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Screening for alcohol problems in primary care: a systematic review.

D A Fiellin1, M C Reid, P G O'Connor

  • 1Yale University School of Medicine, 333 Cedar St, PO Box 208025, New Haven, CT 06520-8025, USA. david.fiellin@yale.edu.

Archives of Internal Medicine
|July 11, 2000
PubMed
Summary

Formal screening tools like AUDIT and CAGE are effective for detecting alcohol problems in primary care. These methods improve recognition compared to other clinical approaches, despite study limitations.

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Area of Science:

  • Medical Research
  • Diagnostic Accuracy
  • Public Health

Background:

  • Primary care physicians are crucial for identifying and managing alcohol-related issues.
  • Early detection of alcohol problems in primary care settings is essential for patient outcomes.

Purpose of the Study:

  • To systematically evaluate the diagnostic accuracy of various screening methods for alcohol problems within primary care settings.
  • To compare the effectiveness of different screening instruments against established criteria.

Main Methods:

  • A comprehensive literature search of MEDLINE (1966-1998) was conducted for relevant English-language studies.
  • Studies focusing on primary care settings and reporting performance characteristics of screening tools were included.
  • Two independent reviewers assessed the methodological quality and results of selected articles.

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Main Results:

  • Thirty-eight studies were analyzed, evaluating tools for at-risk drinking and alcohol abuse/dependence.
  • The Alcohol Use Disorders Identification Test (AUDIT) showed high sensitivity and specificity for at-risk drinking.
  • The CAGE questionnaire was most effective for detecting alcohol abuse and dependence, outperforming other methods.

Conclusions:

  • Formal screening instruments, such as AUDIT and CAGE, are recommended for identifying alcohol problems in primary care.
  • Despite existing methodological limitations in the reviewed studies, these tools enhance problem recognition.
  • Future research should emphasize adherence to rigorous methodological standards for diagnostic test evaluations.