Alcohol screening instruments and psychiatric evaluation outcomes in military aviation personnel

Alcohol-related disorders are the most prevalent psychiatric conditions in the aviation population. Efforts to effectively screen aviators for these disorders are continually sought, as underdiagnosis may negatively impact aviation safety. This study evaluates screening tools that have been validated in non-aviators in terms of their utility for aviator patients.

There were 111 male aviation patients (27 +/- 7 yr) referred for psychiatric evaluation at the Naval Aerospace Medicine Institute who completed the Self-Administered Alcohol Screening Test (SAAST), the Alcohol-Use Disorders Identification Test (AUDIT), and the Common Alcohol Logistical Scale-Revised (CAL-R) prior to evaluation by a staff psychiatrist or psychologist.

There were 40 patients who were qualified psychiatrically with no diagnosis and 49 patients who were disqualified for psychiatric reasons due to a non alcohol-related diagnosis. The remaining 22 patients were disqualified for psychiatric reasons with an alcohol-related diagnosis. The optimal aviator cut-off scores were consistent with those of the general population, although the cut-off score used for the SAAST was set at the published sub-threshold level to provide greater sensitivity. The sensitivity/specificity values for the SAAST, AUDIT, and CAL-R were 59%/94%, 46%/96%, and 68%/81%, respectively.

The psychometrically sophisticated CAL-R is sensitive, specific, and has good negative predictive value, although its use requires a psychologist and its availability is limited. The SAAST and AUDIT can be administered by a flight surgeon or aviation medical examiner (AME). Given the higher sensitivity of the SAAST it may be the most beneficial if administered first. The AUDIT can be used as a follow-up diagnostic test given its higher specificity.