Screening - Alcohol Use Disorders

Screening

Systematic clinical assessment often begins with routine screen-ing to identify active cases, as well as persons at risk. During the past 25 years a number of self-report screening tests have been developed to identify alcoholics as well as persons at risk of alco-hol problems. The Michigan Alcoholism Screening Test (MAST), developed by Selzer (1971), is one of the most often cited instru-ments. It contains 25 items that ask about drinking habits, as well as social, occupational and interpersonal problems associated with excessive drinking. A total score is calculated, placing the individual along a continuum from “nonalcohol dependent” to “definitely alcohol dependent”. There are several shortened ver-sions of the MAST (e.g., the 10-item Brief MAST, the 13-item Short MAST and the 35-item Self-Administered Alcohol Screen-ing Test – SAAST). Perhaps the most widely used alcohol screen-ing test is the CAGE (Ewing, 1984), which contains only four questions: 1) Have you ever felt you ought to Cut (the “C” in CAGE) down on your drinking? 2) Have people Annoyed (A) you by criticizing your drinking? 3) Have you ever felt bad or Guilty (G) about your drinking? 4) Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover that is, an Eye opener (E)? Reliability and validity studies of this test have been conducted in diverse samples (e.g., psychiatric inpatients, ambulatory medical patients, prenatal clinics), with generally acceptable levels of sensitivity. The Alcohol Use Dis-orders Identification Test (AUDIT) (Saunders et al., 1993; Babor), a 10-item screening instrument, may be used as the first step in a comprehensive and sequential alcohol use history. The AUDIT (Table 35.2) covers the domains of alcohol consumption, symp-toms of alcohol dependence and alcohol-related consequences. It has been shown to be sensitive and specific in discriminating alcoholics from nonalcoholics, and is superior to the MAST in identifying hazardous drinkers, that is, those heavy drinkers who have not yet experienced serious harm from their drinking (Bohn et al., 1995). The AUDIT total score increases with the severity of alcohol dependence and related problems, and can be used as part of a comprehensive approach to early identification and pa-tient placement. Because the misuse of both prescribed and illicit.

drugs is common among alcoholics, screening should include other psychoactive substances, including tobacco products.