Article

Screening for Hazardous Drinking Using the Michigan Alcohol Screening Test-Geriatric Version (MAST-G) in Elderly Persons With Acute Cerebrovascular Accidents

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Abstract

Effective and valid screening methods are needed to identify hazardous drinking in elderly persons with new onset acute medical illness. The goal of the current study was to examine the effectiveness of the Michigan Alcohol Screening Test-Geriatric Version (MAST-G) in identifying hazardous drinking among elderly patients with acute cerebrovascular accidents (CVA) and to compare the effectiveness of 2 shorter versions of the MAST-G with the full instrument. The study sample included 100 men and women who averaged 12 days posthemorrhagic or ischemic CVA admitted to a rehabilitation unit and who were at least 50 years of age and free of substance use other than alcohol. This cross-sectional validation study compared the 24-item full MAST-G, the 10-item Short MAST-G (SMAST-G), and a 2-item regression analysis derived Mini MAST-G (MMAST-G) to the reference standard of hazardous drinking during the past 3 months. Alcohol use was collected using the Timeline Followback (TLFB). Recent and lifetime alcohol-related consequences were collected using the Short Inventory of Problems (SIP). Nearly one-third (28%) of the study sample met the World Health Organization (WHO) criteria for hazardous drinking. Moderately strong associations were found for the MAST-G, SMAST-G, and MMAST-G with alcohol quantity and frequency and recent and lifetime alcohol consequences. All 3 MAST-G versions could differentiate hazardous from nonhazardous drinkers and had nearly identical area under the curve characteristics. Comparable sensitivity was found across the 3 MAST-G measures. The optimal screening threshold for hazardous drinking was 5 for the MAST-G, 2 for the SMAST-G, and 1 for the MMAST-G. The 10-item SMAST-G and 2-item MMAST-G are brief screening tests that show comparable effectiveness in detecting hazardous drinking in elderly patients with acute CVA compared with the full 24-item MAST-G. Implications for research and clinical practice are discussed.

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... The data obtained are worrying, as the sample was composed of elderly who were recruited at home and who were monitored by professionals of the Family Health Program, in addition to presenting good levels of lucidity and physical independence, as assessed by the MMSE (mean = 23 points). The fact that they are preserved from the cognitive point of view, and their capacity for autonomy, may facilitate alcohol consumption unperceived by the family and the healthcare team, characterizing this as evidence of an invisible epidemic, since the problems and therefore the rates are underestimated and poorly identified (27,(29)(30) . ...
... According to the literature (9) , a person who responded yes to five or more questions on the MAST-G may have some type of problem with the use of alcohol (9,29) . It was observed that there was practically no difference in relationship to the risk of the existence of alcohol problems among the elderly who answered yes to five or more questions, which is consistent with the results obtained for the original MAST-G in the English language (9,30) . The translation of the instrument into Portuguese did not change the specificity or sensibility observed in the MAST-G in English, which is expected in the validation work. ...
... The general clinical cut off for possible alcohol problems is set at five or more positive answers. Consequently, people ST-G are indicated as having a late life alcohol use problem (Greene, McCaul, & Roger, 2009). ...
... In comparison with previous research, twice as many men and about as many women reported not drinking (McCaul et al, 2009). One of the reasons why more men in this sample reported being abstinent could be the average age of the sample group. ...
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The percentage of elderly people drinking alcohol will grow over the coming years. This research explores the characteristics of elderly people consuming alcohol, problems use and well-being.We questioned 1004 people over 60. Of the participants, 56.8% drank moderately, 18.7% showed a risky drinking behaviour, and 18.4% reported binge drinking. We found no correlation between different drinking patterns and well-being. There is a correlation between the amount of problem use and different drinking patterns. No correlation was found between the drinking patterns and well-being. Elderly people at risk and binge drinking group experienced more problem use
... The data obtained are worrying, as the sample was composed of elderly who were recruited at home and who were monitored by professionals of the Family Health Program, in addition to presenting good levels of lucidity and physical independence, as assessed by the MMSE (mean = 23 points). The fact that they are preserved from the cognitive point of view, and their capacity for autonomy, may facilitate alcohol consumption unperceived by the family and the healthcare team, characterizing this as evidence of an invisible epidemic, since the problems and therefore the rates are underestimated and poorly identified (27,(29)(30) . ...
... According to the literature (9) , a person who responded yes to five or more questions on the MAST-G may have some type of problem with the use of alcohol (9,29) . It was observed that there was practically no difference in relationship to the risk of the existence of alcohol problems among the elderly who answered yes to five or more questions, which is consistent with the results obtained for the original MAST-G in the English language (9,30) . The translation of the instrument into Portuguese did not change the specificity or sensibility observed in the MAST-G in English, which is expected in the validation work. ...
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Objective: To evaluate the internal consistency of the version of the Michigan Alcoholism Screening Test - Geriatric Version (MAST-G) instrument, translated and adapted for Brazil. Method: This was a descriptive, cross-sectional study. Data were collected through a demographic questionnaire, the ICD-10 and the MAST-G, following the steps of translation and cultural adaptation. One hundred eleven elderly in the city of São Carlos, SP, Brazil were interviewed. Results: The mean age of those interviewed was 70 years, with 45% men and 55% women, with the mean education of three years; 92% resided with family; 48% of the subjects consumed alcoholic beverages. The MAST-G presented a good level of reliability, with Cronbach's α = 0.7873, and good levels of sensitivity and specificity with a cutoff score of five positive responses. Conclusion: The Brazilian version of the MAST-G presented internal consistency values similar to the original English version,showing it to be adequate for use in the national context.
... For substance use, the Timeline Followback has demonstrated good test-retest reliability (Sobell et al., 1986(Sobell et al., , 2001Fals-Stewart et al., 2000;Carey et al., 2004). Its agreement with other self-report measures of alcohol use is good (Grant et al., 1995;Seale et al., 2006;Johnson-Greene et al., 2009). It has been shown to be correlated with reports by patient's collaterals (Sobell and Sobell, 1992). ...
... Therefore our findings do not necessarily inform how laboratory tests compare to the usual shorter and likely less reliable questions used in clinical practice to identify heavy drinking. Nevertheless, the TLFB has shown good agreement with shorter self-report instruments of alcohol use (Seale et al., 2006;Johnson-Greene et al., 2009). In the present study, the TLFB was used as a reference standard to understand the potential clinical utility of laboratory tests. ...
Article
AimsManaging patients with alcohol dependence includes assessment for heavy drinking, typically by asking patients. Some recommend biomarkers to detect heavy drinking but evidence of accuracy is limited.Methods Among people with dependence, we assessed the performance of disialo-carbohydrate-deficient transferrin (%dCDT, ≥1.7%), gamma-glutamyltransferase (GGT, ≥66 U/l), either %dCDT or GGT positive, and breath alcohol (> 0) for identifying 3 self-reported heavy drinking levels: any heavy drinking (≥4 drinks/day or >7 drinks/week for women, ≥5 drinks/day or >14 drinks/week for men), recurrent (≥5 drinks/day on ≥5 days) and persistent heavy drinking (≥5 drinks/day on ≥7 consecutive days). Subjects (n = 402) with dependence and current heavy drinking were referred to primary care and assessed 6 months later with biomarkers and validated self-reported calendar method assessment of past 30-day alcohol use.ResultsThe self-reported prevalence of any, recurrent and persistent heavy drinking was 54, 34 and 17%. Sensitivity of %dCDT for detecting any, recurrent and persistent self-reported heavy drinking was 41, 53 and 66%. Specificity was 96, 90 and 84%, respectively. %dCDT had higher sensitivity than GGT and breath test for each alcohol use level but was not adequately sensitive to detect heavy drinking (missing 34-59% of the cases). Either %dCDT or GGT positive improved sensitivity but not to satisfactory levels, and specificity decreased. Neither a breath test nor GGT was sufficiently sensitive (both tests missed 70-80% of cases).Conclusions Although biomarkers may provide some useful information, their sensitivity is low the incremental value over self-report in clinical settings is questionable.
... A score of 2 or more on the SMAST-G indicated need for further assessment. Studies have indicated that the SMAST-G has adequate validity for older adults when compared with DSM-III-R diagnoses of alcohol abuse or dependence ( Blow et al., 1998), and when compared with hazardous drinking as defined by the World Health Organization (Johnson-Greene, McCaul, & Roger, 2009). ...
Article
Previous research has suggested that older adults who misuse alcohol frequently report depressive symptoms as an antecedent to drinking. The objective of the present study was to investigate the extent to which higher levels of depressive symptoms were associated with elders' problem drinking by examining screening data from a three-year pilot program known as the Florida BRITE Project. BRITE (BRief Intervention and Treatment for Elders) is a multisite program offering brief interventions for community-based older adults screening positive for alcohol or medication misuse. Depressive symptoms were assessed using the Short Geriatric Depression Scale: alcohol use was assessed with the first three questions from the Alcohol Use Disorders Identification Test and the Short-Michigan Alcoholism Screening Test-Geriatric version. Multivariate logistic regression revealed that older adults with higher levels of depressive symptoms were at greater risk for screening positive for alcohol problems, particularly among the "young-old" adults. The results not only suggest the importance of screening for both depressive symptoms and alcohol misuse in an older population, but also indicate that older adults are not a homogeneous group.
... The Short MAST-G [29] has ten questions with two "yes" responses indicating a problem with alcohol. In one study, it had a sensitivity of 75 % and specificity of 69 % [36]. It can identify lifetime problem use, but it does not ask information about frequency and quantity of alcohol consumption and does not distinguish among lifetime and current problems. ...
Chapter
Alcohol is the most commonly used substance among older adults, and older adults face unique risks associated with alcohol use due to the aging process and increases in comorbidity with increasing age. However, older adults are infrequently screened for unhealthy alcohol use, even in primary care. In this chapter, we discuss health risks that are associated with alcohol use, and we review several screening tools that have been validated for use with older adults. We also provide an introduction to best practices for screening and assessment for unhealthy use in older adults.
... Alcohol consumption was based on the geriatric version of the Michigan Alcoholism Screening Test (MAST) 23 . The test defines elderly with scores ≤ 1 point as not having a risk of excessive alcohol consumption, while elderly with ≥ 2 points are defined as at risk. ...
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O objetivo deste trabalho foi avaliar o impacto das atividades avançadas de vida diária (AAVD) na incidência de declínio cognitivo. A amostra foi composta por idosos participantes do estudo longitudinal Saúde, Bem-estar e Envelhecimento (SABE). O declínio cognitivo foi avaliado por meio do Mini - Exame do Estado Mental abreviado. As AAVD compreenderam 12 atividades sociais, produtivas, físicas e de lazer que envolvem funções cognitivas superiores. Foram considerados grupos de covariáveis do estudo: fatores sociodemográficos, saúde geral, estilo de vida e funcionalidade. A associação entre a incidência de declínio cognitivo e as variáveis independentes foi avaliada usando-se o modelo de regressão de Poisson múltiplo. A incidência de declínio foi de 7,9%. A média de desempenho de AAVD em 2006 foi significativamente maior entre os idosos que não desenvolveram o declínio. Após análise multivariada os resultados mostraram que quanto maior o número de AAVD realizadas menor a chance de declínio cognitivo no período estudado.
... This difference may be partly due to items included in the DSM-IV criteria for alcohol abuse, such as repeated problems in social relationships and legal issues, which were not stressed in the DSM-III criteria. The cut-off score of 2 points for the SMAST-G for use in screening for at-risk drinking in elderly men in the current study is consistent with cut-off scores reported previously.15,19) Also, 4 points, identified as the optimal cut-off score for use in screening for alcohol use disorders in our study, is thought to be similar to 5 points presented by previous studies.20-22) ...
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In Korea, few studies have been performed on screening instruments for the detection of at-risk drinking and alcohol use disorders in the elderly. This study evaluated the validity of three screening instruments in elderly male drinkers. The subjects were 242 Korean men aged ≥ 65 years. Face-to-face interviews were used to identify at-risk drinking and alcohol use disorders. At-risk drinking was defined according to the criteria for heavy or binge drinking of the National Institute on Alcohol Abuse and Alcoholism. Alcohol use disorder was diagnosed using the criteria of the Diagnostic and Statistical Manual of Mental Disorders IV-text revision. The Alcohol Use Disorder Identification Test (AUDIT), Short Michigan Alcoholism Screening Test-geriatric version (SMAST-G), and cut down, annoyed, guilty, eye-opener (CAGE) questionnaire were used as the alcohol-screening instruments. Based on the diagnostic interview results, sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) of the instruments were compared. For identification of at-risk drinking, the AUDIT AUROC demonstrated greater diagnostic power than did those of SMAST-G and CAGE (both P < 0.001). In screening for alcohol use disorders, the AUDIT AUROC was also significantly higher than those of SMAST-G and CAGE (both P < 0.001). The sensitivity and specificity of screening for at-risk drinking with an AUDIT score ≥ 7 were 77.3% and 85.1%, respectively, whereas those for the alcohol use disorders with an AUDIT score ≥ 11 were 91.3% and 90.8%, respectively. The results suggest that the AUDIT is the most effective tool in identifying problem drinkers among elderly male drinkers.
... , the short version of Michigan Alcoholism Screening Test-Geriatric Version (SMAST-G)(Johnson-Greene et al., 2009) (table 3), and the Alcohol Use Disorders Identification test (AUDIT)(Aalto et al., 2010) are the most common and validated questionnaires used to identify AUDs in the elderly. In particular, CAGE and MAST-G can be used together to improve their sensitivity, and the AUDIT, tailored at a cutoff of ≥ 5 points, is useful to identify HD(Aalto et al., 2010; Culberson, 2006; Johnson-Greene et al., 2009). ...
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To describe potentially hazardous alcohol use among elderly patients in the primary care setting and to assess the widely used CAGE questionnaire (cut down, annoyed by criticism, guilty about drinking, eye-opener drinks) as a tool for detecting self-reported heavy and binge drinking among these patients. Cross-sectional study. The offices of 88 primary care physicians at 21 sites in southeastern Wisconsin. A total of 5065 consecutive consenting patients older than 60 years. A previously validated self-administered questionnaire that included beverage-specific questions about the quantity and frequency of regular drinking in the last 3 months, the number of episodes of binge drinking (> or = 6 drinks per occasion), and the CAGE questionnaire. Fifteen percent of men and 12% of women regularly drank in excess of limits recommended by the National Institute of Alcohol Abuse and Alcoholism (>7 drinks per week for women and >14 drinks per week for men). Nine percent of men and 2% of women reported regularly consuming more than 21 drinks per week. When we administered the CAGE questionnaire, 9% of men and 3% of women screened positive for alcohol abuse within 3 months. The CAGE performed poorly in detecting heavy or binge drinkers; fewer than half were CAGE positive when the standard cutoff of 2 positive answers was used. Alcohol consumption in excess of recommended limits is common among elderly outpatients. The CAGE questionnaire alone is insufficient to detect such drinking. Asking questions on the quantity and frequency of drinking in addition to administering the CAGE increases the number of problem drinkers detected.
Article
Because of the prevalence of substance abuse in general clinical populations, it is important for psychologists to have knowledge and skill in this area. Psychologists also have special expertise to offer in the assessment and treatment of alcohol/drug problems. Current evidence indicates that (a) alcohol/drug problems generally obey ordinary behavioral principles and processes, (b) substance abuse frequently occurs within a broader cluster of psychological problems, (c) the treatment approaches most strongly supported by outcome research are fundamentally psychological in nature, (d) cognitive-behavioral principles are of demonstrable value in motivating change in alcohol/drug use, and (e) clinical skills and styles (e.g., empathy) commonly included in the training of psychologists are important determinants of favorable treatment outcomes with substance use disorders. These factors in the context of changing health care indicate that psychologists should play an increasing role in assessing and treating addictive behaviors.
Article
Increasing emphasis has been placed on the detection and treatment of hazardous and harmful drinking disorders, particularly among patients who are seen in primary care settings. In this review, we summarize the epidemiology and health-related effects of hazardous and harmful drinking and discuss current methods for their detection and treatment. Hazardous drinking is defined as a quantity or pattern of alcohol consumption that places patients at risk for adverse health events, while harmful drinking is defined as alcohol consumption that results in adverse events (e.g., physical or psychological harm). Prevalence estimates range from 4% to 29% for hazardous drinking and from less than 1% to 10% for harmful drinking. Data from several recent large prospective studies suggest that alcohol consumption in quantities consistent with hazardous or harmful drinking may increase risk for adverse health events, such as hemorrhagic stroke and breast cancer. Existing screening instruments, such as the Michigan Alcoholism Screening Test (MAST) or the CAGE questionnaire, while excellent for detecting alcohol abuse or dependence, should not be used alone to screen for hazardous and harmful drinking. The Alcohol Use Disorders Identification Test (AUDIT) is currently the only instrument specifically designed to identify hazardous and harmful drinking. Treatment of these disorders in the form of brief interventions can be successfully accomplished in primary care settings, as demonstrated by a number of well-conducted randomized trials. Given its proven efficacy in the primary care setting, we recommend routine application of this treatment approach.
Article
This report describes the 48-month efficacy and benefit-cost analysis of Project TrEAT (Trial for Early Alcohol Treatment), a randomized controlled trial of brief physician advice for the treatment of problem drinking. Four hundred eighty-two men and 292 women, ages 18-65, were randomly assigned to a control (n = 382) or intervention (n = 392) group. The intervention consisted of two physician visits and two nurse follow-up phone calls. Intervention components included a review of normative drinking, patient-specific alcohol effects, a worksheet on drinking cues, drinking diary cards, and a drinking agreement in the form of a prescription. Subjects in the treatment group exhibited significant reductions (p < 0.01) in 7-day alcohol use, number of binge drinking episodes, and frequency of excessive drinking as compared with the control group. The effect occurred within 6 months of the intervention and was maintained over the 48-month follow-up period. The treatment sample also experienced fewer days of hospitalization (p = 0.05) and fewer emergency department visits (p = 0.08). Seven deaths occurred in the control group and three in the treatment group. The benefit-cost analysis suggests a 43,000 dollars reduction in future health care costs for every 10,000 dollars invested in early intervention. The benefit-cost ratio increases when including the societal benefits of fewer motor vehicle events and crimes. The long-term follow-up of Project TrEAT provides the first direct evidence that brief physician advice is associated with sustained reductions in alcohol use, health care utilization, motor vehicle events, and associated costs. The report suggests that a patient's personal physician can successfully treat alcohol problems and endorses the implementation of alcohol screening and brief intervention in the US health care system.
Article
Brief interventions for alcohol use disorders have been the focus of considerable research. In this meta-analytic review, we considered studies comparing brief interventions with either control or extended treatment conditions. We calculated the effect sizes for multiple drinking-related outcomes at multiple follow-up points, and took into account the critical distinction between treatment-seeking and non-treatment-seeking samples. Most investigations fell into one of two types: those comparing brief interventions with control conditions in non-treatment-seeking samples (n = 34) and those comparing brief interventions with extended treatment in treatment-seeking samples (n = 20). For studies of the first type, small to medium aggregate effect sizes in favor of brief interventions emerged across different follow-up points. At follow-up after > 3-6 months, the effect for brief interventions compared to control conditions was significantly larger when individuals with more severe alcohol problems were excluded. For studies of the second type, the effect sizes were largely not significantly different from zero. This review summarizes additional positive evidence for brief interventions compared to control conditions typically delivered by health-care professionals to non-treatment-seeking samples. The results concur with previous reviews that found little difference between brief and extended treatment conditions. Because the evidence regarding brief interventions comes from different types of investigation with different samples, generalizations should be restricted to the populations, treatment characteristics and contexts represented in those studies.
Article
The aim of the study was to evaluate the validity of the Alcohol Use Disorders Identification Test (AUDIT), the five-item version (AUDIT-5) and the CAGE as screening tests for problem drinking in mentally ill older people. The study was of prospective cross-sectional design with questionnaire survey and interview and included all consecutive referrals to an old age psychiatry service fulfilling inclusion criteria. Sensitivity, specificity and positive predictive values and areas under the receiver operating characteristic curves (AUROC) for the AUDIT, AUDIT-5, and CAGE were the primary outcome measures. Using clinical criteria as the gold standard, the AUDIT, AUDIT-5 and CAGE had AUROCs of 0.961, 0.964, and 0.780 respectively. The AUDIT-5 performed best of the three scales with a sensitivity of 75.0%, specificity of 97.2% and positive predictive value of 83.3% when using a 4/5 cut-point. The AUDIT-5 performed as well as the AUDIT and better than the CAGE in identifying problem drinking in this sample. The AUDIT-5 may be a useful addition to the specialist mental health assessment of older people.
Article
Alcohol abuse and dependence can be disabling disorders, but accurate information is lacking on the prevalence of current DSM-IV alcohol abuse and dependence and how this has changed over the past decade. The purpose of this study was to present nationally representative data on the prevalence of 12-month DSM-IV alcohol abuse and dependence in 2001-2002 and, for the first time, to examine trends in alcohol abuse and dependence between 1991-1992 and 2001-2002. Prevalences and trends of alcohol abuse and dependence in the United States were derived from face-to-face interviews in the National Institute on Alcohol Abuse and Alcoholism's (NIAAA) 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC: n = 43, 093 ) and NIAAA's 1991-1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES: n= 42, 862 ). Prevalences of DSM-IV alcohol abuse and dependence in 2001-2002 were 4.65 and 3.81%. Abuse and dependence were more common among males and among younger respondents. The prevalence of abuse was greater among Whites than among Blacks, Asians, and Hispanics. The prevalence of dependence was higher in Whites, Native Americans, and Hispanics than Asians. Between 1991-1992 and 2001-2002, abuse increased while dependence declined. Increases in alcohol abuse were observed among males, females, and young Black and Hispanic minorities, while the rates of dependence rose among males, young Black females and Asian males. This study underscores the need to continue monitoring prevalence and trends and to design culturally sensitive prevention and intervention programs.
Article
The Alcohol Use Disorders Identification Test (AUDIT) has been extensively researched to determine its capability to accurately and practically screen for alcohol problems. During the 5 years since our previous review of the literature, a large number of additional studies have been published on the AUDIT, abbreviated versions of it, its psychometric properties, and the applicability of the AUDIT for a diverse array of populations. The current article summarizes new findings and integrates them with results of previous research. It also suggests some issues that we believe are particularly in need of further study. A growing body of research evidence supports the criterion validity of English version of the AUDIT as a screen for alcohol dependence as well as for less severe alcohol problems. Nevertheless, the cut-points for effective detection of hazardous drinking as well as identification of alcohol dependence or harmful use in women need to be lowered from the originally recommended value of 8 points. The AUDIT-C, the most popular short version of the AUDIT consisting solely of its 3 consumption items, is approximately equal in accuracy to the full AUDIT. Psychometric properties of the AUDIT, such as test-retest reliability and internal consistency, are quite favorable. Continued research is urged to establish the psychometric properties of non-English versions of the AUDIT, use of the AUDIT with adolescents and with older adults, and selective inclusion of alcohol biomarkers with the AUDIT in some instances. Research continues to support use of the AUDIT as a means of screening for the spectrum of alcohol use disorders in various settings and with diverse populations.
Article
The Alcohol Use Disorders Identification Test Consumption (AUDIT-C) questions have been previously validated as a 3-item screen for alcohol misuse and implemented nationwide in Veterans Affairs (VA) outpatient clinics. However, the AUDIT-C's validity and optimal screening threshold(s) in other clinical populations are unknown. This cross-sectional validation study compared screening questionnaires with standardized interviews in 392 male and 927 female adult outpatients at an academic family practice clinic from 1993 to 1994. The AUDIT-C, full AUDIT, self-reported risky drinking, AUDIT question #3, and an augmented CAGE questionnaire were compared with an interview primary reference standard of alcohol misuse, defined as a Diagnostic and Statistical Manual, 4th ed. alcohol use disorder and/or drinking above recommended limits in the past year. Based on interviews with 92% of eligible patients, 128 (33%) men and 177 (19%) women met the criteria for alcohol misuse. Areas under the receiver operating characteristic curves (AUROCs) for the AUDIT-C were 0.94 (0.91, 0.96) and 0.90 (0.87, 0.93) in men and women, respectively (p=0.04). Based on AUROC curves, the AUDIT-C performed as well as the full AUDIT and significantly better than self-reported risky drinking, AUDIT question #3, or the augmented CAGE questionnaire (p-values <0.001). The AUDIT-C screening thresholds that simultaneously maximized sensitivity and specificity were > or =4 in men (sensitivity 0.86, specificity 0.89) and > or =3 in women (sensitivity 0.73, specificity 0.91). The AUDIT-C was an effective screening test for alcohol misuse in this primary care sample. Optimal screening thresholds for alcohol misuse among men (> or =4) and women (> or =3) were the same as in previously published VA studies.
Article
Previous work has validated a single question to screen for hazardous or harmful drinking, but identifying those patients who have an alcohol use disorder (AUD) among those who screen positive is still time consuming. We therefore sought to develop and validate a brief assessment instrument using DSM-IV criteria for use in primary care medical practice. Four cross-sectional surveys of past-year drinkers. The developmental sample included patients presenting to emergency departments with an acute injury. The second sample, from the same study, was recruited by random-digit dialing. The third sample was recruited in 5 family medicine practices in Georgia. The fourth sample was the National Epidemiologic Survey on Alcohol and Related Conditions. Interviews with the first 3 samples used the Diagnostic Interview Schedule. The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) used the Alcohol Use Disorder and Associated Disabilities Interview Schedule. Two constructs with promising test characteristics were identified: recurrent drinking in hazardous situations and drinking more than intended. Among those who screened positive with the single question in the developmental sample (N=959), if either of the 2 items was positive, the sensitivity for current AUD was 95% and the specificity was 77%. In the second (N=494) and third (N=280) samples, the sensitivity was 94 and 95% and the specificity was 62 and 66%, respectively, among those with a positive screen. In the NESARC sample, including those with at least 1 occasion in the past year of drinking 5 or more drinks (N=7,890), the sensitivity and specificity were 77 and 86%, respectively. The sensitivity and specificity of these 2 items across 4 samples suggest that they could be formulated into 2 questions, potentially providing busy primary care clinicians with an efficient, reasonably accurate assessment instrument to identify AUD among those patients who screen positive with the single screening question.
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