Screening for problem drinking

Abstract

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.

How Primary Care Providers Talk to Patients About Alcohol.

“…This validated screening strategy has 92% sensitivity and 50% specificity for the detection of alcohol misuse in a male, VA primary care population, 31 and a similar strategy has been used previously in trials of brief alcohol counseling 7,8 . A cut‐point ≥1 was used because the standard CAGE cut‐point (≥2) has low sensitivity (53%) for alcohol misuse in this population 32 . Of 7,700 patients from the study clinic who were eligible for ACQUIP, 4,046 (52%) returned the baseline survey before the start of the audiotape study, and 840 (21%) screened positive for alcohol misuse.…”

Reliability and Validity of the Alcohol Use Disorders Identification Test (AUDIT) Imbedded Within a General Health Risk Screening Questionnaire: Results of a Survey in 332 Primary Care Patients

“…Despite the absence of studies that compare various modes of administering the AUDIT, data suggest that the interviewer-or self-administered AUDIT have similar discriminant validity to identify hazardous-drinking and alcohol-dependent behavior. Published reports that evaluated the psychometric properties of self-administered AU-DIT found areas under receiver operating characteristic (AUROC) in the range of 0.78 to 0.99 (Bradley et al, 1998a;Bohn et al, 1995;McKenzie et al, 1996;Volk et al, 1997), whereas interviewer-administered AUDIT had AU-ROC between 0.81 and 0.88 (Bush et al, 1998). Another important characteristic of the AUDIT is its potential for inclusion in broader questionnaires.…”

Cribaje de trastornos por uso de alcohol en pacientes psiquiátricos ambulatorios: influencia de género, edad, y diagnóstico psiquiátrico

“…Por lo tanto, en muestras de pacientes psiquiátricos, un punto de corte de 1 proporciona una sensibilidad alta con suficiente especificidad. Es más, aunque varios estudios han usado un valor de corte de 2 (dos o más respuestas afirmativas) en la CAGE (Berks y McCormick, 2008;Castells y Furlanetto, 2005;Fiellin et al, 2000;Hearne et al, 2002;Mayfield et al, 1974;Paz Filho et al, 2001), varios resultados publicados sugieren que el mejor punto de corte para el cuestionario CAGE con pacientes psiquiátricos es 1 (Agabio et al, 2007;Bradley, Bush, McDonell, Malone, y Fihn, 1998;McGarry y Cyr, 2005;Ogborne, 2000). Respecto de la relación con edad y género, también se ha fijado que el punto de corte para la definición de casos debería ser de una respuesta positiva, dado que este valor puede mejorar la sensibilidad para mujeres y personas mayores (Bradley et al, 1998;Cherpitel, 1995;Jones, Lindsey, Yount, Soltys, y Farani-Enayat, 1993).…”