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Screening for unhealthy alcohol use is not regularly performed in many clinician offices. In a study by Friedmann and colleagues, which was published in the February 2000 issue of the Journal of General Internal Medicine, while 88% of 853 clinicians reported regularly asking about alcohol consumption when interviewing new outpatients, only 13% of clinicians reported using formal alcohol screening tools.
A simpler screening instrument might increase the rates of screening and detection of unhealthy alcohol use. The current study examines the usefulness of a single-question screening tool in the primary care setting.
Adult English-speaking patients recruited from primary care waiting rooms were asked, "How many times in the past year have you had X or more drinks in a day?" (X = 5 for men and 4 for women). A positive response to this single-question screen was defined as more than 1. Patients were considered to have unhealthy alcohol use if a standardized diagnostic interview revealed the presence of an alcohol use disorder or if a validated 30-day calendar method showed risky consumption.
The interview was completed by 286 (73%) of 394 eligible primary care patients. For identification of unhealthy alcohol use, the single-question screen was 81.8% sensitive (95% confidence interval [CI], 72.5% - 88.5%) and 79.3% specific (95% CI, 73.1% - 84.4%). For identification of a current alcohol use disorder, the single-question screen was slightly more sensitive (87.9%; 95% CI, 72.7% - 95.2%) but was less specific (66.8%; 95% CI, 60.8% - 72.3%).
Test characteristics of the single-question screen resembled those of a commonly used 3-item screen. Subject demographics affected diagnostic performance of the single-question screen only minimally.
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So, "how many times in the last year have you had more than 5/4 drinks in a day" seems to be a simple question we can ask to screen.
Maynard Luterman MD
http://cme.medscape.com/
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