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Alcohol Screening Tests Ideal for Healthcare Settings

Initial Diagnosis Can Be Followed Up With In-Depth Testing

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Updated May 16, 2014

Cage Test/Alcohoism
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Physician offices and urgent care centers provide the best opportunity to screen patients for alcohol problems, but research shows that even patients with classic alcohol abuse symptoms are screened only 30 percent of the time in busy health-care settings.

Although hundreds of alcohol screening tests are available, including some elaborate ones with up to 100 questions, short screening tests with only a few questions have been developed to encourage diagnosis in primary and emergency health-care situations.

The shorter tests may not be as accurate or sensitive as the longer ones, but they serve well to screen harmful drinking or alcohol dependence which can be followed up with further in-depth assessment using the more elaborate tests.

The CAGE Test

One of the oldest and most popular screening tools for alcohol abuse is the CAGE test, which is a short, four-question test that diagnoses alcohol problems over a lifetime.

    C - Have you ever felt you should cut down on your drinking?

    A- Have people annoyed you by criticizing your drinking?

    G - Have you ever felt bad or guilty about your drinking?

    E - Eye opener: Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?

Because denial usually accompanies alcohol abuse problems, the CAGE test, like most alcohol screening tests, asks questions about problems associated with drinking rather than the amount of alcohol consumed. Two "yes" answers to the CAGE test indicates problems with alcohol.

The disadvantage of the CAGE test is that it is most accurate for white, middle-aged men and not very accurate for identifying alcohol abuse in older people, white women, and African and Mexican Americans.

The T-ACE Test

The T-ACE test is also only four questions, including three found on the CAGE test, but it has proved to be more accurate in diagnosing alcohol problems in both men and women.

    T - Does it take more than three drinks to make you feel high?

    A - Have you ever been annoyed by people's criticism of your drinking?

    C - Are you trying to cut down on drinking?

    E - Have you ever used alcohol as an eye opener in the morning?

Again, "yes" answers to two of these four questions is an indication of possible alcohol abuse or dependence.

The AUDIT Test

One of the most accurate tests available is the Alcohol Use Disorders Identification Test (AUDIT), which can be accurate 94 percent of the time. It is also accurate across ethic and gender groups. The test contains 10 multiple choice questions that are scored on a point system. A score of more than eight indicates an alcohol problem.

The disadvantage of the AUDIT test, developed by the World Health Organization, is that it takes longer to administer and is more difficult to score than the shorter tests.

Five-Shot Questionnaire

This is another popular short test that contains five multiple-choice questions. It is composed of two questions from the AUDIT test and three questions from the CAGE test. The Five-Shot test is designed to be a shorter form of the AUDIT Questionnaire.

The RAPS4 Test

The Rapid Alcohol Problems Screen (RAPS) asks questions similar as the CAGE test, but from a different perspective. One "yes" answer on the RAPS4 test indicates a possible alcohol abuse problem and the results have shown to be very accurate across gender and ethnic groups.

The TWEAK Test

The TWEAK is a five-item test developed originally to screen for risk drinking during pregnancy. It includes three of the CAGE questions and also asks about the patient's tolerance and blackouts.

The MAST Test

The Michigan Alcohol Screening Test is one of the oldest and most accurate alcohol screening test available. It contains 22 yes-or-no questions with six positive responses indicating a drinking problem. The disadvantage to the MAST test is its length and time required to score in a busy medical office. One advantage of this test is that it also effectively diagnoses adolescents.

The FAST Test

The FAST test is a four-question quiz which was designed specifically for patients being treated in urgent care or emergency room situations. The test is quick and easy to score, but research shows it only detects 90 percent of alcohol problems that are detected using the AUDIT test.

Paddington Alcohol Test

The Paddington Alcohol Test was also designed to be given to patients being treated for falls and accidents in the emergency room. The test contains only three questions and is easy to score. The disadvantage to the PAT test is that it asks direct questions about how much alcohol the patient consumes, which patients tend to minimize or deny.

The SAAST Test

The Self-Administered Alcoholism Screening Test (SAAST) is a 35-question test which asks questions about the patient's loss of control, job performance, drinking consequences, and family history of alcoholism. One major advantage of the SAAST test is that there is a version of the test that can be filled out by someone who knows the patient, such as their spouse.

The disadvantage of the SAAST test is that it is not accurate with older people, white women, and African and Mexican Americans, research has indicated.

Tests for Adolescents

Several tests are designed specifically to diagnose alcohol problems in adolescents. They include:

  • Adolescent Alcohol Involvement Scale (AAIS)
  • Adolescent Obsessive-Compulsive Drinking Scale (A-OCDS)
  • Alcohol Expectancy Questionnaire - Adolescent Form
  • Comprehensive Adolescent Severity Inventory (CASI)
  • Customary Drinking and Drug Use Record (CDDR)
  • Personal Experience Screening Questionnaire (PESQ)
  • Problem Recognition Questionnaire (PRQ)
  • Teen Addiction Severity Index (T-ASI)

Sources:

National Institute on Alcoholism and Alcohol Abuse. Screening Tests. August 2004.

Alcohol Concern. "Primary Care Alcohol Information Service - Screening tools for healthcare setting." Retrieved 2007.

National Council on Alcoholism and Drug Dependence of the San Fernado Valley. "Michigan Alcohol Screening Test (MAST)." Retrieved May 2007.

National Institute on Alcoholism and Alcohol Abuse. Assessing Alcohol Problems - A Guide for Clinicians and Researchers, Second Edition. 2003.

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