Researchers at Boston Medical Center (BMC) have found that a single-screening question recommended by the National Institute of Alcohol Abuse and Alcoholism (NIAAA) accurately identifies unhealthy alcohol use in primary-care patients. This research supports the use of the brief screen in the primary-care setting. The BMC study appears online in the Journal of General Internal Medicine.
Unhealthy alcohol use, the spectrum from risky consumption to alcohol use disorders, alcohol abuse and dependence, is prevalent but under-diagnosed in primary-care settings. Commonly used alcohol screening instruments are comprised of multiple questions, often do not cover the full spectrum of unhealthy use, and can be time consuming to administer. Consequently, many patients are not screened.
The NIAAA recommends a single-question screen for unhealthy alcohol use. The recommended question asks, “How many times in the past year have you had X or more drinks in a day?” (where X is 5 for men and 4 for women). While similar single-question screens have been validated in various settings, the NIAAA recommended screening test had not been validated in the primary-care setting. BMC researchers attempted to validate this version of the screening question in a sample of primary-care patients.
Of the 286 study participants reviewed, unhealthy alcohol use was reported by 31 percent of participants. Six percent consumed risky amounts but did not have alcohol-related problems or a disorder, 13 percent consumed risky amounts and had problems but no current disorder and 12 percent had a current alcohol use disorder. The single-question screen was 81.8 percent sensitive and 79.3 percent specific for the detection of unhealthy alcohol use. It was slightly more sensitive and less specific for the detection of a current alcohol use disorder.
“The single-question screening recommended by the NIAAA appears to have favorable characteristics,” said lead author Peter Smith, MD, attending physician in the section of General Internal Medicine at Boston Medical Center. “Single-question screening tests for unhealthy alcohol use may help to increase the frequency of screening in primary-care.”
Researchers further state that screening and brief intervention by primary-care physicians for those with unhealthy alcohol use reduces risky consumption among those without dependence and improves patient outcomes.