1. Home>
2. Specialties>
3. General Medicine>
4. Summary and Comment

Validation of a Single-Question Alcohol Screening Test

One short simple question effectively identified patients with unhealthy alcohol use.

In busy primary care practices, time-consuming approaches to screening for unhealthy alcohol use are problematic. In this study — conducted in a primary care clinic at a Boston safety-net hospital — researchers attempted to validate the following single-question alcohol screening test that is recommended by the National Institute on Alcohol Abuse and Alcoholism (NIAAA): "How many times in the past year have you had X or more drinks in a day?" (X is 5 for men and 4 for women). A response of one time or more was considered positive for unhealthy alcohol use. After answering the single screening question, participants underwent standardized diagnostic interviews. The study population was 63% black, 17% white, and 16% Latino.

During standardized interviews, 31% of 286 participants were identified as unhealthy alcohol users (12% had current alcohol use disorders as defined by DSM-IV criteria, and 19% consumed risky amounts without having alcohol use disorders). Sensitivity and specificity of the single-question screen for unhealthy alcohol use were 82% and 79%, respectively.

Comment: In this study, performance of a single-question alcohol screening test was reasonable, and results were comparable to those of some multiple-question approaches. Validation of this screening question in primary care settings with different demographic characteristics would be worthwhile. The NIAAA's Clinician's Guide discusses the single-question screen and how to proceed when risky alcohol use is identified.

— Allan S. Brett, MD

Journal Watch General Medicine Deputy Editor Dr. Richard Saitz was a researcher in this study. He did not take part in the decision to cover this article or in the writing of this summary.

Published in Journal Watch General Medicine July 28, 2009

Citation(s):

Smith PC et al. Primary care validation of a single-question alcohol screening test. J Gen Intern Med 2009 Jul; 24:783.

• Medline abstract (Free)

Reader Remarks:

Review and add to remarks on this article

• Alcohol question
  K. A. Cusato, 29 Jul 2009 3:20 PM EST
  If I get someone else to drive and I have just covered 2 hospitals for 2 weeks and I have... [more]
• Reply from article author
  Richard Saitz, MD, Boston Medical Center; Journal Watch Deputy Editor, 12 Aug 2009 4:56 PM EST
  The screening test that was the object of this study does not determine whether a person is or is not... [more]
• the single question
  Sherylle L Garner, In school for Addiction Studies, 16 Feb 2010 11:57 AM EST
  What happens when the pt/ct says they don't drink like that, but in truth they do?

Image Gallery