Can a single question effectively rule-out unhealthy alcohol use in adults ?

Participants were asked, "How many times in the past year have you had X or more drinks in a day?", where X is 5 for men and 4 for women, and a response of 1 or more times is considered positive. This single question is fairly good at ruling out unhealthy use of alcohol in a high prevalence population, with a sensitivity of 81.8%. It is better for excluding patients with alcohol use disorder (sensitivity = 87.9%).

Synopsis:

To conduct this study, researchers approached 286 patients being seen for various reasons in a general internal medicine clinic of an urban safety net hospital. Approximately half the patients were men, 72% had graduated from high school, and 63% were Black or African American. Almost half (46.5%) had a current or past history of a drug use disorder. The prevalence of unhealthy alcohol use -- risky alcohol consumption or an alcohol use disorder -- was 30.8%, and only 6.3% of patients were totally free of alcohol-related problems in their lifetimes. All patients were asked a prescreening question about any alcohol use and 10 were asked the single screening question regardless of the answer to the first question. Alcohol use was defined as risky alcohol consumption, using a 30-day recall of alcohol use. Alcohol use disorder was assessed by using the Composite International Diagnostic Interview Substance Abuse Module to identify abuse and dependence. The single question was 81.8% sensitive and 79.3% specific for identifying any unhealthy use of alcohol. Sensitivity was higher (87.9%) for detecting alcohol use disorder but less specific (66.8%). These results were similar to the 3-question Alcohol Use Disorders Identification-Consumption (AUDIT-C) screening test also administered to the same patients. This study was administered by a research associate and not the patients' individual physicians, and results in clinical practice may be different.

Reference:

Smith PC, Schmidt SM, Allensworth-Davies D, Saitz R. Primary care validation of a single-question alcohol screening test. J Gen Intern Med 2009;24(7):783-788.