Screening Tests

Several hundred screening instruments are available today to aid clinicians and others in identifying patients with alcohol problems. Many of these tools are presented in the guide, Assessing Alcohol Problems: A Guide for Clinicians and Researchers,1 available from the National Institute on Alcohol Abuse and Alcoholism. (1 National Institute on Alcohol Abuse and Alcoholism. Assessing Alcohol Problems: A Guide for Clinicians and Researchers, 2d ed. NIH Pub. No. 033745. Washington, DC: U.S. Dept. of Health and Human Services, Public Health Service. Revised 2003, may be accessed online at www.niaaa.nih.gov/publications/protraining.htm.) This issue of Alcohol Research & Health highlights some of the most popular screening tools for identifying hazardous or risky drinking. Two instruments in particular, the AUDIT and the CAGE, are cited throughout this issueprimarily because of their usefulness in a variety of settings and with a range of target populations. In contrast, the T-ACE is a test developed to ascertain drinking in a very specific populationpregnant women. The AUDIT, CAGE, and T-ACE are presented here in their entirety. See the Assessing Alcohol Problems guide for a full description of these and other instruments, including their target audiences, reliability, clinical utility, research applications, and source references, as well as administrative issues such as scoring, time requirements, training required to deliver the screening tests, their costs, and copyright issues. CAGE C Have you ever felt you should cut down on your drinking? A Have people annoyed you by criticizing your drinking? G Have you ever felt bad or guilty about your drinking? E Eye opener: Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover? The CAGE can identify alcohol problems over the lifetime. Two positive responses are considered a positive test and indicate further assessment is warranted.

T-ACE T A C E

Tole Have Have Eyestea The T-ACE, w use, including score of 2 or m or E = 1 point e = 2 points.

The Alcohol Use Disorders Identification Test (AUDIT) can detect alcohol problems experienced in the last year. A score of 8+ on the AUDIT generally indicates harmful or hazardous drinking. Questions 18 = 0, 1, 2, 3, or 4 points. Questions 9 and 10 are scored 0, 2, or 4 only.

Appendix B: DSM-IV-TR Diagnostic Criteria for Alcohol Abuse and Dependence

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ALCOHOL ABUSE
(A) A maladaptive pattern of drinking, leading to clinically significant impairment or distress, as manifested by at least one of the following occurring within a 12-month period: Recurrent use of alcohol resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to alcohol use; alcohol-related absences, suspensions, or expulsions from school; neglect of children or household) Recurrent alcohol use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by alcohol use) Recurrent alcohol-related legal problems (e.g., arrests for alcohol-related disorderly conduct) Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol (e.g., arguments with spouse about consequences of intoxication). (B) Never met criteria for alcohol dependence. Go to:

ALCOHOL DEPENDENCE
(A) A maladaptive pattern of drinking, leading to clinically significant impairment or distress, as manifested by three or more of the following occurring at any time in the same 12-month period: Need for markedly increased amounts of alcohol to achieve intoxication or desired effect; or markedly diminished effect with continued use of the same amount of alcohol The characteristic withdrawal syndrome for alcohol; or drinking (or using a closely related substance) to relieve or avoid withdrawal symptoms Drinking in larger amounts or over a longer period than intended. Persistent desire or one or more unsuccessful efforts to cut down or

control drinking Important social, occupational, or recreational activities given up or reduced because of drinking A great deal of time spent in activities necessary to obtain, to use, or to recover from the effects of drinking Continued drinking despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to be caused or exacerbated by drinking. (B) No duration criterion separately specified, but several dependence criteria must occur repeatedly as specified by duration qualifiers associated with criteria (e.g., persistent, continued). Source: Adapted from American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. Washington, DC: APA, 2000.