Risky drinking among community pharmacy customers in New Zealand and their attitudes towards pharmacist screening and brief interventions

Introduction and Aims. To estimate the prevalence of risky drinking among customers in community pharmacies and to explore customer attitudes towards screening and brief intervention (SBI). Design and Methods. Cross‐sectional, anonymous survey, using random selection of community pharmacies in New Zealand to collect data using self‐completion questionnaires and an opportunity to enter a prize draw. Participants were customers/patients attending the community pharmacy on a specific, randomly selected day (Monday to Friday) in one set week. Alcohol Use Disorder Identification Test (AUDIT)‐C using a cut‐off score of 5 was used to measure risky drinking. Attitudes towards pharmacists engaging in SBI for risky drinkers were measured. Results. 2384 completed customer/patient questionnaires from 43 participating pharmacies. Almost 84% ever drank alcohol and using a score of 5 or more as a cut‐off, 30% of the sample would be considered as risky drinkers. Attitudes were generally positive to pharmacists undertaking SBI. Logistic regression with AUDIT‐C positive or negative as the dependent variable found those taking medicines for mental health and liver disease being more likely to score negative on the AUDIT‐C, and smokers and those purchasing hangover cures were more likely than average to have a positive AUDIT‐C screen. Discussion and Conclusions. This study indicates there is scope for community pharmacists to undertake SBI for risky drinking, and that customers find this to be acceptable. Targeted screening may well be useful, in particular for smokers. Further research is required to explore the effectiveness of SBI for risky drinkers in this setting.[Sheridan J, Stewart J, Smart R, McCormick R. Risky drinking among community pharmacy customers in New Zealand and their attitudes towards pharmacist screening and brief interventions. Drug Alcohol Rev 2012;31:56–63]     

Brief alcohol screening in a clinical psychiatric population: special attention needed

Introduction and Aims. Abbreviated versions of the Alcohol Use Disorders Identification Test (AUDIT) and single‐item screeners show promising results but have not previously been investigated in a clinical psychiatric setting. The aim of the present study was to investigate the capacity of three brief screening methods to detect hazardous drinking in a psychiatric treatment‐seeking population. Design and Methods. Data were collected from consecutive patients (n = 1811) visiting a general psychiatric clinic. The screening capacity of the heavy episodic drinking (HED) screener, AUDIT item # 3 (AUDIT‐3) and the three consumption items of AUDIT (AUDIT‐C) was compared to the result of the full 10‐item AUDIT with cut‐off points 6 for women and 8 for men. Results. The HED screener and AUDIT‐3 with recommended cut‐offs captured low rates of hazardous drinkers when compared to the full AUDIT. Lowering the cut‐offs created rates far above those of the full AUDIT. AUDIT‐C with recommended cut‐off limits categorised nearly the same rates of men as the full AUDIT but much higher rates of women. Raising the cut‐off for women approached the detection rate of AUDIT‐C closely to that of the full AUDIT. Discussion and Conclusions. The findings of this study suggest that the HED screener is not sensitive enough in the clinical psychiatric setting. When designing alcohol screening measures to be used all over health‐care organisations, special attention should be paid to psychiatric patients. If a somewhat more extensive screening tool is used, the full AUDIT is recommended.[Nehlin C, Fredriksson A, Jansson L. Brief alcohol screening in a clinical psychiatric population: Special attention needed. Drug Alcohol Rev 2012;31:538–543]     

Web‐based screening and advice for hazardous drinkers: Use of a Spanish site

Introduction and Aims. A website for implementing screening and brief intervention on alcohol was launched in Barcelona, Spain, in October 2006. Its aim was to reach hazardous drinkers who probably would not ask for advice. This article describes use of the site, profiles users and discusses limitations concerning screening. Design and Methods. The website included screening, advice and information. Demographic and self‐screening data (typical weekly consumption and the Alcohol Use Disorders Identification Test, AUDIT) were examined. Results. In a 12 month period, 12 138 visitors entered the website, 2574 started self‐assessment, 1342 completed the table and 724 of these participants completed the AUDIT. These users had a mean age of 27.6 years, one‐third of them drank above recommended weekly limits and 84.1% of those who completed the AUDIT (n = 724) scored positive (≥5); a total of 70.3% of identified at‐risk drinkers entered the advice section. Among visitors to the site, risk factors for hazardous drinking were: being male,≥35 years of age, and drinking heavily at weekends. Discussion and conclusions. The percentage of hazardous drinkers accessing the site was high, and visitors reported that they liked the design, that it was easy to use and that it provided relevant information. Most of those who had sought advice considered it to be helpful. The website seems to be an accessible and useful tool for young people and might be used in youth centres as well as in health‐care settings, such as primary care and emergency centres, where it could contribute to health promotion and constitute an easier alternative to screening and brief intervention given by the staff.[Rodríguez‐Martos A, Castellano Y. Web‐based screening and advice for hazardous drinkers: Use of a Spanish site. Drug Alcohol Rev 2009;28:54–59]     

Comparison of Three Methods to Assess Binge Consumption: One-Week Retrospective Drinking Diary,AUDIT, and Quantity/Frequency

Binge consumption contributes substantially to the occurrence of alcohol-related harm. Despite its importance, binge drinking is not well defined in the literature. The present study examines the proportions of respondents identified as binge drinkers by three separate measures: a 1-week retrospective drinking diary (RD), the Alcohol Use Disorders Identification Test (AUDIT), and a quantity/frequency (QF) question. Overall, AUDIT detected the highest proportion of binge drinkers, followed by QF and RD. There was also good agreement between QF and RD, as well as QF and AUDIT. Ultimately, the measure of choice should be that which provides information most appropriate to the purposes of each study.     

Binge drinking and its detection among middle-aged men using AUDIT, AUDIT-C and AUDIT-3

Binge (heavy episodic) drinking is common, but there is little knowledge on how this drinking pattern could be detected. This study compares three structured questionnaires among binge drinking middle-aged men. All 45-year-old men in the city of Tampere, Finland, were asked to fill in the Alcohol Use Disorders Identification Test (AUDIT). Based on the interview on their drinking the men were divided into non-binging moderate drinkers (n = 352), binging moderate drinkers (n = 130), non-binging heavy drinkers (n = 10) and binging heavy drinkers (n = 63). The complete AUDIT, AUDIT-C (first three AUDIT questions inquiring quantity-frequency) and AUDIT-3 (the third binging-frequency question of AUDIT) in detecting binge drinking were compared. The complete AUDIT was effective in detecting binge drinkers by a cut-off score of >or=8 or >or=7. The optimal cut-off score for AUDIT-C was >or= 6 and that for AUDIT-3 >or=2. The area under the curve (AUC) among all risky drinkers (binging moderate and binging heavy and non-binging heavy drinkers) for AUDIT was 0.824 (95% CI 0.789 - 0.859), for AUDIT-C 0.829 (95% CI 0.795 - 0.864) and for AUDIT-3 0.779 (0.739 - 0.818). The complete AUDIT and its short versions are applicable in populations where binging is the dominant drinking pattern, but the cut-off scores should be tailored to individual cultures.     

Rates of alcohol consumption and risk status among Australian university students vary by assessment questions

Introduction and Aims. Different self‐report methods tend to produce different estimates of alcohol consumption. The present study compares differences in rates and risk levels based on responses to a modified version of the Daily Drinking Questionnaire (m‐DDQ) and quantity‐frequency (QF) questions. Design and Methods. The sample comprised 2082 university students, 61% of whom were female and 39% male with a mean age of 23.5 years. An email containing an online link to a brief six‐question survey was emailed to students enrolled in participating faculties at the University of Wollongong, Australia. Current drinkers completed m‐DDQ and QF questions about alcohol consumption. Results. QF methods identified significantly lower estimates of consumption (Mean = 9.15, SD = 12.51) compared with m‐DDQ (Mean = 13.06, SD = 14.07). Allocation to risk categories based on the Australian Alcohol Guidelines were conducted for both the m‐DDQ and QF methods. Almost twice as many students were found to be drinking at levels considered risky using the m‐DDQ method compared with QF. In addition, the relative rank order of participants varied significantly between the two methods. Discussion and Conclusions. The m‐DDQ method identified higher rates of drinking and categorised almost twice as many individuals into risky categories of drinking compared with QF. Such variations have major implications for identification of risk groups in health promotion or prevention programs.[Utpala‐Kumar R, Deane FP. Rates of alcohol consumption and risk status among Australian university students vary by assessment questions. Drug Alcohol Rev 2009]     

Exploring Risky Drinking and Knowledge of Safe Drinking Guidelines in Older Adults

Background: Risky drinking criteria in older adults lack consistency across the literature. The variable definitions of risk have contributed in part, to widely differing prevalence estimates for risky drinking, ranging from 1% to 15%. Objectives: (1) To identify the prevalence of different types of risky drinking by applying several different criteria, (2) To investigate whether older adults have knowledge of the National Health and Medical Research Council recommended guidelines for safe drinking. Methods: The study population consisted of community dwelling past-year drinkers (n = 292) aged ≥60 years. Participants completed a postal survey on alcohol consumption using the AUDIT-C. Results: Applying multiple risky drinking criteria indicated that 6.6% to 31.7% of women and 21.6% to 44.8% of men were risky drinkers. Men were more likely than women to have inaccurate knowledge of the NHMRC guidelines, and nearly 59.2% of men who exceeded 14 drinks per week reported either not knowing the recommended limits or reported limits that exceeded the guidelines. Conclusions/Importance: A substantial number of older men drank at risky levels and overestimated safe drinking limits. Greater education on the vulnerability to alcohol-related harm together with greater screening practice by health professionals and service providers is recommended. Findings illustrate how different risky drinking criteria vary in their average AUDIT-C scores, with the NHMRC criteria showing greater average scores compared to other criteria. Results also imply that cutoff scores of ≥4 for women and ≥6 for men are consistent with a range of risky drinking criteria in older adults.     

Risky drinking and its detection among medical students

The drinking patterns of physicians may affect their own health and how they treat patients with substance use disorders. This is why we wanted to find out risky drinking among medical students. A questionnaire was delivered to all medical students at the University of Tampere and risky alcohol drinking was defined as a minimum score of five for women and six for men in the AUDIT-C alcohol screen (rating 0 to 12). The respondent rate was 94% (n = 465). Of the whole sample 33% were risky drinkers, 24% of women and 49% of men. After the first study year the female risky drinkers significantly decreased and men increased their drinking. Significantly more men but not women with moderate alcohol use reduced drinking during the first year of studies compared with risky drinkers of the same gender. The AUDIT-C scored higher in the subgroups of risky drinkers willing to reduce drinking compared with those who did not want to cut down drinking (7.3. and 6.5., p < 0.001). In the male sample the third AUDIT-C sub-question on binge drinking (= AUDIT-3, rating 0 to 4) at a cut-off point of ≥ 2 was nearly as effective as the whole AUDIT-C at a cut-off point of ≥ 6. This was not the case in the female sub-sample. Risky drinking is common among medical students and continues throughout the studies especially among men. AUDIT-3 is a short and reliable screening tool for male but not for female students.     

Primary care validation of a single screening question for drinkers

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.     

Problem drinking profiles of patients presenting to general practitioners: analysis of Alcohol Use Disorders Identification Test (AUDIT) scores for the Auckland area

AIM: To quantify the prevalence and demography of at-risk and problematic drinkers in the population attending a random selection of general practices and to compare this with similar studies. METHOD: A study examining the uptake and utilisation of the "DRINKLESS" package to 369 New Zealand general practitioners was conducted during 1995/6. The "DRINKLESS" package was developed with the World Health Organisation collaborative study for brief intervention for at-risk alcohol consumption. The package uses the Alcohol Use Disorders Identification Test (AUDIT). There were 15,670 completed AUDIT questionnaires collected during the study. These were analysed to ascertain the prevalence and demography of at-risk and problematic drinkers attending general practitioners. RESULTS: There were 16% of patients identified as having either "risky drinking" or "problematic or dependent drinking". This pattern varied according to the occupation, age and gender of patients. CONCLUSIONS: The data confirm that large numbers of patients presenting to general practitioners experience alcohol problems of varying degrees. This study also suggests that the AUDIT will have satisfactory detection rates in a primary care setting.     

Measuring women's alcohol consumption in an Australian inner-urban community using the AUDIT

The alcohol consumption of a systematically sampled population of women from an Australian inner-urban community was measured using the AUDIT (Alcohol Use Disorders Identification Test) in three different ways to produce varying estimations of hazardous and harmful drinking. The study was located in an area in which there is a high density of licensed premises and its female population contains large numbers of women who are young, students and professionals and thus considered to be potentially risky drinkers. Five hundred and twenty-five women returned completed questionnaires giving a response rate of 74%. Using an AUDIT score of eight as the cut-off point, 21% of women were classified as being at risk of having problems associated with their alcohol consumption. These women were more likely than women who scored less than eight to be beer drinkers, to drink at licensed premises and drink with male and female friends. An association between higher AUDIT scores and being unmarried was found. This paper argues that investigating the social and contextual factors associated with women's potentially problematic drinking can promote more effective community-based interventions.     

The relationship between alcohol screening questionnaires and mortality among male veteran outpatients

OBJECTIVE: This study evaluated whether responses to alcohol screening questionnaires predicted mortality in a Department of Veterans Affairs (VA) primary care population. METHOD: This study involved 5,703 male outpatients (mean age = 64) who were enrolled in General Internal Medicine clinics at three Veterans Affairs (VA) medical centers and returned mailed questionnaires in 1993-94. The two questionnaires included the CAGE and Alcohol Use Disorders Identification Test (AUDIT) alcohol screening tests. Mortality was ascertained using the VA Beneficiary Identification and Record Locator System. Five-year crude and adjusted mortality rates were calculated for patients who screened positive and patients who screened negative on each alcohol screening test. RESULTS: The risk of mortality was increased among drinkers who scored > or = 8 on the full AUDIT (hazard ratio: 1.47; 95% confidence interval [CI]: 1.08-2.00) or the three AUDIT consumption questions (1.58; 1.11-2.27), after adjusting for age, smoking, sociodemographic characteristics and chronic illnesses. The risk of mortality was also increased among drinkers who reported drinking > or = 3 drinks daily (1.69; 1.28-2.22) or prior alcohol treatment (1.66; 1.27-2.17), in "fully adjusted" models. A positive CAGE score (> or = 2) was associated with significantly increased risk of mortality among drinkers in a model adjusted only for age and smoking (1.27; 1.02-1.58). Among nondrinkers, neither a positive CAGE score (> or = 2) nor report of prior alcohol treatment was associated with increased risk of mortality. CONCLUSIONS: VA outpatients who reported drinking during the previous year and who had a positive result on an alcohol screening test experienced higher mortality over the subsequent 5 years than did patients who screened negative.     

Short forms of the AUDIT in a Web‐based study of young drinkers

Introduction. The Alcohol Use Disorders Identification Test (AUDIT) is under‐studied among young drinkers, as are the contributions of individual items to total AUDIT scores, and online performance of the existing briefer versions of this instrument. Design and Methods. This study examined individual items of the AUDIT, and various combinations, including the existing briefer versions, in relation to total AUDIT scores in a Web‐based study of young drinkers. A total of 167 young people aged 16–24 years old who had consumed any alcohol within the previous 7 days were recruited by both offline and online methods. Results. Considered individually, items 3, 4, 5 and 8 were predictive of the majority of the variance in total AUDIT scores in this Web‐based study. Existing briefer versions of the AUDIT do not better predict total scores than possible alternative combinations of items, for which acceptable levels of sensitivity and specificity for screening have been demonstrated. Conclusions. Short forms of the AUDIT, particularly those based only on consumption questions, require further validation study in online applications with young people.[McCambridge J, Thomas BA. Short forms of the AUDIT in a Web‐based study of young drinkers. Drug Alcohol Rev 2009;28:18–24]     

Community pharmacy service users' views and perceptions of alcohol screening and brief intervention

Introduction and Aims. Community pharmacists have the potential to deliver alcohol screening and brief interventions (SBI) to pharmacy users. However, little is known if SBI would be utilised and views of people who might use the service. Therefore, the aim was to investigate potential barriers and enablers of pharmacy SBI. Design and Methods. Purposive sampling was used to select four pharmacies within the London borough of Westminster, UK. Semistructured interview schedule recorded participants' views of pharmacy SBI. The Alcohol Use Disorder Identification Test‐Consumption (AUDIT‐C) was incorporated to record views of high and low‐risk drinkers. Categorical data were analysed and content analysis undertaken. Results. Of the 237 participants (149 female) approached 102 (43%) agreed to be interviewed (63 female). Of these 98 completed AUDIT‐C, with 51 (52%) identified as risky drinkers. Risky drinkers were significantly identified among the younger age group (χ² = 11.03, P = 0.004), professional occupations (χ² = 10.41, P = 0.015), with higher qualifications (χ² = 10.46, P = 0.033), were least frequent visitors to a pharmacy (χ² = 11.58, P = 0.021) and more frequently identified in multiple pharmacy establishments than independents (χ² = 8.52, P = 0.004). Most were willing to discuss drinking (97, 96%) and accept written information (99, 98%). Accessibility and anonymity were reported as positive aspects and concerns were expressed about lack of privacy and time (pharmacist and user). Discussion and Conclusions. This study reports the first results of pharmacy users' views on SBI. Regardless of drinking status, most were willing to utilise the service and positive about pharmacists' involvement.[Dhital R, Whittlesea CM, Norman IJ, Milligan P. Community pharmacy service users' views and perceptions of alcohol screening and brief intervention. Drug Alcohol Rev 2010;29;596–602]     

Prevalence of hazardous-harmful drinking in a southern Thai community

The objective of this study was to identify the prevalence and characteristics of hazardous - harmful drinkers in a Thai community population using a cross-sectional survey in two urban and five rural areas in Southern Thailand. Face-to-face interviews were conducted with 1005 subjects, aged ≥ 35, at the community centres to collect data on demographic characteristics and smoking and drinking patterns. The Alcohol Use Identification Test (AUDIT) was used to classify the subjects into three groups: hazardous - harmful drinkers (AUDIT ≥ 8), non-problem drinkers (AUDIT= 1 - 7) and non-drinkers (AUDIT= 0). Blood samples were drawn from 200 randomly selected subjects to determine the gamma glutamyltransferease (GGT) level. The analysis was performed on 898 respondents, 325 males and 573 females. Age-adjusted prevalence of hazardous - harmful drinkers was 10% (27%in males and 1% in females). Adjusted for other variables, men were seven times (95% CI = 4.2 - 11.5) more likely to be non-problem drinkers and 42 times (95% CI =18.1 - 99.0) more likely to be hazardous - harmful drinkers than women. Median intensity of drinking was 43 g and 25 g per drinking day in the hazardous - harmful and non-problem drinkers, respectively. Of all the subjects, 48%, 25% and 15% of the hazardous - harmful, non-problem and non-drinkers had abnormal GGT. Hazardous - harmful drinking is a prevalent problem in male general population in Thailand. [Assanangkornchai S, Pinkaew P, Apakupakul P. Prevalence of hazardous - harmful drinking in a southern Thai community. Drug Alcohol Rev 2003;22:287 - 293]     

Problem drinking among married men in India: comparison between husband's and wife's reports

Introduction and Aims. This study compared the husband's report and wife's report of her husband's problem drinking, among residents of an urban slum in Bangalore, India. Design and Methods. The data come from a feasibility study to prevent HIV infection among at‐risk women in Bangalore. Household enumeration was carried out (n = 509) to choose 100 married men between 18 and 50 years who reported problem drinking (scores 8 and above) on the Alcohol Use Disorder Identification Test (AUDIT). Wives of these married men, considered to be at risk for HIV because of their husband's hazardous drinking, were subsequently recruited for the study (n = 100). Written informed consent was obtained; wives were asked about the drinking history of their husbands through the AUDIT‐WR (Wife's Report) developed for the present study. Results. Prevalence of problem drinking in the enumerated sample (n = 509) was high (n = 186; 37%). The husband's report and his wife's report of his problem drinking was concordant (r = 0.57–0.75) on eight out of 10 items, and the total AUDIT score. Discussion and Conclusions. The AUDIT‐WR is a reliable and culturally relevant measure of husband's problem drinking. In India, men with problem drinking are hard to reach. Therefore, proxy report of the wife may be useful when the husband is either unavailable or uncooperative for assessment.[Satyanarayana VA, Vaddiparti K, Chandra PS, O'Leary CC, Benegal V, Cottler LB. Problem drinking among married men in India: comparison between husband's and wife's reports. Drug Alcohol Rev 2010]     

Alcohol consumption appears to protect against non-alcoholic fatty liver disease

Aliment Pharmacol Ther 2011; 33: 378–388

Summary

Background Moderate alcohol consumption may have certain beneficial effects against non‐alcoholic fatty liver disease, which is associated with metabolic syndrome. Aim To determine the association between drinking pattern and fatty liver in Japanese men and women. Methods A cross‐sectional study was performed with health checkup data including information concerning alcohol consumption and ultrasonographic assessment of fatty liver. Results We analysed 4957 men and 2155 women without reported liver diseases (median age, 49 years). In men, 40% of nondrinkers and 28% of drinkers had fatty liver. Alcohol consumption was inversely associated with fatty liver (adjusted odds ratio, 0.54; 95% confidence interval, 0.46–0.63). The prevalence of fatty liver in each category of drinking frequency was 38% (1–3 days/week), 29% (4–6 days/week), and 24% (daily drinking); there was a significant inverse correlation between drinking frequency and the prevalence of fatty liver (P < 0.001). In women, 16% of nondrinkers and 10% of drinkers had fatty liver. Drinking less than 20 g on 1–3 days/week was associated with low prevalence of fatty liver (adjusted odds ratio, 0.47; 95% confidence interval, 0.23–0.96). Conclusions Alcohol consumption appears to protect against non‐alcoholic fatty liver disease.     

Gender and the assessment of at-risk drinking: evidence from the GENACIS Canada (2004-2005) telephone survey version of the AUDIT

The alcohol use disorders identification test (AUDIT) is widely used in general population surveys as a method of determining prevalence of hazardous drinking. However, its interpretation has been questioned particularly regarding the unequal contribution of the items to the total score, specifically, that the drinking frequency item contributes disproportionately to the score and may lead to inappropriate identification of some drinkers as hazardous drinkers. To explore these issues further as well as possible gender differences in the applicability of the AUDIT, we conducted analyses using a modified version of the AUDIT (AUDIT(M)) as part of a general population survey that used random digit dialing and computer-assisted telephone interviewing. Item and factor analyses were performed separately for men and women, and the impacts of excluding the frequency of drinking item in the measurement of mean scores, percentages and types of problems for men and women were examined. We found that the AUDIT(M) items loaded onto three distinct dimensions for both men and women: frequency of drinking; usual quantity and frequency of heavy-episodic drinking; problem consequences from drinking. In addition, we found that excluding the frequency question may give a more meaningful estimate of the percent of drinkers actually at risk of experiencing problems from drinking for both men and women. Finally, although our analyses identified only minor gender differences in the structure of the AUDIT and good sensitivity for identifying problem drinkers among both men and women, significant gender differences in the types of problems experienced suggest that use and interpretation of the AUDIT should routinely take gender into consideration.     

Comparison of Short Questionnaires on Alcohol Drinking Behavior in a Nonclinical Population of 36-Year-Old Men and Women

Little is known on the diagnostic characteristics of brief questionnaires on alcohol drinking behaviors. This report investigates the determinants of three short alcohol questionnaires and investigates their diagnostic utility as screening tools for alcohol-related problems in a general population from The Netherlands. This report uses cross-sectional data obtained in the year 2000 from 36-year-old healthy male (N = 166) and female (N = 165) volunteers who reported to drink alcohol at least occasionally. Since they were 13-years-old these volunteers have been members of the Amsterdam Growth And Health Longitudinal Study, which started as a school-based study in 1977. Among many other variables, quantity–frequency questions (QF), the CAGE questionnaire, and a question on the highest number of alcoholic units consumed on one occasion during the previous month (MAX) were asked. The sensitivity, specificity, Cohen's kappa, and diagnostic odds ratio of QF, CAGE, MAX, and combinations of these three brief questionnaires were calculated using a 7-item questionnaire on alcohol-related problems as reference. Both in women and men, the prevalence of most alcohol-related problems and of a high QF, CAGE, and MAX was low. QF, CAGE, and MAX, as well as all possible combinations of the three questionnaires, were poor in detecting last-year alcohol-related problems. The CAGE appeared to perform worse than the even shorter and easier-to-interpret QF and MAX. In this healthy population of 36-year-old men and women, using the QF, MAX, and especially the CAGE questionnaire as screening instruments for alcohol-related problems resulted in many false positive and false negative classifications.     

Do primary care physicians’ own AUDIT scores predict their use of brief alcohol intervention? A cross-sectional survey

BACKGROUND: To define whether the Alcohol Use Disorders Identification Test (AUDIT) scores of primary care physicians themselves predict their willingness to use brief alcohol intervention. METHODS: Cross-sectional self-administered questionnaire survey to all 3193 physicians providing primary health care in Finland. The response rate was 1909 (59.8%). Odds ratios from multinomial regression analysis were calculated for self-reported frequency (never, occasionally or regularly) of conducting brief interventions by physicians with AUDIT scores of 0-1, 2, 3, 4, 5-7 or >or=8. RESULTS: The prevalence of heavy drinkers based on AUDIT score (>or=8) was 14.5% among all physicians, 7.0% among females and 27.0% among males. Of the respondents 9.4% reported doing brief intervention regularly and 50.0% occasionally. AUDIT scores did not significantly predict either regular or occasional use of brief intervention. Instead, some other independent predictors for more frequent use of brief intervention were found. These included having a specialist licence in general practice or occupational health care and the location of the practice, but not gender or age. CONCLUSIONS: The present results indicate that in general heavy drinking among primary care physicians do not explain the low frequency with which brief intervention is used in primary health care.