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Research ArticleOriginal Research From PBRNS

Comfortably Engaging: Which Approach to Alcohol Screening Should We Use?

Daniel C. Vinson, James M. Galliher, Carol Reidinger and Jennifer A. Kappus
The Annals of Family Medicine September 2004, 2 (5) 398-404; DOI: https://doi.org/10.1370/afm.83
Daniel C. Vinson
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James M. Galliher
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Carol Reidinger
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Jennifer A. Kappus
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Article Figures & Data

Tables

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    Table 1.

    The 2 Screening Approaches Used in the Current Study

    Screening ApproachPositive Screening Result
    Single question
    “When was the last time you had more than X drinks in 1 day?” (X = 4 for women and 5 for men)Any time in the past 3 months
    CAGE questions
    “Have you ever felt that you should cut down on your drinking?”1 or more positive responses
    “Have people annoyed you by criticizing your drinking?”
    “Have you ever felt bad or guilty about your drinking?”
    “Have you ever had a drink first thing in the morning (an eye-opener) to steady your nerves or get rid of a hangover?”
    • View popup
    Table 2.

    Demographic Information and Prevalence of a Positive Alcohol Use Disorders Identification Test (AUDIT) Score

    CharacteristicsMissouri NetworkAAFP National Network
    Participating clinicians, n3113
    Patients approached, n2,577767
    Refused (of those approached), n (%)231 (9)55 (7)
    Not eligible, n (%)139 (5)42 (5)
    Missed, n (%)73 (3)4 (1)
    Patients participating (% of those approached), n (%)2,134 (83)666 (87)
    Complete data (% of enrolled), n (%)1,739 (81)595 (89)
    Female patients, %6762
    Age, mean y (SD)43 (18)52 (17)
        Interquartile range, y27–5339–64
    Patients with an AUDIT score ≥5, %1712
    Patients with an AUDIT score ≥8, %86
    • View popup
    Table 3:

    Alcohol-Related Discussions: Duration and Comfort as Reported by Clinicians and Patients, by Percentage of Respondents

    Missouri NetworkAAFP National Network
    ResponsesSingle QuestionCAGE QuestionsSingle QuestionCAGE Questions
    Note: none of the differences within a given network is statistically significant.
    Duration of the alcohol-related discussion
    Estimating duration as <1 min
        Clinician’s perception82839394
        Paient’s perception85818382
    Clinicians rating the discussion
    Clinicians rate themselves as
        Somewhat or quite comfortable78809492
        Neutral151555
        Somewhat or very uncomfortable7513
    Clinician perceives patients to be
        Very candid or fairly open86879596
        Neutral111143
        Somewhat or very defensive3211
    Patients rating the discussion
    Patients rate themselves as
        Somewhat or quite comfortable68717070
        Neutral24222425
        Somewhat or very uncomfortable8765
    • View popup
    Table 4.

    Patient Self-Report of What They Plan to Do Regarding Their Alcohol Use, Including Only Patients Whose AUDIT Scores Were 5 or Greater

    Missouri NetworkAAFP National Network
    Stage of Change 27 Single Question No. (%)CAGE Questions No. (%)Single Question No. (%)CAGE Questions No. (%)
    AUDIT = Alcohol Use disorders Identification Test; CAGE = an acronym for a 4-question screening test for alcoholism (Table 1).
    Note: Within a given network, the 2 distributions are not statistically significantly different. Column percents may not total 100% because of rounding.
    Precontemplation
    “I don’t drink. ”7 (5)5 (5)3 (8)0
    “I don’t plan to change my drinking pattern because it is not a problem for me.”76 (53)62 (60)19 (48)16 (48)
    Contemplation
    “I don’t plan to change my drinking pattern even though it may be a problem for me.”7 (5)4 (4)2 (5)
    “I’ll think about my drinking pattern.”16 (11)8 (8)4 (10)3 (9)
    Planning
    “I’ll keep track of how much I drink.”13 (9)6 (6)3 (8)3 (9)
    Action
    “I’ll cut down on my drinking.”17 (12)14 (14)6 (15)7 (21)
    “I’ll quit drinking.”3 (2)2 (2)1 (3)2 (6)
    Maintenance
    “I’m a recovering alcoholic.”5 (3)2 (2)1 (3)
    Missing data 2 (5)1 (3)
    Total 1441034033

Additional Files

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  • The Article in Brief

    There are many tests available that doctors can use to help determine if a patient has a problem with alcohol. A test in which the doctor asks a single question about the patient�s alcohol use was compared with a 4-question test. Most patients, including those who indicated that they might have a problem with alcohol, were equally comfortable with either test. Among patients who might have a problem with alcohol, about one third reported thinking about or planning to change their drinking behavior.

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    1 Sep 2004
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    Comfortably Engaging: Which Approach to Alcohol Screening Should We Use?
    Daniel C. Vinson, James M. Galliher, Carol Reidinger, Jennifer A. Kappus
    The Annals of Family Medicine Sep 2004, 2 (5) 398-404; DOI: 10.1370/afm.83

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    Comfortably Engaging: Which Approach to Alcohol Screening Should We Use?
    Daniel C. Vinson, James M. Galliher, Carol Reidinger, Jennifer A. Kappus
    The Annals of Family Medicine Sep 2004, 2 (5) 398-404; DOI: 10.1370/afm.83
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