Screening for Problem Drinking
September 1, 1998
Screening for Problem Drinking
Though under-recognized, a substantial minority (10-36%) of patients seen by primary care clinicians suffer alcohol abuse or dependency. In an attempt to identify problem drinkers, clinicians may employ questionnaires such as CAGE or AUDIT (Alcohol Use Disorders Identification Test). One noted potential deficit of CAGE is the question about whether the patient has ever had an alcohol problem. A positive response to this question may represent a distant past dysfunction-not highly pertinent to the patient's immediate health status. Additionally, CAGE may not be a good screen for heavy drinkers (averaging more than 14 drinks weekly or 5 drinks daily). In 1993, the World Health Organization reported AUDIT as specifically designed to identify heavy drinkers.
Among 6116 patients from three VA medical centers, the CAGE and AUDIT screens were mailed to 2875 respondents who acknowledged drinking a minimum of five drinks over the preceding year. In addition to the written questionnaires, a subgroup of 447 subjects agreed to telephone interviews to obtain more exacting data about specifics of drinking behaviors. This report details a comparison in a subgroup of 261 subjects who returned written questionnaires and underwent telephone interviews.
The AUDIT was superior to CAGE in identifying heavy drinkers. Similarly, AUDIT was superior in detecting active alcohol abuse or dependence. The authors conclude that, although the absolute magnitude of the differences is small, AUDIT should be the screening tool of choice for heavy drinking.
Bradley KA, et al. J Gen Intern Med 1998;13:379-388.
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