Primary care validation of a single screening question for drinkers.
OBJECTIVE
The aim of this study was to conduct a primary care validation study of a single screening question for alcohol misuse ("When was the last time you had more than X drinks in 1 day?," where X was four for women and X was five for men), which was previously validated in a study conducted in emergency departments.


METHODS
This cross-sectional study was accomplished by interviewing 625 male and female adult drinkers who presented to five southeastern primary care practices. Patients answered the single question (coded as within 3 months, within 12 months, ever, or never), Alcohol Use Disorders Identification Test (AUDIT), and AUDIT consumption questions (AUDIT-C). Alcohol misuse was defined as either at-risk drinking, identified by a 29-day Timeline Followback interview or a current (past-year) alcohol-use disorder by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria, or both.


RESULTS
Among 625 drinkers interviewed, 25.6% were at-risk drinkers, 21.7% had a current alcohol- use disorder, and 35.2% had either or both conditions. Considering "within the last 3 months" as positive, the sensitivity of the single question was 80% and the specificity was 74%. Chi-square analyses revealed similar sensitivity across ethnic and gender groups; however, specificity was higher in women and whites (p = .0187 and .0421, respectively). Considering "within the last 12 months" as positive increased the question's sensitivity, especially for those with alcohol-use disorders. The area under the receiver operating characteristic curve of the single alcohol screening question (0.79) was slightly lower than for the AUDIT and AUDIT-C, but sensitivity and specificity were similar.


CONCLUSIONS
A single question about the last episode of heavy drinking is a sensitive, time-efficient screening instrument that shows promise for increasing alcohol screening in primary care practices.
Seale
J Paul
JP
Department of Family Medicine, Medical Center of Central Georgia and Mercer University School of Medicine, Macon, Georgia 31206, USA. seale.paul@mccg.org
Boltri
John M
JM
Shellenberger
Sylvia
S
Velasquez
Mary M
MM
Cornelius
Monica
M
Guyinn
Monique
M
Okosun
Ike
I
Sumner
Heather
H
D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D011320:Primary Health Care / Q000379:methods*; D015203:Reproducibility of Results; D012307:Risk Factors; D011795:Surveys and Questionnaires