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Primary Care Validation of a Single Screening Question for Drinkers

J. Paul Seale, John M. Boltri, Sylvia Shellenberger, Mary M. Velasquez, Monica Cornelius, Monique Guyinn, Ike Okosun, Heather Sumner

Objective: The aim of this study was to conduct a primary care validation study of a single screening question for alcohol misuse (“When was the last time you had more than X drinks in 1 day?,” where X was four for women and X was five for men), which was previously validated in a study conducted in emergency departments. Method: This cross-sectional study was accomplished by interviewing 625 male and female adult drinkers who presented to five southeastern primary care practices. Patients answered the single question (coded as within 3 months, within 12 months, ever, or never), Alcohol Use Disorders Identification Test (AUDIT), and AUDIT consumption questions (AUDIT-C). Alcohol misuse was defined as either at-risk drinking, identified by a 29-day Timeline Followback interview or a current (past-year) alcohol-use disorder by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria, or both. Results: Among 625 drinkers interviewed, 25.6% were at-risk drinkers, 21.7% had a current alcohol-use disorder, and 35.2% had either or both conditions. Considering “within the last 3 months” as positive, the sensitivity of the single question was 80% and the specificity was 74%. Chi-square analyses revealed similar sensitivity across ethnic and gender groups; however, specificity was higher in women and whites (p = .0187 and .0421, respectively). Considering “within the last 12 months” as positive increased the question’s sensitivity, especially for those with alcohol-use disorders. The area under the receiver operating characteristic curve of the single alcohol screening question (0.79) was slightly lower than for the AUDIT and AUDIT-C, but sensitivity and specificity were similar. Conclusions: A single question about the last episode of heavy drinking is a sensitive, time-efficient screening instrument that shows promise for increasing alcohol screening in primary care practices. (J. Stud. Alcohol 67: 778-784, 2006)