Article Figures & Data
Figures
- Figure 1
Flowchart of patient enrollment.
Tables
Category Standard Definitiona Study Definitionb No alcohol consumption Denies alcohol use on AUDIT-C and DSM-IV–based questions Moderate drinking On 1 occasion drinking <4 drinks for a woman or <5 drinks for a man, and in a week drinking <8 drinks for a woman or <15 drinks for a man Negative on both the AUDIT-C and the 2-question DSM-IV– based screen Hazardousdrinkingc On 1 occasion drinking >3 drinks for a woman or >4 drinks for a man, or in a week drinking >7 drinks for a woman or >14 drinks for a man Positive AUDIT-C but negative on the 2-question DSM-IV–based screen Harmfuldrinkingc Alcohol use disorders, ie, alcohol abuse or alcohol dependence defined using DSM-IV criteria Positive on the 2-question DSM-IV–based screen, with or without a positive AUDIT-C -
AUDIT-C = Alcohol Use Disorders Identification Test-Consumption; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders-IV.
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↵a From the National Institute on Alcohol Abuse and Alcoholism.39,40
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↵b Based on patients’ responses to our screening instruments. See the Supplemental Appendix for the AUDIT-C scoring key.
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↵c Alcohol problems defined as either hazardous or harmful drinking as identified on screening tests noted above.
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- Table 2
Sensitivity of Clinician Suspicion Using Different Criteria to Identify Which Patients Have an Alcohol Problem
Criteria and Threshold for Identifying Patients With Alcohol Problem Sensitivity % Total AUDIT-C score: a positive screening test defined as a score at the given level or above ≥3 (women), ≥4 (men) 16.1 6 7 8 9 10 61.1 Changing a positive screening test to negative if drinking on a “typical day” was ≤2 drinks and if the frequency of episodic heavy drinking was less often than monthly 21.6 Changing a positive screen to negative if drinking on a “typical day” was ≤2 drinks regardless of the frequency of episodic heavy drinking 21.7 Using only the third AUDIT-C question on episodic heavy drinking Monthly 27.9 Weekly 38.7 Daily or almost daily 73.3 -
AUDIT-C = Alcohol Use Disorders Identification Test-Consumption.
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Supplemental Appendix
Supplemental Appendix. Scoring Key for the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C)
Files in this Data Supplement:
- Supplemental data: Appendix - PDF file, 1 page, 188 KB
The Article in Brief
Clinician Suspicion of an Alcohol Problem: An Observational Study From the AAFP National Research Network
Daniel C. Vinson , and colleagues
Background In clinical practice, detection of alcohol problems often relies on clinicians' suspicion instead of use of a screening instrument. This study assesses the sensitivity, specificity, and predictive values of clinician suspicion compared with screen-detected alcohol problems.
What This Study Found In this study, primary care clinicians missed most (more than 70 percent) of patients with an alcohol problem when they relied on clinical suspicion instead of using a screening instrument. In a sample of 1,699 patients, 171 patients (10 percent) screened positive for hazardous drinking and 64 patients (4 percent) screened positive for harmful drinking using validated screening instruments. Clinicians suspected either hazardous or harmful drinking in only 81 of those patients (5 percent). Conversely, when clinicians suspected a patient had an alcohol problem, they were correct 98 percent of the time.
Implications
- These findings, the authors conclude, support the routine use of a screening tool to supplement clinicians' suspicions about alcohol problems.
