Screening for Unhealthy Alcohol Use: Questionnaire Is Best
Some clinicians have questioned whether blood tests are better than self-report questionnaires for alcohol screening. To compare these screening methods, researchers in Wales first assessed 1794 men with the Alcohol Use Disorders Identification Test (AUDIT), a 10-item alcohol screening questionnaire that, for this study, was embedded in a general lifestyle questionnaire. They then conducted blood tests in 112 men who screened positive on the AUDIT (score of >=8) and 82 who screened negative.
- For unhealthy alcohol use, sensitivity and specificity* were highest for the AUDIT.
Sensitivity Specificity AUDIT69% 98% Carbohydrate-deficient transferrin (CDT)47% 71% Gamma-glutamyltransferase (GGT)37% 72% Mean corpuscular volume (MCV)32% 71% Aspartate aminotransferase (AST)20% 80%
- For alcohol dependence, sensitivity and specificity were also highest for the AUDIT (84% and 83%, respectively).
- The cost of identifying a patient with unhealthy alcohol use was lowest for the AUDIT ($12.48 versus $72.59 for GGT, $130.92 for MCV, $132.74 for AST, and $291.89 for CDT).**
Comments:
The results of this study confirm that a validated questionnaire is more sensitive, more specific, and cheaper than blood tests, and therefore is the best way to screen for unhealthy alcohol use.
Richard Saitz, MD, MPH
*Sensitivity is the proportion of patients with the disorder that test positive; specificity is the proportion of patients without the disorder who test negative.
**Costs were converted from British pounds to US dollars in early March 2006.
Reference:
Coulton S, Drummond C, James D, et al. Opportunistic screening for alcohol use disorders in primary care: a comparative study. BMJ. 2006;332(7540):511–517.