Single-Question Alcohol Screen Detects Unhealthy Alcohol Use in a Primary Care Setting

A 2005 Guideline from the National Institute on Alcohol Abuse and Alcoholism recommended a single-question screen that had yet to be validated in clinical settings: “How many times in the past year have you had X or more drinks in a day?”, where X was 4 drinks for women and 5 drinks for men. In this cross-sectional study, researchers conducted a validation study of this single-question screen among 286 patients recruited from an urban primary care setting. The sensitivity and specificity of the question was compared with a calendar-based assessment designed to assess risky consumption levels and a structured questionnaire designed to establish DSM-IV criteria for an alcohol use disorder.

• The single-question screen was 84% sensitive and 78% specific for risky consumption and 88% sensitive and 67% specific for a current alcohol use disorder.

• The single-question screen was 82% sensitive and 79% specific for any unhealthy use (risky consumption or an alcohol use disorder).

• The single-question screen performed comparably to the 3-item AUDIT-C.*

• Test characteristics did not vary by gender, ethnicity, or education.

Comments:

The brevity and performance of this single-question screen recommends its use to detect both risky drinking and alcohol use disorders in the busy primary care setting. The phrasing of the item should facilitate more discussion of heavy episodic (binge) drinking, a major source of adverse consequences among nondependent drinkers. The vast majority of people who drink heavily at times are not dependent, and any success in decreasing their drinking will greatly reduce societal and personal harms from alcohol use.

Peter D. Friedmann, MD, MPH

Reference:

Smith PC, Schmidt SM, Allensworth- Davies D, et al. Primary care validation of a single-question alcohol screening test. J Gen Intern Med. 2009;24(7):783–788.