Use of a single alcohol screening question to identify other drug use.
BACKGROUND
People who consume unhealthy amounts of alcohol are more likely to use illicit drugs. We tested the ability of a screening test for unhealthy alcohol use to simultaneously detect drug use.


METHODS
Adult English speaking patients (n=286) were enrolled from a primary care waiting room. They were asked the screening question for unhealthy alcohol use "How many times in the past year have you had X or more drinks in a day?", where X is 5 for men and 4 for women, and a response of one or more is considered positive. A standard diagnostic interview was used to determine current (past year) drug use or a drug use disorder (abuse or dependence). Oral fluid testing was also used to detect recent use of common drugs of abuse.


RESULTS
The single screening question for unhealthy alcohol use was 67.6% sensitive (95% confidence interval [CI], 50.2-82.0%) and 64.7% specific (95% CI, 58.4-70.6%) for the detection of a drug use disorder. It was similarly insensitive for drug use detected by oral fluid testing and/or self-report.


CONCLUSIONS
Although a patient with a drug use disorder has twice the odds of screening positive for unhealthy alcohol use compared to one without a drug use disorder, suggesting patients who screen positive for alcohol should be asked about drug use, a single screening question for unhealthy alcohol use was not sensitive or specific for the detection of other drug use or drug use disorders in a sample of primary care patients.
Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Avenue, Second Floor, Boston, MA 02118, United States. Electronic address: peter.smith@bmc.org.
Peter C
PC
Smith
Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Avenue, Second Floor, Boston, MA 02118, United States; Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue, Third Floor, Boston, MA 02118, United States.
Debbie M
DM
Cheng
School of Health Sciences, Cleveland State University, 2121 Euclid Avenue, HS 124, Cleveland, OH 44115, United States.
Donald
D
Allensworth-Davies
Data Coordinating Center, Boston University School of Public Health, 801 Massachusetts Avenue, Third Floor, Boston, MA 02118, United States.
Michael R
MR
Winter
Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Avenue, Second Floor, Boston, MA 02118, United States; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Avenue, Second Floor, Boston, MA 02118, United States; Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Talbot Building, Boston, MA 02118, United States.
Richard
R
Saitz
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D019966:Substance-Related Disorders / Q000175:diagnosis*; D055815:Young Adult
Alcohol; Drug use; Primary care; Screening