The effectiveness of routine screening questions in the detection of alcoholism

To assess the prevalence of alcoholism in an ambulatory medical clinic and to determine the effectiveness of screening questions for alcoholism, 232 new patients in a medical primary care unit were interviewed using a questionnaire that included the Michigan Alcoholism Screening Test (MAST). Based on MAST scores, 47 of 232 subjects were designated as alcoholics, yielding a prevalence of alcoholism of 20.3%. Sensitivities and specificities for alcohol-use questions were calculated using the MAST diagnosis of alcoholism. The questions "How much do you drink?" and "How often do you drink?" yielded low sensitivities of 34.0% and 46.8%, respectively. The question "Have you ever had a drinking problem?" considered alone had a high sensitivity of 70.2%; when combined with "When was your last drink?" this question had a sensitivity of 91.5%. We recommend the routine incorporation of these last two questions into the medical history in light of the high prevalence of alcoholism in this outpatient population.