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Research Summary

Patients Who Initially Screen Negative for Unhealthy Alcohol Use May Need to be Screened Again

The optimal interval of repeat outpatient screening for unhealthy alcohol use is not known, especially among those who screen negative initially. To determine whether some patients who screen negative for unhealthy alcohol use have a risk of converting to a positive screen in the future, researchers retrospectively examined Alcohol Use Disorder Identification Test–Consumption (AUDIT-C) data collected from 462,126 outpatients screened on 2 occasions (one year apart). The main outcome was conversion from a negative AUDIT-C score (0–2 in women and 0–3 in men) to a positive score (≥3 in women and ≥4 in men).

  • Initially, 75% of the patients screened had a negative AUDIT-C score; 18% had a positive score; and 8% had addiction treatment or an alcohol use disorder diagnosis in the year before initial screening or between the initial and subsequent screens.
  • Overall, 5% of women and 6% of men with initial negative screens converted to a positive screen the following year.
  • In adjusted analyses, younger men with initial scores of 3 were most likely to convert to positive screens. In contrast, older patients, women, and those with initial scores of 0 were least likely to convert. In no patient subgroup was the probability of converting to a positive screen below 2% or greater than 39%.

Comments:

This study suggests that the probability of converting from a negative to a positive screen for unhealthy alcohol use is high enough to justify repeating the screen for all patients after one year. It does not address whether patients with more than 2 consecutive negative screens should be eligible for cessation of screening. Kevin L. Kraemer, MD, MSc

Reference:

Lapham GT, Rubinsky AD, Heagerty PJ, et. al. Probability and Predictors of Patients Converting from Negative to Positive Screens for Alcohol Misuse. Alcohol Clin Exp Res. 2013 [Epub ahead of print]. doi: 10.1111/acer.12260.

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