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Home > Effectiveness Bank Bulletin [Brief screening tools for alcohol].

Drug and Alcohol Findings. (2013) Effectiveness Bank Bulletin [Brief screening tools for alcohol]. Effectiveness Bank Bulletin, 17 Jan, .

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A comparison of two single-item screeners for hazardous drinking and alcohol use disorder.
Dawson D.A., Pulay A.J., Grant B.F. Alcoholism, Clinical and Experimental Research: 2010, 34(2), p. 364–374.

Can you get away with asking just a single question to identify risky drinkers and even dependent drinkers? When the thresholds are suitably adjusted, asking either about frequency of heavy drinking or maximum single-occasion consumption worked remarkably well in the US general population.

Summary
Financial pressure on primary care providers to minimise the length of appointments and obtain necessary medical information as economically as possible has increased interest in ways to screen patients for alcohol problems which consist of a single question. Generally this question has been about how often or whether in a given period the patient has consumed over a certain amount of alcohol, in the USA generally five standard drinks for men and four for women, equivalent to about nine and seven UK units respectively. Depending on the precise criteria, these can identify a large proportion (around 8 in 10) of people which more extended tests show have alcohol use disorders (abuse or dependence) or who drink at hazardous levels, while also correctly identifying most who do not – measures known respectively as sensitivity and specificity.

An alternative approach tried to date only once is not to how often someone as drunk heavily, but how much as a maximum they drank in standard drinks or some other unit of alcohol, and then to find a quantity which most acceptably identifies problem drinkers while not falsely identifying non-problem drinkers.

In both cases it is important to test whether the performance of the tests is as good for men as for women and whether criteria need to be adjusted. Similarly for different age groups, especially since young people often 'binge' drink yet do not meet criteria for alcohol use disorder, while older people may not and yet still be problem drinkers.

This study tested these two approaches as screening methods in a representative sample of 43,093 US adults. Its two questions were:
• Frequency "During the last 12 months, about how often did you drink [five for men, four for women] or more drinks in a single day?"
• Maximum "During the last 12 months, what was the largest number of drinks that you drank in a single day?"

The questions were embedded in a survey which included other questions about drinking in the last 12 months, plus a 33-item interview which enabled a diagnosis of alcohol dependence or abuse according to US criteria. Also identified was past-year hazardous drinking was defined as in excess of national US low-risk drinking guidelines. At issue was how well at various thresholds the single questions identified any problem drinking (hazardous, abuse or dependence), alcohol use disorder (abuse or dependence), or specifically dependence. Optimal thresholds were defined as those resulting in the best combination of sensitivity (identifying problem drinkers) and specificity (identifying non-problem drinkers).


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