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. 2001 Mar;51(464):206–217.

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

B Aertgeerts 1, F Buntinx 1, S Ansoms 1, J Fevery 1
PMCID: PMC1313952  PMID: 11255902

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.

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Selected References

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  1. 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] [Google Scholar]
  2. Allen J. P., Litten R. Z., Fertig J. B., 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] [Google Scholar]
  3. Allen J., Litten R. Z., Lee A. What you need to know: detecting alcohol problems in general medical practice. Singapore Med J. 1998 Jan;39(1):38–41. [PubMed] [Google Scholar]
  4. 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] [Google Scholar]
  5. Buchsbaum D. G., Buchanan R. G., Lawton M. J., Schnoll S. H. Alcohol consumption patterns in a primary care population. Alcohol Alcohol. 1991;26(2):215–220. doi: 10.1093/oxfordjournals.alcalc.a045103. [DOI] [PubMed] [Google Scholar]
  6. Bush K., Kivlahan D. R., McDonell M. B., Fihn S. D., Bradley K. A. 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. doi: 10.1001/archinte.158.16.1789. [DOI] [PubMed] [Google Scholar]
  7. Cleary P. D., Miller M., Bush B. T., Warburg M. M., Delbanco T. L., Aronson M. D. Prevalence and recognition of alcohol abuse in a primary care population. Am J Med. 1988 Oct;85(4):466–471. doi: 10.1016/s0002-9343(88)80079-2. [DOI] [PubMed] [Google Scholar]
  8. Cowan P. F. An intervention to improve the assessment of alcoholism by practicing physicians. Fam Pract Res J. 1994 Mar;14(1):41–49. [PubMed] [Google Scholar]
  9. Deehan A., Marshall E. J., 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] [Google Scholar]
  10. Ewing J. A. Detecting alcoholism. The CAGE questionnaire. JAMA. 1984 Oct 12;252(14):1905–1907. doi: 10.1001/jama.252.14.1905. [DOI] [PubMed] [Google Scholar]
  11. Fleming M. F., Barry K. L., Manwell L. B., 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] [Google Scholar]
  12. Glatt M. M. Training general practitioners. Alcohol Alcohol. 1997 Sep-Oct;32(5):627–628. doi: 10.1093/oxfordjournals.alcalc.a008305. [DOI] [PubMed] [Google Scholar]
  13. Hanley J. A., McNeil B. J. A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology. 1983 Sep;148(3):839–843. doi: 10.1148/radiology.148.3.6878708. [DOI] [PubMed] [Google Scholar]
  14. Hanley J. A., McNeil B. J. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982 Apr;143(1):29–36. doi: 10.1148/radiology.143.1.7063747. [DOI] [PubMed] [Google Scholar]
  15. 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] [Google Scholar]
  16. Hill A., Rumpf H. J., 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] [Google Scholar]
  17. Hoeksema H. L., de Bock G. H. 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] [Google Scholar]
  18. Isaacson J. H., 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. doi: 10.1007/BF02599279. [DOI] [PubMed] [Google Scholar]
  19. Knottnerus J. A., Leffers P. The influence of referral patterns on the characteristics of diagnostic tests. J Clin Epidemiol. 1992 Oct;45(10):1143–1154. doi: 10.1016/0895-4356(92)90155-g. [DOI] [PubMed] [Google Scholar]
  20. Lairson D. R., Harrist R., Martin D. W., Ramby R., Rustin T. A., Swint J. M., 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. doi: 10.2190/H8QV-KAYU-QBYH-1LN3. [DOI] [PubMed] [Google Scholar]
  21. 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] [Google Scholar]
  22. Lesch O. M., Walter H., Freitag H., Heggli D. E., Leitner A., Mader R., Neumeister A., Passweg V., Pusch H., Semler B. Carbohydrate-deficient transferrin as a screening marker for drinking in a general hospital population. Alcohol Alcohol. 1996 May;31(3):249–256. doi: 10.1093/oxfordjournals.alcalc.a008144. [DOI] [PubMed] [Google Scholar]
  23. Magruder-Habib K., Durand A. M., Frey K. A. Alcohol abuse and alcoholism in primary health care settings. J Fam Pract. 1991 Apr;32(4):406–413. [PubMed] [Google Scholar]
  24. Maisto S. A., Connors G. J., Allen J. P. Contrasting self-report screens for alcohol problems: a review. Alcohol Clin Exp Res. 1995 Dec;19(6):1510–1516. doi: 10.1111/j.1530-0277.1995.tb01015.x. [DOI] [PubMed] [Google Scholar]
  25. 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. doi: 10.1176/ajp.131.10.1121. [DOI] [PubMed] [Google Scholar]
  26. Meerkerk G. J., Njoo K. H., Bongers I. M., Trienekens P., van Oers J. A. 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] [Google Scholar]
  27. 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] [Google Scholar]
  28. Phelps G. L., Johnson N. P. Bright lights in dark places: physician recognition of alcoholism. J S C Med Assoc. 1990 Jan;86(1):17–18. [PubMed] [Google Scholar]
  29. 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. doi: 10.1136/bmj.314.7078.420. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Robins L. N., Wing J., Wittchen H. U., Helzer J. E., Babor T. F., Burke J., Farmer A., Jablenski A., Pickens R., Regier D. A. 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. doi: 10.1001/archpsyc.1988.01800360017003. [DOI] [PubMed] [Google Scholar]
  31. Romelsjö A., Andersson L., Barrner H., Borg S., Granstrand C., Hultman O., Hässler A., Källqvist A., Magnusson P., Morgell R. A randomized study of secondary prevention of early stage problem drinkers in primary health care. Br J Addict. 1989 Nov;84(11):1319–1327. doi: 10.1111/j.1360-0443.1989.tb00733.x. [DOI] [PubMed] [Google Scholar]
  32. Schmidt A., Barry K. L., Fleming M. F. Detection of problem drinkers: the Alcohol Use Disorders Identification Test (AUDIT). South Med J. 1995 Jan;88(1):52–59. [PubMed] [Google Scholar]
  33. Senft R. A., Polen M. R., Freeborn D. K., Hollis J. F. Brief intervention in a primary care setting for hazardous drinkers. Am J Prev Med. 1997 Nov-Dec;13(6):464–470. [PubMed] [Google Scholar]
  34. Seppä K., Lepistö J., Sillanaukee P. Five-shot questionnaire on heavy drinking. Alcohol Clin Exp Res. 1998 Nov;22(8):1788–1791. [PubMed] [Google Scholar]
  35. 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. doi: 10.1111/j.1530-0277.1995.tb00980.x. [DOI] [PubMed] [Google Scholar]
  36. Wittchen H. U., Robins L. N., Cottler L. B., Sartorius N., Burke J. D., 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;159:645-53, 658. doi: 10.1192/bjp.159.5.645. [DOI] [PubMed] [Google Scholar]

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