Performance of alcoholism screening questionnaires in elderly veterans

Morton, Joy L.; Jones, Thomas V.; Manganaro, Maureen A.

doi:10.1016/s0002-9343(96)80069-6

Cited by 82 publications

(61 citation statements)

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“…Most previous studies of the AUDIT and CAGE have evaluated these instruments as intervieweradministered questionnaires. 1,[4][5][6][7][8][9][10][11][12][13]30,36 Three studies of interviewer-administered CAGE questionnaires in elderly VA populations similar to ours found the sensitivity of the CAGE (Ն2) for DSM-III-R lifetime alcohol abuse or depen- dence to be 78% to 82%. [10][11][12] Our sensitivity for the selfadministered CAGE (Ն2) compared with the same comparison standard was 53% (95% confidence interval [CI] 44%, 61%).…”

Section: Discussionmentioning

confidence: 79%

“…22,23,35 All screening questionnaires were evaluated as self-administered instruments, with the two versions of the CAGE embedded in a Health History Questionnaire, and the AUDIT included in a questionnaire explicitly addressing drinking practices. Not surprisingly, given the past-year time frame of the AUDIT, 13 the CAGE and its augmented version performed better than the AUDIT for identification of lifetime alcohol abuse or dependence. Interestingly, however, the augmented version of the CAGE performed significantly better than the AUDIT for detection of active alcohol abuse or dependence.…”

Section: Discussionmentioning

confidence: 99%

“…2 The 4-item CAGE questionnaire is a brief, effective screening questionnaire for alcohol abuse and dependence. 1,[3][4][5][6][7][8][9][10][11][12][13] However, the CAGE asks about alcohol problems "ever" experienced, so many patients who respond "yes" to the CAGE questions may have had alcohol problems only in the distant past. A more useful questionnaire screen would predominantly identify patients with "active" alcohol abuse or dependence, who meet diagnostic criteria, and have had at least one alcohol-related symptom in the past year.…”

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confidence: 99%

“…The only published comparison of the AUDIT and CAGE in a primary care population used lifetime alcohol abuse or dependence as the comparison standard. 13 Not surprisingly, given the AUDIT's explicit focus on past-year symptoms, it performed poorly compared to the CAGE for identifying alcohol abuse and dependence ever. 13 Emergency department studies have found the AUDIT to perform better than the CAGE questionnaire as a screen for current alcohol abuse or dependence.…”

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confidence: 99%

“…13 Not surprisingly, given the AUDIT's explicit focus on past-year symptoms, it performed poorly compared to the CAGE for identifying alcohol abuse and dependence ever. 13 Emergency department studies have found the AUDIT to perform better than the CAGE questionnaire as a screen for current alcohol abuse or dependence. 7,8 The length of the 10-item AUDIT, however, is a disadvantage.…”

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confidence: 99%

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Screening for problem drinking

et al. 1998

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OBJECTIVE:To compare self-administered versions of three questionnaires for detecting heavy and problem drinking: the CAGE, the Alcohol Use Disorders Identification Test (AUDIT), and an augmented version of the CAGE. DESIGN:Cross-sectional surveys. SETTING: Three Department of Veterans Affairs general medical clinics.PATIENTS: Random sample of consenting male outpatients who consumed at least 5 drinks over the past year ("drinkers"). Heavy drinkers were oversampled. MEASUREMENTS:An augmented version of the CAGE was included in a questionnaire mailed to all patients. The AUDIT was subsequently mailed to "drinkers." Comparison standards, based on the tri-level World Health Organization alcohol consumption interview and the Diagnostic Interview Schedule, included heavy drinking ( Ͼ 14 drinks per week typically or Ն 5 drinks per day at least monthly) and active DSM-IIIR alcohol abuse or dependence (positive diagnosis and at least one alcohol-related symptom in the past year). Areas under receiver operating characteristic curves (AUROCs) were used to compare screening questionnaires. MAIN RESULTS:Of 393 eligible patients, 261 (66%) returned the AUDIT and completed interviews. For detection of active alcohol abuse or dependence, the CAGE augmented with three more questions (AUROC 0.871) performed better than either the CAGE alone or AUDIT (AUROCs 0.820 and 0.777, respectively). For identification of heavy-drinking patients, however, the AUDIT performed best (AUROC 0.870). To identify both heavy drinking and active alcohol abuse or dependence, the augmented CAGE and AUDIT both performed well, but the AUDIT was superior (AUROC 0.861). CONCLUSIONS:For identification of patients with heavy drinking or active alcohol abuse or dependence, the self-administered AUDIT was superior to the CAGE in this population.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Screening for problem drinking

et al. 1998

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The AUDIT Alcohol Consumption Questions (AUDIT-C)<subtitle>An Effective Brief Screening Test for Problem Drinking</subtitle>

et al. 1998

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Objective: To evaluate the 3 alcohol consumption questions from the Alcohol Use Disorders Identification Test (AUDIT-C) as a brief screening test for heavy drinking and/or active alcohol abuse or dependence. Methods:Patients from 3 Veterans Affairs general medical clinics were mailed questionnaires. A random, weighted sample of Health History Questionnaire respondents, who had 5 or more drinks over the past year, were eligible for telephone interviews (N = 447). Heavy drinkers were oversampled 2:1. Patients were excluded if they could not be contacted by telephone, were too ill for interviews, or were female (n = 54). Areas under receiver operating characteristic curves (AUROCs) were used to compare mailed alcohol screening questionnaires (AUDIT-C and full AUDIT) with 3 comparison standards based on telephone interviews: (1) past year heavy drinking (Ͼ14 drinks/week or Ն5 drinks/ occasion); (2) active alcohol abuse or dependence according to the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, criteria;and (3) either.Results: Of 393 eligible patients, 243 (62%) completed AUDIT-C and interviews. For detecting heavy drinking, AUDIT-C had a higher AUROC than the full AUDIT (0.891 vs 0.881; P = .03). Although the full AUDIT performed better than AUDIT-C for detecting active alcohol abuse or dependence (0.811 vs 0.786; P<.001), the 2 questionnaires performed similarly for detecting heavy drinking and/or active abuse or dependence (0.880 vs 0.881).Conclusions: Three questions about alcohol consumption (AUDIT-C) appear to be a practical, valid primary care screening test for heavy drinking and/or active alcohol abuse or dependence.

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Hazardous and Harmful Alcohol Consumption in Primary Care

Reid¹,

Fiellin²,

O’Connor³

1999

Arch Intern Med

315

207

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Increasing emphasis has been placed on the detection and treatment of hazardous and harmful drinking disorders, particularly among patients who are seen in primary care settings. In this review, we summarize the epidemiology and health-related effects of hazardous and harmful drinking and discuss current methods for their detection and treatment. Hazardous drinking is defined as a quantity or pattern of alcohol consumption that places patients at risk for adverse health events, while harmful drinking is defined as alcohol consumption that results in adverse events (e.g., physical or psychological harm). Prevalence estimates range from 4% to 29% for hazardous drinking and from less than 1% to 10% for harmful drinking. Data from several recent large prospective studies suggest that alcohol consumption in quantities consistent with hazardous or harmful drinking may increase risk for adverse health events, such as hemorrhagic stroke and breast cancer. Existing screening instruments, such as the Michigan Alcoholism Screening Test (MAST) or the CAGE questionnaire, while excellent for detecting alcohol abuse or dependence, should not be used alone to screen for hazardous and harmful drinking. The Alcohol Use Disorders Identification Test (AUDIT) is currently the only instrument specifically designed to identify hazardous and harmful drinking. Treatment of these disorders in the form of brief interventions can be successfully accomplished in primary care settings, as demonstrated by a number of well-conducted randomized trials. Given its proven efficacy in the primary care setting, we recommend routine application of this treatment approach.

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Performance of alcoholism screening questionnaires in elderly veterans

Cited by 82 publications

References 11 publications

Screening for problem drinking

Screening for problem drinking

The AUDIT Alcohol Consumption Questions (AUDIT-C)<subtitle>An Effective Brief Screening Test for Problem Drinking</subtitle>

Hazardous and Harmful Alcohol Consumption in Primary Care

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