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Journal of General Internal Medicine

, Volume 24, Issue 7, pp 783–788

First Online: 27 February 2009Received: 17 August 2008Revised: 14 January 2009Accepted: 23 January 2009ABSTRACT

BACKGROUNDUnhealthy alcohol use is prevalent but under-diagnosed in primary care settings.

OBJECTIVETo validate, in primary care, a single-item screening test for unhealthy alcohol use recommended by the National Institute on Alcohol Abuse and Alcoholism NIAAA.

DESIGNCross-sectional study.

PARTICIPANTSAdult English-speaking patients recruited from primary care waiting rooms.

MEASUREMENTSParticipants were asked the single screening question -How many times in the past year have you had X or more drinks in a day?-, where X is 5 for men and 4 for women, and a response of >1 is considered positive. Unhealthy alcohol use was defined as the presence of an alcohol use disorder, as determined by a standardized diagnostic interview, or risky consumption, as determined using a validated 30-day calendar method.

MAIN RESULTSOf 394 eligible primary care patients, 286 73% completed the interview. The single-question screen was 81.8% sensitive 95% confidence interval CI 72.5% to 88.5% and 79.3% specific 95% CI 73.1% to 84.4% for the detection of unhealthy alcohol use. It was slightly more sensitive 87.9%, 95% CI 72.7% to 95.2% but was less specific 66.8%, 95% CI 60.8% to 72.3% for the detection of a current alcohol use disorder. Test characteristics were similar to that of a commonly used three-item screen, and were affected very little by subject demographic characteristics.

CONCLUSIONSThe single screening question recommended by the NIAAA accurately identified unhealthy alcohol use in this sample of primary care patients. These findings support the use of this brief screen in primary care.

KEY WORDSalcohol screening test alcoholics primary care validation NIAAA An erratum to this article can be found at

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Autor: Peter C. Smith - Susan M. Schmidt - Donald Allensworth-Davies - Richard Saitz


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