Supported by VA HSR&D Grants SDR96-002 and IIR99-376 to the Veterans Affairs Ambulatory Care Quality Improvement Project (SDF), Grant K23AA00313 from NIAAA (KAB), and the Robert Wood Johnson Foundation (KAB). Views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs, the University of Washington, the NIAAA, or the Robert Wood Johnson Foundation.
Using Alcohol Screening Results and Treatment History to Assess the Severity of At-Risk Drinking in Veterans Affairs Primary Care Patients
Article first published online: 3 MAY 2006
Alcoholism: Clinical and Experimental Research
Volume 28, Issue 3, pages 448–455, March 2004
How to Cite
Bradley, K. A., Kivlahan, D. R., Zhou, X.-H., Sporleder, J. L., Epler, A. J., McCormick, K. A., Merrill, J. O., McDonell, M. B. and Fihn, S. D. (2004), Using Alcohol Screening Results and Treatment History to Assess the Severity of At-Risk Drinking in Veterans Affairs Primary Care Patients. Alcoholism: Clinical and Experimental Research, 28: 448–455. doi: 10.1097/01.ALC.0000117836.38108.38
- Issue published online: 3 MAY 2006
- Article first published online: 3 MAY 2006
- Received for publication January 2, 2003; accepted December 1, 2003.
- Alcohol Screening;
- Alcohol Drinking;
- Primary Care
Abstract: Background: Primary care providers need practical methods for managing patients who screen positive for at-risk drinking. We evaluated whether scores on brief alcohol screening questionnaires and patient reports of prior alcohol treatment reflect the severity of recent problems due to drinking.
Methods: Veterans Affairs general medicine outpatients who screened positive for at-risk drinking were mailed questionnaires that included the Alcohol Use Disorders Identification Test (AUDIT) and a question about prior alcohol treatment or participation in Alcoholics Anonymous (“previously treated”). AUDIT questions 4 through 10 were used to measure past-year problems due to drinking (PYPD). Cross-sectional analyses compared the prevalence of PYPD and mean Past-Year AUDIT Symptom Scores (0–28 points) among at-risk drinkers with varying scores on the CAGE (0–4) and AUDIT-C (0–12) and varying treatment histories.
Results: Of 7861 male at-risk drinkers who completed questionnaires, 33.9% reported PYPD. AUDIT-C scores were more strongly associated with Past-Year AUDIT Symptom Scores than the CAGE (p < 0.0005). The prevalence of PYPD increased from 33% to 46% over the range of positive CAGE scores but from 29% to 77% over the range of positive AUDIT-C scores. Among subgroups of at-risk drinkers with the same screening scores, patients who reported prior treatment were more likely than never-treated at-risk drinkers to report PYPD and had higher mean Past-Year AUDIT Symptom Scores (p < 0.0005). We propose a simple method of risk-stratifying patients using AUDIT-C scores and alcohol treatment histories.
Conclusions: AUDIT-C scores combined with one question about prior alcohol treatment can help estimate the severity of PYPD among male Veterans Affairs outpatients.