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Research Summary

The Greater the Score, the Greater the Risk? Alcohol Screening Scores and the Probability of Dependence

Although the US Preventive Services Task Force recommends screening and brief intervention to reduce at-risk drinking, no practical approach exists to identify which patients who screen positive for at-risk drinking meet criteria for alcohol dependence, which usually requires more specialized treatment. This cross-sectional study sought to identify risk zones in alcohol screening scores to estimate the probability of alcohol dependence using 5 common screening tools.* Analyses were based on secondary data from a prospective validation study of alcohol screening tests that included 392 men and 927 women recruited from primary-care practice. A diagnosis of alcohol dependence was established via assessment with the Alcohol Use Disorders and Associated Disabilities Interview Schedule (AUDADIS). Stratum-specific likelihood ratios were calculated to empirically identify and evaluate score ranges on the screening tests.

  • Twelve percent of men and 6% of women met DSM-IV criteria for past-year alcohol dependence.
  • AUDIT scores of 15–40 in men and 13–40 in women were associated with an 87% and 94% probability of past-year alcohol dependence, respectively.
  • AUDIT-C scores of 10–12 were associated with a 75% probability of past-year alcohol dependence in men and an 88% probability in women.
  • The second highest risk zone on both the AUDIT and AUDIT-C conferred a 40–50% probability of past-year alcohol dependence in both men and women.
  • Risk zones for the single-item screening tests and the CAGE were not useful for identifying alcohol dependence.

*The Alcohol Use Disorders Identification Test (AUDIT), a validated 10-item screening questionnaire scored 0–40; the AUDIT-C (3 consumption items from the AUDIT), scored 0–12; 1 single-item screening question regarding the frequency of drinking ≥ 6 drinks per occasion, scored 0–4; 1 single-item screening question asking how many days in the past month the patient drank ≥5 drinks, scored 0-30; and the CAGE, a validated 4-item screening questionnaire asking about alcohol-related events occurring in the patient's lifetime, scored 0–4.

Comments:

Although this study was strengthened by a large sample size, there were relatively small numbers of men and women in the highest screening-test risk zones. Despite this limitation, results suggest that patients who score in the highest risk zone on the AUDIT and AUDIT-C may benefit from more immediate assessment for alcohol dependence and, if needed, referral. Jeanette M. Tetrault, MD

Reference:

Rubinsky AD, Kivlahan DR, Volk RJ, et al. Estimating risk of alcohol dependence using alcohol screening scores. Drug Alcohol Depend. 2010;108(2):29–36.

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