SCREENING FOR DRINKING PROBLEMS BY PATIENT SELF-REPORT - EVEN SAFE LEVELS MAY INDICATE A PROBLEM

Background: Physicians often screen their ambulatory patients for seri ous drinking problems by asking questions related to the quantity of a lcohol that they consume. Never previously reported is whether this '' quantitative'' approach to screening can be used to effectively screen ambulatory patients for the presence of a serious drinking problem. M ethods: The project interviewed 510 patients attending an inner city g eneral medicine practice with the alcohol module of the Diagnostic int erview Schedule, revised for the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition. Collected data also included reported quantity, frequency, and recency of drinking. We then calcula ted the sensitivity, specificity, positive predictive values, and rece iver operating characteristic curve for zero to two, three to five, si x to 11, 12 to 23, and 24 or more standard drinks as reported by 155 p atients who reported drinking within 30 days of their visit. Results: Forty-eight of 155 active drinkers met the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition criteria for alcohol dependence or abuse. Only five patients with an active diagnosis fail ed to report drinking within 30 days of their visit. The calculated ar ea under the receiver operating characteristic curve for reported quan tity was 0.81. The sensitivities of reported consumption decline with increasing drinking, while the specificities and positive predictive v alues rise. The report of drinking between six and 12 drinks per week was associated with a positive predictive value of 0.54 for an active Diagnostic and Statistical Manual of Mental Disorders, Revised Third E dition, diagnosis. Conclusions: Patient self-report of drinking can be used to screen actively drinking outpatients on the general medicine service for serious drinking problems. Further, in an urban general me dicine outpatient population, even federally recommended levels of dri nking may indicate a problem. Our data suggest that physicians' recomm endations be adjusted for the setting in which they practice.