title: The TWEAK is weak for alcohol screening among female Veterans Affairs outpatients.
abstract: BACKGROUND
  The optimal brief questionnaire for alcohol screening among female patients has not yet been identified. This study compared the performance of the TWEAK (tolerance, worried, eye-opener, amnesia, cutdown), the Alcohol Use Disorders Identification Test (AUDIT), and the AUDIT Consumption (AUDIT-C) as self-administered screening tests for hazardous drinking and/or active alcohol abuse or dependence among female Veterans Affairs (VA) outpatients.
  
  
  METHODS
  Women were included in the study if they received care at VA Puget Sound and completed both a self-administered survey containing the AUDIT and TWEAK screening questionnaires and subsequent in-person interviews with the Alcohol Use Disorders and Associated Disabilities Interview Schedule. Sensitivities, specificities, positive and negative likelihood ratios, and areas under Receiver Operating Characteristic curves were computed for each screening questionnaire compared with two interview-based comparison standards: (1) active DSM-IV alcohol abuse or dependence and (2) hazardous drinking and/or active DSM-IV alcohol abuse or dependence, the more appropriate target for primary care screening.
  
  
  RESULTS
  Of 393 women who completed screening questionnaires and interviews, 39 (9.9%) met diagnostic criteria for alcohol abuse or dependence, and 89 (22.7%) met criteria for hazardous drinking or alcohol abuse or dependence. The TWEAK had relatively low sensitivities (0.62 and 0.44) but adequate specificities (0.86 and 0.89) for both interview-based comparison standards, even at its lowest cut-point (>/=1). The AUDIT and AUDIT-C were superior, with the following areas under the receiver operating characteristic curve for active alcohol abuse or dependence and hazardous drinking and/or active alcohol abuse or dependence, respectively: AUDIT, 0.90 [95% confidence interval (CI), 0.85-0.95] and 0.87 (95% CI, 0.84-0.91); AUDIT-C, 0.91 (95% CI, 0.88-0.95) and 0.91 (95% CI, 0.88-0.94); and TWEAK, 0.76 (95% CI, 0.66-0.86) and 0.67 (95% CI, 0.60-0.74).
  
  
  CONCLUSIONS
  The TWEAK has low sensitivity as an alcohol-screening questionnaire among female VA outpatients and should be evaluated further before being used in other female primary care populations. The three-item AUDIT-C was the optimal brief alcohol-screening questionnaire in this study.
authors.affiliation: Department of Veterans Affairs, Veterans Health Administration, Veterans Affairs Puget Sound Health Care System, Center of Excellence in Substance Abuse Treatment and Education, Seattle, WA 98108, USA. kristen.bush@med.va.gov
authors.forename: Kristen R
authors.initials: KR
authors.lastname: Bush
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Kivlahan
authors.forename: Tania M
authors.initials: TM
authors.lastname: Davis
authors.forename: Dorcas J
authors.initials: DJ
authors.lastname: Dobie
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Sporleder
authors.forename: Amee J
authors.initials: AJ
authors.lastname: Epler
authors.forename: Katharine A
authors.initials: KA
authors.lastname: Bradley
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000175:diagnosis* / Q000453:epidemiology*; D000553:Ambulatory Care; D016001:Confidence Intervals; D005260:Female; D006306:Health Surveys; D006801:Humans; D008875:Middle Aged; D011795:Surveys and Questionnaires; D014481:United States; D014728:Veterans / Q000523:psychology*; D016387:Women's Health