Basic Questions Are Best Way to Spot Alcohol Problems, a Study at Yale Shows

A few carefully worded questions are the best way of spotting alcohol problems during routine medical appointments, a study by Yale researchers shows.

Out of 38 studies of screening methods for alcohol problems in primary care physicians’ practices, the four so-called CAGE questions and the Alcohol Use Disorders Identification Test (AUDIT) were the most effective in identifying patients with alcohol abuse and dependence problems and at-risk, hazardous, or harmful drinking. The studies were conducted from 1966 through 1998.

“The literature is full of research on the effectiveness of a variety of methods for screening for alcohol problems in a variety of settings, including hospitals, emergency rooms and clinics,” said Patrick O’Connor, M.D., professor of internal medicine and senior author of the study published in the Archives of Internal Medicine.

“This is the first study to examine the evidence in the literature for the effectiveness of these instruments,” he said. “This is important because primary care physicians have been urged to screen their patients for alcohol problems, but may often neglect to do so. Examining and establishing the effectiveness of screening in primary care may encourage appropriate use of existing screening instruments.”

David Fiellen, M.D., assistant professor of medicine, is the lead author of the study. M. Carrington Reid, M.D., assistant professor of internal medicine, geriatrics, is co-author.

The four CAGE questions are: Have you ever tried to cut down on your drinking? Have people annoyed you by criticizing your drinking? Have you ever felt bad or guilty about your drinking? Have you ever taken a drink first thing in the morning, an eye opener, to steady your nerves or get rid of a hangover?

These questions tended to give the clearest picture of the patient’s drinking behaviors that might indicate alcohol abuse and dependence over their lifetime.

The first three questions of the 10-question AUDIT instrument address the quantity and frequency of alcohol consumption. These questions were found to be the most effective in showing more recent drinking behavior and problems.

Patients can answer the questions on a form they fill out while waiting to see their doctor, or they can be asked directly when meeting with the physician.

O’Connor said blood tests are not good indicators of alcohol problems because they only reveal markers of advanced alcohol abuse, such as liver problems. The blood tests also are frequently normal in patients with significant earlier stage drinking problems.

“There are a lot of people with drinking problems who are missing work and getting arrested for drinking while intoxicated who might not show any physical problems on a blood test,” O’Connor said. “You want to try to get them before they appear in an emergency room or hospital. At that point, they are often far advanced.”

Not only can drinking problems be identified earlier with primary care screening, there also is evidence that brief counseling by primary care physicians can help decrease drinking behavior and prevent alcohol problems down the road, he said.

(O’Connor can be reached at 203-688-6532).

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