Single-Question Screening for Unhealthy Alcohol Use

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Single-Question Screening for Unhealthy Alcohol Use

A single question about alcohol consumption, which might improve clinician adherence to screening guidelines, accurately identified patients with unhealthy alcohol use.

The four-question CAGE questionnaire was validated as an alcohol screening instrument more than 3 decades ago and is well known by physicians, but is used rarely. A simpler, more straightforward method of screening might make clinicians more likely to screen. Researchers compared the performance of several brief tests for detecting unhealthy alcohol use (i.e., the spectrum from risky amounts through dependence). They screened 1537 emergency department patients with acute injuries, 1151 emergency patients with medical illnesses, and 1112 randomly selected people who were contacted by telephone.

Researchers asked each subject a question about alcohol consumption in a day ("When was the last time you had more than X drinks in 1 day?" [where X=5 for men and 4 for women]); a question about average consumption per occasion; and three standard questions about frequency and quantity of consumption. Diagnostic interviews were used to determine the presence of an alcohol-use disorder, and validated calendar methods were used to determine amounts consumed. When the threshold value was set at "in the past 3 months," the question about consumption in a day performed the best of the three tests (sensitivity and specificity, 85% and 70% in men and 82% and 77% in women). Findings were similar whether screening was conducted in person or by telephone.

Comment: These findings suggest that asking a single question can identify unhealthy alcohol use. These data could lead to easier adherence to practice guidelines that recommend screening adults for alcohol misuse (Journal Watch Apr 13 2004), and they even validate telephone screening, which could save precious face-to-face time in the office.

— Richard Saitz, MD, MPH, FACP, FASAM

Published in Journal Watch General Medicine June 24, 2005

Citation(s):

Canagasaby A and Vinson DC. Screening for hazardous or harmful drinking using one or two quantity-frequency questions. Alcohol Alcohol 2005 May/Jun; 40:208-13.

Original article (Subscription may be required)
Medline abstract (Free)

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