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

Article Figures & Data

Table 1.

The 2 Screening Approaches Used in the Current Study

Screening Approach	Positive 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?”

Table 2.

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

Characteristics	Missouri Network	AAFP National Network
Participating clinicians, n	31	13
Patients approached, n	2,577	767
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, %	67	62
Age, mean y (SD)	43 (18)	52 (17)
Interquartile range, y	27–53	39–64
Patients with an AUDIT score ≥5, %	17	12
Patients with an AUDIT score ≥8, %	8	6

Table 3:

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

	Missouri Network		AAFP National Network
Responses	Single Question	CAGE Questions	Single Question	CAGE 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 perception	82	83	93	94
Paient’s perception	85	81	83	82
Clinicians rating the discussion
Clinicians rate themselves as
Somewhat or quite comfortable	78	80	94	92
Neutral	15	15	5	5
Somewhat or very uncomfortable	7	5	1	3
Clinician perceives patients to be
Very candid or fairly open	86	87	95	96
Neutral	11	11	4	3
Somewhat or very defensive	3	2	1	1
Patients rating the discussion
Patients rate themselves as
Somewhat or quite comfortable	68	71	70	70
Neutral	24	22	24	25
Somewhat or very uncomfortable	8	7	6	5

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 Network		AAFP 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	144	103	40	33

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.