Screening for alcohol abuse with a few key questions

There are a variety of screening methods available for detecting alcohol problems. According to a review by Yale investigators, however, asking a few carefully worded questions during routine medical appointments is the best way of spotting alcohol problems before they get out of hand.

The study, led by David A. Fiellin, M.D., assistant professor of medicine, reviewed 38 previous studies of screening methods for alcohol problems in primary care physicians’ practices. It showed that the four so-called CAGE questions and the Alcohol Use Disorders Identification Test (AUDIT) were the most effective in identifying patients with alcohol abuse and dependence problems and at-risk, hazardous or harmful drinking. Patrick G. O’Connor, M.D., M.P.H., professor of medicine and senior author of the study published in August in the Archives of Internal Medicine, said, “This is the first study to examine the evidence in the literature for the effectiveness of these instruments, which focuses specifically on their use in primary care settings. This is important because primary care physicians have been urged to screen their patients for alcohol problems but may often neglect to do so.”

The four CAGE questions are: Have you ever tried to Cut down on your drinking? Have people Annoyed you by criticizing your drinking? Have you ever felt bad or Guilty about your drinking? Have you ever taken a drink first thing in the morning, an Eye opener, to steady your nerves or get rid of a hangover?

The first three questions of the 10-question AUDIT instrument address the quantity and frequency of alcohol consumption. These questions were found to be the most effective in showing more recent drinking behavior and problems.

O’Connor said blood tests are not good indicators of alcohol problems because they generally only reveal markers of advanced alcohol abuse, such as liver problems. “There are many people with drinking problems who are missing work and getting arrested for driving while intoxicated who might not show any physical problems on a blood test,” O’Connor said. “You want to try to get them before they appear in an emergency room or hospital. At that point, they are often far advanced.”