title: Using alcohol screening results and treatment history to assess the severity of at-risk drinking in Veterans Affairs primary care patients.
abstract: BACKGROUND
  Primary care providers need practical methods for managing patients who screen positive for at-risk drinking. We evaluated whether scores on brief alcohol screening questionnaires and patient reports of prior alcohol treatment reflect the severity of recent problems due to drinking.
  
  
  METHODS
  Veterans Affairs general medicine outpatients who screened positive for at-risk drinking were mailed questionnaires that included the Alcohol Use Disorders Identification Test (AUDIT) and a question about prior alcohol treatment or participation in Alcoholics Anonymous ("previously treated"). AUDIT questions 4 through 10 were used to measure past-year problems due to drinking (PYPD). Cross-sectional analyses compared the prevalence of PYPD and mean Past-Year AUDIT Symptom Scores (0-28 points) among at-risk drinkers with varying scores on the CAGE (0-4) and AUDIT-C (0-12) and varying treatment histories.
  
  
  RESULTS
  Of 7861 male at-risk drinkers who completed questionnaires, 33.9% reported PYPD. AUDIT-C scores were more strongly associated with Past-Year AUDIT Symptom Scores than the CAGE (p < 0.0005). The prevalence of PYPD increased from 33% to 46% over the range of positive CAGE scores but from 29% to 77% over the range of positive AUDIT-C scores. Among subgroups of at-risk drinkers with the same screening scores, patients who reported prior treatment were more likely than never-treated at-risk drinkers to report PYPD and had higher mean Past-Year AUDIT Symptom Scores (p < 0.0005). We propose a simple method of risk-stratifying patients using AUDIT-C scores and alcohol treatment histories.
  
  
  CONCLUSIONS
  AUDIT-C scores combined with one question about prior alcohol treatment can help estimate the severity of PYPD among male Veterans Affairs outpatients.
authors.affiliation: Northwest Health Services Research and Development Center of Excellence, Primary and Specialty Medical Care Service,VA Puget Sound Health Care System, Seattle, WA 98108, USA. willi@u.washington.edu
authors.forename: Katharine A
authors.initials: KA
authors.lastname: Bradley
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Kivlahan
authors.forename: Xiao-Hua
authors.initials: XH
authors.lastname: Zhou
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Sporleder
authors.forename: Amee J
authors.initials: AJ
authors.lastname: Epler
authors.forename: Kinsey A
authors.initials: KA
authors.lastname: McCormick
authors.forename: Joseph O
authors.initials: JO
authors.lastname: Merrill
authors.forename: Mary B
authors.initials: MB
authors.lastname: McDonell
authors.forename: Stephan D
authors.initials: SD
authors.lastname: Fihn
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology / Q000628:therapy; D000437:Alcoholism / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D000553:Ambulatory Care / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014728:Veterans / Q000706:statistics & numerical data*