A Simplified Method to Assess Alcohol Use Disorders
One of the challenges with alcohol screening in primary care settings is the lack of a brief assessment to determine whether abuse or dependence is present in screen-positive patients. In this study, researchers developed a simple assessment with data from the cases (1522 injured patients) of a case-control study. They validated the assessment with data from the controls (1124 noninjured patients) from the same study, a primary care sample (n=623), and a nationally representative sample of U.S. adults (n=26,946).
- Among subjects in the developmental sample, 2 criteria*—recurrent drinking in physically hazardous situations and drinking more or for longer than intended—had a sensitivity of 96% and a specificity of 85% for current alcohol use disorders.
- Among all subjects in the 3 validation samples, the criteria had a sensitivity of 72% to 94% and a specificity of 80% to 95%.
- Among screen-positive** subjects in the 3 validation samples, the criteria had a sensitivity of 77% to 95% and a specificity of 62% to 86%.
Clinicians must be able to quickly and accurately assess the presence of an alcohol use disorder if alcohol screening and intervention strategies are to be effective. Although the 2 criteria had reasonable sensitivity and specificity for alcohol use disorders in this retrospective study, it is not clear how the relevant questions should be worded for use in primary care settings or how they would perform outside the context of a large diagnostic questionnaire. As the researchers mention, the items should be tested prospectively in practice settings.Kevin L. Kraemer, MD, MSc
*Based on positive responses to 3 questions from the Diagnostic Interview Schedule and 4 questions from the Alcohol Use Disorder and Associated Disabilities Interview Schedule
**Defined in the case-control and primary care studies as >4 in one day for women, >5 for men over the past 3 months; defined in national survey as ≥5 or more drinks in a single day over the past 12 months
Vinson DC, Kruse RL, Seale JP. Simplifying alcohol assessment: two questions to identify alcohol use disorders. Alcohol Clin Exp Res. 2007;31(8):1392–1398.