Two Simple Questions Help Doctors Identify Alcoholics

Primary care doctors have a range of screening tools at their disposal for the detection of diagnosable cases of alcohol use disorder (alcoholism and alcohol abuse). However, they may not have the time to administer such a screening to every patient they see over the course of a day or week. In a study published in July 2014 in the British Journal of General Practice, researchers from three British institutions sought to determine if doctors can accurately identify significant drinking problems with the help of a shorter, less time-consuming screening procedure that consists of only one or two questions.

Alcohol Use Disorder

The terms of alcohol use disorder allow doctors to diagnose serious drinking problems in any person who has at least two out of 11 relevant symptoms. Examples of these symptoms include repeatedly drinking more alcohol than planned, experiencing a rising tolerance to the effects of alcohol, allocating outsized amounts of time and/or resources to drinking-related activities, experiencing recurring alcohol cravings, experiencing noteworthy negative consequences from drinking and continuing to drink after going through clearly negative alcohol-related experiences. Some of these symptoms traditionally belong to a separately maintained definition for alcoholism, while others traditionally belong to a separately maintained definition for non-addicted alcohol abuse. As a reflection of the modern scientific consensus on the intertwined nature of alcoholism and alcohol abuse, the alcohol use disorder diagnosis treats the symptoms of both drinking issues as equally relevant and co-occurring problems.

Available Screening Tools

A screening tool is a test that a doctor can use to identify people likely to have a certain mental or physical health issue. The results of a screening do not qualify as an official diagnosis; however, they give health professionals preliminary information that can lead to a diagnosis. Two of the most widely used screening tools for the detection of significant drinking problems are the Alcohol Use Disorders Identification Test (AUDIT) and the CAGE questionnaire. The AUDIT screening contains 10 questions that probe alcohol-related behaviors in the individual; the screening also comes in a shorter three-question form called AUDIT-C. The CAGE questionnaire contains five alcohol-related questions. Longer screening tools for drinking problems include the Michigan Alcohol Screening Test, which contains 25 questions. As a rule, primary doctors (who by definition do not specialize in substance treatment) tend to rely on shorter screening procedures, as long as those procedures are relatively accurate. However, partly due to time constraints, many primary physicians do not regularly screen their patients for alcohol problems.

One or Two Questions

In the study published in the British Journal of General Practice, researchers from the Leicester Royal Infirmary, the National Collaborating Centre for Mental Health and the University of Leicester used an analysis of 17 previous projects to determine if primary doctors with no specialization in substance-related issues can accurately identify drinking problems with just a single question or with two questions. The questions under consideration were, “How often do you have six or more drinks on one occasion?” and, “As a result of your drinking, did anything happen in the last year that you wish didn’t happen?” All told, 5,646 people were asked these questions by their doctors.

After completing their analysis, the researchers concluded that the single question, “How often do you have six or more drinks on one occasion?” led to the identification of people affected by alcohol problems 54.5 percent of the time and also led to the accurate identification of unaffected people 87.3 percent of the time. The accuracy rate for identifying affected individuals increases when both questions are asked. In combination, they led to the identification of people affected by alcohol problems fully 87.2 percent of the time and also led to the identification of unaffected people 79.8 percent of the time.

The study’s authors believe that the combined use of the two indicated questions produces results accurate enough to significantly increase doctors’ ability to administer alcohol screenings in a sufficiently brief amount of time. They note that people who test positive for drinking problems after answering the questions should receive a longer follow-up screening such as AUDIT or the CAGE questionnaire. The additional use of one of these longer screenings increases the accuracy of the overall results by a relatively small but substantial amount. The study’s authors emphasize the usefulness of the shorter screening procedure for identifying people not normally thought of as at-risk alcohol consumers.

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