• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of brjgenpracRCGP homepageJ R Coll Gen Pract at PubMed CentralBJGP at RCGPBJGP at RCGP
Br J Gen Pract. Mar 2001; 51(464): 206–217.
PMCID: PMC1313952

Screening properties of questionnaires and laboratory tests for the detection of alcohol abuse or dependence in a general practice population.

Abstract

BACKGROUND: Early identification of alcohol abuse or dependence is important in general practice because many diseases are influenced by alcohol. General practitioners, however, fail to recognise most patients with alcohol problems. AIM: To assess the diagnostic performance of the CAGE and AUDIT questionnaires, their derivatives, and laboratory tests in screening for alcohol abuse or dependence in a primary care population (male and female patients), attending their general practitioner (GP). DESIGN OF STUDY: A diagnostic cross-sectional study. SETTING: A random sample of patients who were over 18 years of age (n = 1992) attending 69 general practices situated in the same region in Belgium. METHOD: Alcohol questionnaires (CIDI 1.1, section I, CAGE, AUDIT, AUDIT-C, Five-Shot, and AUDIT Piccinelli) were completed, demographic information was recorded, and patients underwent conventional blood tests, including mean corpuscular volume, liver function tests, the gamma-glutamyl transferase test, and carbohydrate-deficient transferrin (CDT, estimated using %CDT). Calculations of sensitivity, specificity, positive predictive value, negative predictive value, odds ratios with their 95% CIs, and receiver operating characteristic (ROC) curves for different scores of the questionnaires and laboratory tests, using DSM-III-R as the reference standard. RESULTS: The past-year prevalence of alcohol abuse or dependence in this population was 8.9% (178/1992) of which there were 132 male and 45 female patients attending a general practice. The GPs identified 33.5% of patients with alcohol abuse or dependence. Among male patients, all questionnaires had reasonable sensitivities between 68% and 93% and hence at lower cut-points than recommended. Only the sensitivity of the CAGE, even at its lowest cut-point of > or = 1 was lower (62%). In female patients the sensitivities were lower; however, odds ratios were higher for different questionnaires. The receiver operating characteristic (ROC) curves did not differ between the questionnaires. The laboratory tests had low diagnostic accuracy with areas under the ROC curves (AUCs) between 0.60 and 0.67 for female patients and 0.57 and 0.65 for male patients. CONCLUSIONS: This is one of the largest known studies on alcohol abuse or dependence among family care practices. We confirm earlier results that the AUDIT questionnaire seems equally appropriate for males and females; however, screening properties among male patients are higher. Nevertheless, the Five-Shot questionnaire is shorter and easier to use in a general practice setting and has nearly the same diagnostic properties in male and female general practice patient populations. We confirm that conventional laboratory tests are of no use for detecting alcohol abuse or dependence in a primary care setting. Also, the %CDT cannot been used as a screening instrument in this general practice population.

Full Text

The Full Text of this article is available as a PDF (118K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Cleary PD, Miller M, Bush BT, Warburg MM, Delbanco TL, Aronson MD. Prevalence and recognition of alcohol abuse in a primary care population. Am J Med. 1988 Oct;85(4):466–471. [PubMed]
  • Phelps GL, Johnson NP. Bright lights in dark places: physician recognition of alcoholism. J S C Med Assoc. 1990 Jan;86(1):17–18. [PubMed]
  • Magruder-Habib K, Durand AM, Frey KA. Alcohol abuse and alcoholism in primary health care settings. J Fam Pract. 1991 Apr;32(4):406–413. [PubMed]
  • Buchsbaum DG, Buchanan RG, Lawton MJ, Schnoll SH. Alcohol consumption patterns in a primary care population. Alcohol Alcohol. 1991;26(2):215–220. [PubMed]
  • Hill A, Rumpf HJ, Hapke U, Driessen M, John U. Prevalence of alcohol dependence and abuse in general practice. Alcohol Clin Exp Res. 1998 Jun;22(4):935–940. [PubMed]
  • Allen J, Litten RZ, Lee A. What you need to know: detecting alcohol problems in general medical practice. Singapore Med J. 1998 Jan;39(1):38–41. [PubMed]
  • Fleming MF, Barry KL, Manwell LB, Johnson K, London R. Brief physician advice for problem alcohol drinkers. A randomized controlled trial in community-based primary care practices. JAMA. 1997 Apr 2;277(13):1039–1045. [PubMed]
  • Anderson P. Effectiveness of general practice interventions for patients with harmful alcohol consumption. Br J Gen Pract. 1993 Sep;43(374):386–389. [PMC free article] [PubMed]
  • Romelsjö A, Andersson L, Barrner H, Borg S, Granstrand C, Hultman O, Hässler A, Källqvist A, Magnusson P, Morgell R, et al. A randomized study of secondary prevention of early stage problem drinkers in primary health care. Br J Addict. 1989 Nov;84(11):1319–1327. [PubMed]
  • Senft RA, Polen MR, Freeborn DK, Hollis JF. Brief intervention in a primary care setting for hazardous drinkers. Am J Prev Med. 1997 Nov-Dec;13(6):464–470. [PubMed]
  • Deehan A, Marshall EJ, Strang J. Tackling alcohol misuse: opportunities and obstacles in primary care. Br J Gen Pract. 1998 Nov;48(436):1779–1782. [PMC free article] [PubMed]
  • Glatt MM. Training general practitioners. Alcohol Alcohol. 1997 Sep-Oct;32(5):627–628. [PubMed]
  • Cowan PF. An intervention to improve the assessment of alcoholism by practicing physicians. Fam Pract Res J. 1994 Mar;14(1):41–49. [PubMed]
  • Hoeksema HL, de Bock GH. The value of laboratory tests for the screening and recognition of alcohol abuse in primary care patients. J Fam Pract. 1993 Sep;37(3):268–276. [PubMed]
  • Meerkerk GJ, Njoo KH, Bongers IM, Trienekens P, van Oers JA. Comparing the diagnostic accuracy of carbohydrate-deficient transferrin, gamma-glutamyltransferase, and mean cell volume in a general practice population. Alcohol Clin Exp Res. 1999 Jun;23(6):1052–1059. [PubMed]
  • Lesch OM, Walter H, Freitag H, Heggli DE, Leitner A, Mader R, Neumeister A, Passweg V, Pusch H, Semler B, et al. Carbohydrate-deficient transferrin as a screening marker for drinking in a general hospital population. Alcohol Alcohol. 1996 May;31(3):249–256. [PubMed]
  • Maisto SA, Connors GJ, Allen JP. Contrasting self-report screens for alcohol problems: a review. Alcohol Clin Exp Res. 1995 Dec;19(6):1510–1516. [PubMed]
  • Ewing JA. Detecting alcoholism. The CAGE questionnaire. JAMA. 1984 Oct 12;252(14):1905–1907. [PubMed]
  • Aertgeerts B, Buntinx F, Fevery J, Ansoms S. Is there a difference between CAGE interviews and written CAGE questionnaires? Alcohol Clin Exp Res. 2000 May;24(5):733–736. [PubMed]
  • Perdrix A, Decrey H, Pécoud A, Burnand B, Yersin B. Dépistage de l'alcoolisme en cabinet médical: applicabilité du questionnaire "CAGE" par le médecin praticien. Groupe des praticiens PMU. Schweiz Med Wochenschr. 1995 Sep 23;125(38):1772–1778. [PubMed]
  • Lawner K, Doot M, Gausas J, Doot J, See C. Implementation of CAGE alcohol screening in a primary care practice. Fam Med. 1997 May;29(5):332–335. [PubMed]
  • Lairson DR, Harrist R, Martin DW, Ramby R, Rustin TA, Swint JM, Harlow K, Cobb J. Screening for patients with alcohol problems: severity of patients identified by the CAGE. J Drug Educ. 1992;22(4):337–352. [PubMed]
  • Allen JP, Litten RZ, Fertig JB, Babor T. A review of research on the Alcohol Use Disorders Identification Test (AUDIT). Alcohol Clin Exp Res. 1997 Jun;21(4):613–619. [PubMed]
  • Seppä K, Lepistö J, Sillanaukee P. Five-shot questionnaire on heavy drinking. Alcohol Clin Exp Res. 1998 Nov;22(8):1788–1791. [PubMed]
  • Piccinelli M, Tessari E, Bortolomasi M, Piasere O, Semenzin M, Garzotto N, Tansella M. Efficacy of the alcohol use disorders identification test as a screening tool for hazardous alcohol intake and related disorders in primary care: a validity study. BMJ. 1997 Feb 8;314(7078):420–424. [PMC free article] [PubMed]
  • Seppä K, Mäkelä R, Sillanaukee P. Effectiveness of the Alcohol Use Disorders Identification Test in occupational health screenings. Alcohol Clin Exp Res. 1995 Aug;19(4):999–1003. [PubMed]
  • Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Arch Intern Med. 1998 Sep 14;158(16):1789–1795. [PubMed]
  • Hasin D, Paykin A. Alcohol dependence and abuse diagnoses: concurrent validity in a nationally representative sample. Alcohol Clin Exp Res. 1999 Jan;23(1):144–150. [PubMed]
  • Robins LN, Wing J, Wittchen HU, Helzer JE, Babor TF, Burke J, Farmer A, Jablenski A, Pickens R, Regier DA, et al. The Composite International Diagnostic Interview. An epidemiologic Instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Arch Gen Psychiatry. 1988 Dec;45(12):1069–1077. [PubMed]
  • Wittchen HU, Robins LN, Cottler LB, Sartorius N, Burke JD, Regier D. Cross-cultural feasibility, reliability and sources of variance of the Composite International Diagnostic Interview (CIDI). The Multicentre WHO/ADAMHA Field Trials. Br J Psychiatry. 1991 Nov;159:645–658. [PubMed]
  • Mayfield D, McLeod G, Hall P. The CAGE questionnaire: validation of a new alcoholism screening instrument. Am J Psychiatry. 1974 Oct;131(10):1121–1123. [PubMed]
  • Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982 Apr;143(1):29–36. [PubMed]
  • Hanley JA, McNeil BJ. A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology. 1983 Sep;148(3):839–843. [PubMed]
  • Knottnerus JA, Leffers P. The influence of referral patterns on the characteristics of diagnostic tests. J Clin Epidemiol. 1992 Oct;45(10):1143–1154. [PubMed]
  • Schmidt A, Barry KL, Fleming MF. Detection of problem drinkers: the Alcohol Use Disorders Identification Test (AUDIT). South Med J. 1995 Jan;88(1):52–59. [PubMed]
  • Isaacson JH, Butler R, Zacharek M, Tzelepis A. Screening with the Alcohol use Disorders Identification Test (AUDIT) in an inner-city population. J Gen Intern Med. 1994 Oct;9(10):550–553. [PubMed]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

  • Cited in Books
    Cited in Books
    PubMed Central articles cited in books
  • MedGen
    MedGen
    Related information in MedGen
  • PubMed
    PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...