Identification of risk drinking women: T-ACE screening tool or the medical record

Risk drinking for women is defined by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) as >7 drinks per week or >3 drinks per occasion. This study compares the T-ACE screening tool and the medical record for identification of risk drinking by 611 women receiving outpatient treatment for diabetes, hypertension, infertility, or osteoporosis in Boston, Massachusetts, between February 2005 and May 2009.

All subjects completed a diagnostic interview about their health habits, and medical records were abstracted. Calculations were weighted to reflect the oversampling of risk drinking women.

T-ACE-positive women (n = 419) had significantly more drinks per drinking day (2.1 vs. 1.6, p < 0.0001) and a trend toward more binges (6.3 vs. 3.8, p = 0.07) but similar percent drinking days and risk drinking weeks compared with those with negative screens (n = 192). Among the 521 (85%) medical records available, 46% acknowledged alcohol use, 25% denied use, and 29% were silent. The rates of abstinence among women were 2%, 17%, and 4%, respectively. Significantly more women were risk drinkers (63%) and had current alcohol use disorders (12%) when their medical records acknowledged alcohol use.

The main findings of this study are that neither the T-ACE nor the medical record was especially effective in identifying risk drinking by the women enrolled in the study. The identification of risky or heavy alcohol use in women, particularly if they have health problems exacerbated by alcohol, is desirable and represents an area of improvement for patients and providers alike.