Recently a test was conducted among 61 test subjects to determine if there is a simple way to determine if someone has a problem with alcoholism. There is much interest in ultra-short alcohol screening for primary care inpatient rehabs that treat alcoholism. Brief screening consisting of one or two questions is thought to be useful alone or in combination with longer tests as recommended by the addiction treatment center.
Short Accurate Alcoholism Screening
The scientists wanted to determine whether there is room for a shorter survey to be used more widely without sacrificing accuracy.
The study was conducted with a comprehensive search that identified 61 analyses of single questions to detect alcohol problems including 17 that took place in primary care, using a robust interview standard. The BJGP (British Journal of General Practice) had these findings:
After many adjustments, diagnostic accuracy of a single-question approach was given by a sensitivity of 54.5%, two questions had a sensitivity of 87.2% and overall of 79.8% .
By looking at each question individually, the most successful single question was a modification of the Single Alcohol Screening Question (SASQ) namely, ‘How often do you have six or more drinks on one occasion?’
The best approach appears to be two questions followed by the CAGE Questionnaire, which achieved an overall accuracy of 90.9% and required only 3.3 questions per attendee.
The test concluded that two brief questions can be used as an initial screen for alcohol problems but only when combined with a second-step screen. An alcohol intervention should be considered for those individuals who answer positively on both steps.
The CAGE questionnaire, among other methods, has been widely used in identifying alcoholism. By far the most important question in the CAGE questionnaire is the use of a drink as an Eye Opener, so much so that some clinicians use a “yes” to this question alone as a positive to the questionnaire; this is due to the fact that the use of an alcoholic drink as an Eye Opener denotes abuse since the patient is going through withdrawal in the morning, hence the need for a drink as an Eye Opener.
1. Have you ever felt you should Cut down on your drinking?
2. Have people Annoyed you by criticizing your drinking?
3. Have you ever felt bad or Guilty about your drinking?
4. Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (Eye-opener)?
Scoring: Item responses on the CAGE questions are scored 0 for “no” and 1 for “yes” answers, with a higher score being an indication of alcohol problems. A total score of two or greater is considered clinically significant.
The normal cutoff for the CAGE is two positive answers, however, the Consensus Panel recommends that the primary care clinicians lower the threshold to one positive answer to cast a wider net and identify more patients who may have substance abuse disorders.
Alcoholism’s Negative Affect on Society
The World Health Organization estimates that there are 140 million people with alcoholism worldwide. The various health problems associated with long-term alcohol consumption are generally perceived as detrimental to society, for example, money due to lost labor-hours, medical costs, and secondary treatment costs.
Alcohol use is a major contributing factor for head injuries, motor vehicle accidents, violence, and assaults. Beyond money, there are also significant social costs to both the alcoholic and their family and friends. For instance alcohol consumption by a pregnant woman can lead to fetal alcohol syndrome, an incurable and damaging condition.
Estimates of the economic costs of alcohol abuse, collected by the World Health Organization, vary from one to six percent of a country’s GDP. One Australian estimate pegged alcohol’s social costs at 24% of all drug abuse costs; a similar Canadian study concluded alcohol’s share was 41%. One study quantified the cost to the UK of all forms of alcohol misuse in 2001 as £18.5–20 billion. All economic costs in the United States in 2006 have been estimated at $223.5 billion.