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An Effective Brief Screening Test for Problem Drinking

Kristen Bush, MPH; Daniel R. Kivlahan, PhD; Mary B. McDonell, MS; Stephan D. Fihn, MD, MPH; Katharine A. Bradley, MD, MPH; for the Ambulatory Care Quality Improvement Project (ACQUIP)

Arch Intern Med. 1998;158:1789-1795.

Objective  To evaluate the 3 alcohol consumption questions from the Alcohol Use Disorders Identification Test (AUDIT-C) as a brief screening test for heavy drinking and/or active alcohol abuse or dependence.

Methods  Patients from 3 Veterans Affairs general medical clinics were mailed questionnaires. A random, weighted sample of Health History Questionnaire respondents, who had 5 or more drinks over the past year, were eligible for telephone interviews (N=447). Heavy drinkers were oversampled 2:1. Patients were excluded if they could not be contacted by telephone, were too ill for interviews, or were female (n=54). Areas under receiver operating characteristic curves (AUROCs) were used to compare mailed alcohol screening questionnaires (AUDIT-C and full AUDIT) with 3 comparison standards based on telephone interviews: (1) past year heavy drinking (>14 drinks/week or 5 drinks/occasion); (2) active alcohol abuse or dependence according to the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, criteria; and (3) either.

Results  Of 393 eligible patients, 243 (62%) completed AUDIT-C and interviews. For detecting heavy drinking, AUDIT-C had a higher AUROC than the full AUDIT (0.891 vs 0.881; P=.03). Although the full AUDIT performed better than AUDIT-C for detecting active alcohol abuse or dependence (0.811 vs 0.786; P<.001), the 2 questionnaires performed similarly for detecting heavy drinking and/or active abuse or dependence (0.880 vs 0.881).

Conclusions  Three questions about alcohol consumption (AUDIT-C) appear to be a practical, valid primary care screening test for heavy drinking and/or active alcohol abuse or dependence.

From Health Services Research and Development (Mss Bush and McDonell, and Drs Fihn and Bradley), the Center of Excellence for Substance Abuse Treatment and Education (Ms Bush and Dr Kivlahan), and Medicine Service (Drs Fihn and Bradley), VA Puget Sound Health Care System, Seattle Division, Wash; the Departments of Medicine (Drs Fihn and Bradley), Psychiatry and Behavioral Services (Ms Bush and Dr Kivlahan), and Health Services (Drs Fihn and Bradley), University of Washington, Seattle.

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