Which of the following is the method of choice for detecting alcohol dependence and hazardous drinking in primary care settings?
Exam Question Aug 2008
AUDIT is used in primary care settings as it accurately detects both alcohol dependence and hazardous drinking. CAGE is good at detecting dependence only.
Exam Question Aug 2008
AUDIT is used in primary care settings as it accurately detects both alcohol dependence and hazardous drinking. CAGE is good at detecting dependence only.
Alcohol screening tools
A variety of tools have been devised to assist in the diagnosis of alcohol problems.
AUDIT (Alcohol Use Disorders Identification Test), was developed by the WHO as a simple method of screening for excessive drinking. The test consists of 10 questions and attempts to cover the three domains of harmful use, hazardous use, and dependence.
- 10 item questionnaire
- Takes about 2-3 minutes to complete
- Has been shown to be superior to CAGE and biochemical markers for predicting alcohol problems
- Minimum score = 0, maximum score = 40
- A score of 8 or more in men, and 7 or more in women, indicates a strong likelihood of hazardous or harmful alcohol consumption
- A score of 15 or more in men, and 13 or more in women, is likely to indicate alcohol dependence
- AUDIT-C is an abbreviated form consisting of 3 questions
http://libdoc.who.int/hq/2001/WHOMSDMSB01.6a.pdf
FAST (Fast Alcohol Screening Test), is a short and rapid test with just 4 questions that was developed to be used in a busy medical setting.
- 4 item questionnaire (see table below)
- Minimum score = 0, maximum score = 16
- The score for hazardous drinking is 3 or more
- With relation to the first question 1 drink = 1/2 pint of beer or 1 glass of wine or 1 single spirits
- If the answer to the first question is 'never' then the patient is not misusing alcohol
- If the response to the first question is 'Weekly' or 'Daily or almost daily' then the patient is a hazardous, harmful or dependent drinker. Over 50% of people will be classified using just this one question
| Number | Question |
|---|---|
| 1 | MEN: How often do you have EIGHT or more drinks on one occasion? WOMEN: How often do you have SIX or more drinks on one occasion? |
| 2 | How often during the last year have you been unable to remember what happened the night before because you had been drinking? |
| 3 | How often during the last year have you failed to do what was normally expected of you because of drinking? |
| 4 | In the last year has a relative or friend, or a doctor or other health worker been concerned about your drinking or suggested you cut down? |
http://alcoholism.about.com/od/tests/a/fast.htm
CAGE is a 4 question screening tool. Two or more positive answers suggests problem drinking.
The CAGE is a well known but recent research has questioned its value as a screening test two or more positive answers is generally considered a 'positive' result.
| Letter | Question |
|---|---|
| C | Have you ever felt you should Cut down on your drinking? |
| A | Have people Annoyed you by criticising your drinking? |
| G | Have you ever felt bad or Guilty about your drinking? |
| E | Have you ever had a drink in the morning to get rid of a hangover (Eye opener)? |
SASQ (Single alcohol screening questionnaire), asks only one question, when was the last time you had more than x alcoholic drinks in one day? (Where x is 8 for men and 6 for women). An answer of within 3 months indicates harmful or hazardous drinking.
PAT (Paddington Alcohol Test), was developed for use in a busy A&E department to detect hazardous drinking.
MAST (Michigan Alcoholism Screening Test) is useful for detecting dependent drinkers.
Rapid Alcohol Problem Screen 4 (RAPS4) Consists of four questions and has been found to be highly effective in detecting alcohol dependence. A 'yes' answer to at least one of the four questions suggests that your drinking is harmful.
| Letter | Question |
|---|---|
| R (remorse) | Have you had a feeling of guilt or remorse after drinking? |
| A (amnesia) | Has a friend or a family member ever told you about things you said or did while you were drinking that you could not remember? |
| P (performance) | Have you failed to do what was normally expected of you because of drinking? |
| S (starter drinker behaviour) | Do you sometimes take a drink when you first get up in the morning? |
