Performance of screening instruments for alcohol problems in the ER: A comparison of Mexican-Americans and Mexicans in Mexico

The performance of standard screening instruments and alternate measures ag ainst ICD-10 (International Classification of Diseases, 10th revision) and DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th revision ) criteria for alcohol dependence and separately for harmful drinking/abuse were compared between probability samples of 1511 emergency room (ER) pati ents from three hospitals in Pachuca, Mexico, and 586 Mexican-American ER p atients in Santa Clara County, California. Sensitivity was highest for the Alcohol Use Disorders Identification Test (AUDIT), TWEAK, and Rapid Alcohol Problems Screen (RAPS) for alcohol dependence; sensitivity was highest for holding five or more drinks for harmful drinking/abuse in both samples. Al l instruments performed better for alcohol dependence than for abuse/harmfu l drinking. Arrests for drinking and driving performed better in Santa Clar a than in Pachuca, while a positive Breathalyzer reading and reporting drin king prior to the event performed better in Pachuca; both were significantl y more sensitive among the injured compared to the noninjured in Pachuca. T he data suggest that instrument performance may be similar between those in Pachuca and those in the low acculturation group in Santa Clara, relative to those scoring higher on acculturation. While standard screening instrume nts appear to work reasonably well in both samples for alcohol dependence, variation across gender. injury, and acculturation subgroups suggests atten tion should be given to choosing the ''best'' instrument.