What are the types of alcoholic screening tests, such as Alcohol Use Disorders Identification Test (AUDIT)?

From the Guidelines

The AUDIT (Alcohol Use Disorders Identification Test) is the most effective screening tool for detecting alcohol-related problems in primary care settings, with an optimal balance of sensitivity and specificity when cutoff points of 4 or more are used 1. The AUDIT is a 10-question assessment that evaluates alcohol consumption patterns, dependence symptoms, and alcohol-related problems. Some of the key questions in the AUDIT include:

• How often do you have a drink containing alcohol?
• How many drinks containing alcohol do you have on a typical day when you are drinking?
• How often do you have 5 or more drinks on one occasion? For quicker screenings, the CAGE questionnaire (focusing on Cutting down, Annoyance by criticism, Guilty feelings, and Eye-openers) provides a simple 4-question format. The MAST (Michigan Alcoholism Screening Test) offers a more comprehensive 25-question evaluation for detecting alcohol dependence. For primary care settings, the AUDIT-C (a 3-question version of AUDIT) and the Single Alcohol Screening Question (SASQ) provide efficient options. These screenings help identify potential alcohol use disorders early, allowing for timely intervention. Healthcare providers typically select a screening tool based on the clinical setting, available time, and the specific patient population. Regular screening is recommended as part of routine healthcare visits, particularly in emergency departments, primary care, and mental health settings where alcohol-related issues are commonly encountered 1. The sensitivity and specificity of AUDIT-C are best balanced at cutoff points of 4 or more (74% to 76% and 80% to 83%, respectively) and 3 or more (74% to 88% and 64% to 83%, respectively) 1. Single-question screening has a reported sensitivity of 82% to 87% and specificity of 61% to 79% 1. However, the sensitivity of these screening tests varies by sex and achieving similar sensitivity for women requires a cutoff 1 point lower than that for men 1. Although the CAGE questionnaire has frequently been used in primary care settings as a low-burden screening tool for alcohol disorders, it has comparatively poor sensitivity for identifying risky or hazardous drinking, particularly among older adults and pregnant women 1. The USPSTF prefers the AUDIT, AUDIT-C, and single-question screening approaches due to their optimal performance characteristics for detecting the full spectrum of alcohol misuse in adults, young adults, and pregnant women 1. Brief counseling interventions in adults with screening-detected risky or hazardous drinking have been shown to positively affect several unhealthy drinking behaviors, including heavy episodic drinking, high average weekly intake of alcohol, and consumption above recommended intake limits 1. Twenty-three randomized, controlled trials compared the effects of behavioral counseling interventions with usual care in adults with screening-detected alcohol misuse, with most interventions evaluating brief counseling sessions 1. The USPSTF found adequate evidence that brief counseling interventions in adults with screening-detected risky or hazardous drinking positively affect several unhealthy drinking behaviors 1. Overall, the AUDIT is the most effective screening tool for detecting alcohol-related problems in primary care settings, and regular screening is recommended as part of routine healthcare visits.

From the Research

Types of Alcoholic Screening Tools

There are several types of alcoholic screening tools, including:

• CAGE questionnaire: a short, easily administered questionnaire that asks about attempts to cut back on drinking, being annoyed at criticisms about drinking, feeling guilty about drinking, and using alcohol as an eye opener 2
• AUDIT (Alcohol Use Disorders Identification Test): a screening tool developed for use in primary health care settings to identify hazardous and harmful patterns of alcohol consumption 3, 4
• Serum gamma-glutamyl transferase (GGT): an objective blood biochemical marker of excessive alcohol intake 5
• Combination of CAGE and GGT: a sensitive and useful tool for alcohol dependence screening 5

Effectiveness of Alcoholic Screening Tools

The effectiveness of these screening tools varies:

• The CAGE questionnaire has a sensitivity of 85% and a specificity of 89% for detecting alcohol abuse 2
• The AUDIT has a high sensitivity and specificity for detecting hazardous and harmful patterns of alcohol consumption, but its performance varies by sex and population 3
• The combination of CAGE and GGT has been shown to be effective in screening for alcohol dependence, with a high sensitivity and specificity 5
• Serum GGT has a low sensitivity for detecting excessive alcohol intake, but can be useful when combined with other screening tools 5, 6

Limitations of Alcoholic Screening Tools

There are limitations to these screening tools:

• The AUDIT may not perform well in identifying women or individuals with a low prevalence of alcohol use disorders 3
• The CAGE questionnaire may not detect all cases of alcohol abuse, and its sensitivity and specificity can vary depending on the population being screened 2, 6
• Serum GGT and other laboratory parameters may have low sensitivity and specificity for detecting alcohol dependence, and should be used in combination with other screening tools 6