  N. Calonge.  Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: recommendation statement. , 2004, American family physician.

[18]  D. Vinson,et al.  Screening for hazardous or harmful drinking using one or two quantity-frequency questions. , 2005, Alcohol and alcoholism.

[19]  D. Vinson,et al.  Validation of a single screening question for problem drinking. , 2001, The Journal of family practice.

[20]  R. Centor,et al.  Screening for alcohol abuse using CAGE scores and likelihood ratios. , 1991, Annals of internal medicine.

[21]  Ulrich John,et al.  Screening for alcohol use disorders and at-risk drinking in the general population: psychometric performance of three questionnaires. , 2002, Alcohol and alcoholism.

[22]  Neil Skolnik,et al.  Helping Patients Who Drink Too Much , 2005 .

[23]  M. Gardner,et al.  Confidence intervals for research findings , 1992, British journal of obstetrics and gynaecology.

[24]  K. Bush,et al.  Screening for problem drinking , 1998, Journal of general internal medicine.

[25]  R. Kruse,et al.  Simplifying alcohol assessment: two questions to identify alcohol use disorders. , 2007, Alcoholism, clinical and experimental research.

[26]  D. Mayfield,et al.  The CAGE questionnaire: validation of a new alcoholism screening instrument. , 1974, The American journal of psychiatry.

[27]  P. O'Connor,et al.  Screening for alcohol problems in primary care: a systematic review. , 2000, Archives of internal medicine.

[28]  P. Diehr,et al.  The AUDIT alcohol consumption questions: reliability, validity, and responsiveness to change in older male primary care patients. , 1998, Alcoholism, clinical and experimental research.

[29]  Linda C. Sobell,et al.  Timeline Follow-Back A Technique for Assessing Self-Reported Alcohol Consumption , 1992 .

[30]  Ting-kai Li,et al.  Quantifying the risks associated with exceeding recommended drinking limits. , 2005, Alcoholism, clinical and experimental research.

[31]  T. M. Davis,et al.  Two brief alcohol-screening tests From the Alcohol Use Disorders Identification Test (AUDIT): validation in a female Veterans Affairs patient population. , 2003, Archives of internal medicine.

[32]  R. Feinn,et al.  Psychometric properties of the short index of problems as a measure of recent alcohol-related problems. , 2003, Alcoholism, clinical and experimental research.

[33]  D. Vinson,et al.  Screening for problem drinking: does a single question work? , 1998, The Journal of family practice.

[34]  S H Schnoll,et al.  A program of screening and prompting improves short-term physician counseling of dependent and nondependent harmful drinkers. , 1993, Archives of internal medicine.

[35]  S. Shellenberger,et al.  Primary care validation of a single screening question for drinkers. , 2006, Journal of studies on alcohol.