SCREENING FOR PROBLEM DRINKING - DOES A SINGLE QUESTION WORK

BACKGROUND. Brief interventions with problem drinkers have been shown to be effective, but physicians often do not ask about alcohol use. If a single question could effectively screen for problem drinking, it m ight facilitate intervention with problem drinkers. METHODS. A cross-s ectional study was undertaken to address the clinical utility of the q uestion, ''On any single occasion during the past 3 months, have you h ad more than 5 drinks containing alcohol?'' Placing it between questio ns about tobacco and seat-belt use, we presented the three questions i n writing to 1435 patients; 95.3% answered them. With a systematic sam ple of 101 patients who answered yes and 99 who answered no, we admini stered the Alcohol Use Disorders Identification Test in writing follow ed by two gold-standard interview instruments: (1) a calendar-based re view of drinking, with at-risk drinking defined as drinking more than 4 drinks on one occasion or more than 14 drinks per week for men, and more than 3 drinks on one occasion or 7 per week for women; and (2) th e alcohol questions in the Composite International Diagnostic Intervie w, with alcohol-use disorders defined by the Diagnostic and Statistica l Manual of Mental Disorders (DSM-IV) criteria. We defined problem dri nking as either at-risk drinking in the previous month or an alcohol-u se disorder in the past 12 months. RESULTS. The single question had a positive predictive value of 74% and negative predictive value of 88% for problem drinking, with a sensitivity of 62% and a specificity of 9 3%. The question's utility was similar for detecting at-risk drinking and current alcohol-use disorders; it correctly identified all 29 pati ents who had both. CONCLUSIONS. A single question about alcohol can de tect at-risk drinking and current alcohol-use disorders with clinicall y useful positive and negative predictive values.