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CORK Bibliography: Screening Tests

108 citations. January 2006 to present

Prepared: June 2007

Aalto M; Seppa K. Use of laboratory markers and the AUDIT questionnaire by primary care physicians to detect alcohol abuse by patients. Alcohol and Alcoholism 40(6): 520-523, 2005. (14 refs.)

Aims: To evaluate how often laboratory markers [Mean corpuscular volume (MCV), Gamma-glutamyl transferase, Aspartate aminotransferase, Alanine aminotransferase, or Carbohydrate-deficient transferrin (CDT)] and the Alcohol Use Disorders Identification Test (AUDIT) are used to detect alcohol abuse in primary health care. Methods: Cross-sectional self-administered questionnaire survey to all 3193 primary health care physicians in Finland. Response rate was (65.7%). Results: CDT was used at least occasionally by 43.4% of the physicians. Corresponding figures were 53.4% for conventional alcohol laboratory markers (MCV, transaminases) and 67.0% for AUDIT. Almost all the respondents used some laboratory marker to detect alcohol abuse. The use of brief alcohol intervention was associated with the greater likelihood that a physician uses different methods to detect alcohol abuse. The data also indicates that gender, age, and having a specialist licence influence activity in using different methods. Conclusions: Considering the ambivalences in relation to alcohol issues in health care, the use of CDT and AUDIT are reasonably frequent. This may indicate that tools to facilitate the work may also help in adapting new activities.

Aalto M; Tuunanen M; Sillanaukee P; Seppa K. Effectiveness of structured questionnaires for screening heavy drinking in middle-aged women. Alcoholism: Clinical and Experimental Research 30(11): 1884-1888, 2006. (19 refs.)

Background: There is a need for an effective and feasible alcohol screening instrument. The aim of the study was to evaluate how the abbreviated versions of the Alcohol Use Disorders Identification Test (AUDIT) questionnaire perform in comparison with the original AUDIT and what the optimal cutoffs are when screening for heavy drinking among women. Methods: All the 40-year-old women in the city of Tampere, Finland, are invited yearly for a health screening. From 1 year, data from 894 women (response rate 68.2%) invited for a health screening were utilized in the study. The original 10-item AUDIT, AUDIT-C, Five Shot, AUDIT-PC, AUDIT-3, AUDIT-QF, and CAGE were evaluated against the Timeline Followback. Consumption of at least 140 g of absolute ethanol per week on average during the past month was considered heavy drinking. Results: In the Timeline Followback, the mean +/- SD weekly reported alcohol consumption was 45 +/- 67 g (range 0-936 g) of absolute ethanol. Of the women, 6.2% (55/894) were heavy drinkers. The optimal combination of sensitivity and specificity was reached for the AUDIT with cutoff >= 6, for the AUDIT-C with cutoff >= 5, for the Five Shot with cutoff >= 2.0, for the AUDIT-PC with cutoff >= 4, and for the AUDIT-QF with cutoff >= 4. When choosing the optimal cutoffs, the AUDIT-C, the Five Shot, the AUDIT-PC, and the AUDIT-QF performed as well as the 10-item AUDIT. With these cutoffs, sensitivities were 0.84 to 0.93 and specificities were 0.83 to 0.90. The AUDIT-3 and the CAGE did not perform as well as the other questionnaires. Conclusions: The 10-item AUDIT, AUDIT-C, Five Shot, AUDIT-PC, and AUDIT-QF seem to be equally effective tools in screening for heavy drinking among middle-aged women. However, their applicability is achieved only if the cutoffs are tailored according to gender.

Adewuya AO. Validation of the Alcohol Use Disorders Identification Test (AUDIT) as a screening tool for alcohol-related problems among Nigerian university students. Alcohol and Alcoholism 40(6): 575-577, 2005. (15 refs.)

Aims: To investigate the screening properties of the alcohol use disorders identification test (AUDIT) in the detection of alcohol-related problems among Nigerian university students. Methods: Eight hundred and ten students completed the AUDIT. A percentage of them were assessed for alcohol-related diagnosis with structured clinical interview. Results: The AUDIT at cut-off of 5 and above could clearly identify participants with alcohol-related problems with sensitivity of 0.935 and specificity of 0.915. Conclusions: The AUDIT is a valid instrument for screening for alcohol-related problems in Nigerian university students.

Aros S; Mills JL; Torres C; Henriquez C; Fuentes A; Capurro T et al. Prospective identification of pregnant women drinking four or more standard drinks (>= 48 g) of alcohol per day. Substance Use & Misuse 41(2): 183-197, 2006. (15 refs.)

We aimed to identify drinking rates in a prospectively identified cohort of pregnant women, and subsequently, to identify the drinkers of 48 g or more alcohol/day among them, by using complementary methods for verifying self/reported drinking habits. A research team of social workers and health professionals at the Maipu Clinic, located in a lower middle class neighborhood of Santiago, Chile, conducted interviews of women attending a prenatal clinic between August 1995 and July 2000. Women whose interview responses met predefined criteria (identified in the text) were further evaluated by home visits. We interviewed 9,628 of 10,917 (88%) women receiving prenatal care. By initial interview, 42.6% of women reported no drinking, 57.4% some alcohol consumption, and 3.7% consuming at least one standard drink (15 mL of absolute alcohol) per day. Of the 887 women who had home visits, 101 were identified as consuming on average at least 4 drinks/day (48 g). To determine the best home visit questionnaire items for identifying those drinking at least 4 drinks per day, 48 women who openly admitted drinking this amount were compared with 786 women who were not considered drinkers after the home visit. The 48 self-reported 48 g/day drinkers were significantly more likely to get tipsy when drinking before (p = 0.01) or during (p < 0.0001) pregnancy, to have started drinking at a younger age (p = 0.007), or to exhibit signs of low self-esteem (p < 0.0001), sleep or appetite problems (p < 0.0001), bad interpersonal relationships (p < 0.0001) or having family members with fetal alcohol syndrome features (p < 0.009). In conclusion, using complementary methods of alcohol misuse ascertainment during pregnancy, we found that at least 1% of pregnant women in a Santiago, Chile, clinic population were drinking at levels that are clearly dangerous to the fetus (48 g/day or more). We identified specific interview questions that may help screen for alcohol use of 48 g/day or more in pregnant women.

Babor TF; Kadden RM. Screening and interventions for alcohol and drug problems in medical settings: What works? Journal of Trauma 59(3, Supplement S): s80-s87, 2005. (64 refs.)

This article summarizes current knowledge about the accuracy of screening tests and the efficacy of interventions for substance use disorders in different medical settings (including trauma centers) where the practitioners are not specialists in the management of substance use disorders. In the first section, we introduce basic screening approaches for psychoactive substance use disorders and issues of natural history, risk factors, and populations at risk. Next, we review recent scientific research on the development of screening tests and the evaluation of early intervention services for persons at risk. We conclude that reliable and valid screening tests are available to detect alcohol use disorders but that further work is needed before routine screening for drug use disorders is warranted. We found strong evidence to support the effectiveness of brief interventions in managing at-risk drinkers; however, the evidence is only suggestive for drug use disorders. Finally, we explore the implications of the findings for developing a public health approach to early intervention, particularly as it relates to the unique needs of trauma centers.

Baez A. Development of an objective structured clinical examination (OSCE) for practicing substance abuse intervention competencies: An application in social work education. Journal of Social Work Practice in the Addictions 5(3): 3-20, 2005. (38 refs.)

The substance abuse skills OSCE (Objective Structured Clinical Examination) was developed by an interdisciplinary faculty team at New York University from 2001 to 2003. The aims of the project were to teach medical, nursing, and social work students screening and brief intervention skills, provide a practice opportunity and feedback to students on their ability to demonstrate substance abuse skills, and to expose students to interdisciplinary collaboration. After students were educated and participated in the OSCE, the mean score on their substance abuse knowledge questionnaires increased from 6.24 (SD = 1.522) at pretest to 8.06 (SD = 1.600) at post test (t(16) = -6.080, p < .002). According to the faculty observer performance checklists, students manifested the fifteen competencies on the checklist at an average rate of 79.0%. Students rated the overall experience of participating in the OSCE highly favorably, at 4.9 on a five-point scale. While the OSCE proved to be highly compatible with the teaching and practicing of substance abuse intervention skills, it is a tool that also has relevance and applicability for the practicing and assessing of many other social work skills, and can be a powerful addition to the ways in which the field approaches the challenge of assessing competence in more direct ways.

Baldwin JA; Johnson RM; Gotz NK; Wayment HA; Elwell K. Perspectives of college students and their primary health care providers on substance abuse screening and intervention. Journal of American College Health 55(2): 115-119, 2006. (32 refs.)

The authors conducted a needs assessment among students and health-care providers of a southwestern university health center with the goal of developing health-care-provider training addressing substance-abuse screening and intervention. They collected data from focus groups of undergraduate students and structured interviews and questionnaires with health-care providers. They identified gaps in provider and student perspectives on the extent of substance abuse on campus and the perceived roles of health-care providers and patients in screening and conducting interventions for substance abuse. These findings suggest that training for college health-care providers regarding substance-abuse brief screening and intervention should emphasize confidentiality of student medical records, the importance of nonjudgmental attitudes toward students, and the role of the provider as one who is competent and appropriate to address substance abuse. Such training should also educate providers about the types of substances students are using.

Batki SL; Kauffman JF; Marion I; Parrino MW; Woody GE. Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs. Treatment Improvement Protocol (TIP) 43. Rockville MD: Center for Substance Abuse Treatment, 2005. (648 report refs.)

This TIP incorporates the many changes in medication-assisted treatment for opioid addiction that have developed over the past decade. It describes the nature and dimension of opioid use disorders and their treatment, and the historical and regulatory developments. It incorporates recommendations by a consensus panel and evidence-based practices. It also examines the related medical, psychiatric, sociological and substance use disorders and their treatment as part of a comprehensive treatment program. Medications included in the discussion are methadone, LAAM, naltrexone, and buprenorphine. Beyond discussion of the pharmacology of these medications, separate chapters consider screening and assessment, patient-treatment matching, phases of treatment, providing comprehensive care and maximizing client retention, the role of drug testing, associated medical problems, treatment of multiple substance use, treatment of co-occurring disorders, treatment during pregnancy, and administrative issues.

Bedregal LE; Sobell LC; Sobell MB; Simco E. Psychometric characteristics of a Spanish version of the DAST-10 and the RAGS. Addictive Behaviors 31(2): 309-319, 2006. (44 refs.)

Although Hispanics/Latinos constitute the largest ethnic minority group in the United States, there are few culturally and linguistically valid Spanish language clinical assessment instruments. This shortage is even more critical in the addictions field. This article presents the psychometric characteristics of two drug abuse screening instruments; the Drug Abuse Screening Test (DAST-10), and the Reduce Annoyed Guilty Start (RAGS) test that were translated into Spanish. Participants included 60 drug abusers, 35 alcohol abusers, and 127 individuals with no alcohol and/or drug problem. Results indicated that the Spanish versions of the two drug abuse screening instruments were reliable and unidimensional and differentiated drug abusers from non-substance abusers and from alcohol abusers.

Benjamin AB; Mossman D; Graves NS; Sanders RD. Tests of a symptom checklist to screen for comorbid psychiatric disorders in alcoholism. Comprehensive Psychiatry 47(3): 227-233, 2006. (56 refs.)

In the treatment of substance use disorders, it is advantageous to identify patients with comorbid (nonsubstance) psychiatric disorders because treating comorbid disorders improves outcome. Because accurate psychiatric diagnosis is time-consuming, there is a need for strategies to screen for these comorbid conditions. This study used receiver operating characteristic analysis to investigate a symptom checklist (revised Symptom Checklist 90 [SCL-90-R]) as a screening instrument for comorbid conditions diagnosed using the Structured Clinical Interview for DSM-IV in 171 primarily military personnel with alcohol use disorders. Several approaches to applying receiver operating characteristic analysis to this problem are demonstrated. Although these results require replication in other populations, the SCL-90-R performed well in predicting comorbid conditions, with an area under the Curve of 0.88 for current and 0.85 for lifetime comorbid diagnoses. Self-report symptom checklists such as the SCL-90-R may be useful in screening substance rehabilitation patients for more detailed psychiatric assessment and may prove clinically useful in the assessment of alcoholic patients.

Berman AH; Bergman H; Palmstierna T; Schlyter F. Evaluation of the Drug Use Disorders Identification Test (DUDIT) in criminal justice and detoxification settings and in a Swedish population sample. European Addiction Research 11(1): 22-31, 2005. (18 refs.)

Psychometric properties of the 11-item self-report Drug Use Disorders Identification Test (DUDIT) were evaluated in a sample of heavy drug users from prison, probation, and inpatient detoxification settings, and in a general Swedish population sample. In the drug user sample, the DUDIT predicted drug dependence with a sensitivity of 90% for both DSM-4 and ICD-10 and a respective specificity of 78 and 88%. Reliability according to Cronbach's alpha coefficient was 0.80. In the population sample, 3.1% scored positive on the DUDIT; T-score values are suggested. The DUDIT screens effectively for drug-related problems in clinically selected groups and may prove useful in the context of public health surveys.

Bernard M; Bolognini M; Plancherel B; Chinet L; Laget J; Stephan P; Halfon O. French validity of two substance-use screening tests among adolescents: A comparison of the CRAFFT and DEP-ADO. Journal of Substance Use 10(6): 386-395, 2005. (30 refs.)

Aim: The objective of this study was to compare the criterion validity of the CRAFFT and DEPADO. Method: One hundred and sixty-three adolescents (80 from the general population and 83 regular substance users) completed the ADAD and the MINI questionnaires, as well as either the CRAFFT or the DEP-ADO in roughly equal proportions, between March 2002 and August 2003. Sensitivity and specificity were calculated. Results: Both questionnaires had high sensitivity but the DEP-ADO showed a better specificity than CRAFFT. A score equal or higher than 8 on the scale of DEP-ADO appeared to be an appropriate threshold for problems related to substance use. DEP-ADO had a sensitivity of 92.0% and a specificity of 80.6% with severity rating scores of ADAD (alcohol and drug areas combined). With the MINI diagnoses, DEP-ADO had a sensitivity of 95.1% and a specificity of 68.9%. Conclusion: DEP-ADO appears to have higher diagnostic utility for identifying substance use than CRAFFT in regard to sensitivity and specificity. However, the CRAFFT has the advantage of considering substance use over a lifetime period. Further studies should be targeting younger subjects and more diverse substance-use patterns.

Bernstein SL; Cannata M. Nicotine dependence, motivation to quit, and diagnosis in emergency department patients who smoke. Addictive Behaviors 31(2): 288-297, 2006. (22 refs.)

Objectives: To assess the effect of diagnosis on motivation to quit in adult smokers in an emergency department (ED). Methods: A survey of patients visiting two EDs from September to November, 2003. Patients screening positive for smoking completed a Fagerstrom Test for Nicotine Dependence and Ladder of Contemplation. ICD9 codes and disposition status were recorded. Smoking-related diagnoses were drawn from standard sources. Data were analyzed with parametric and non-parametric statistics. Results: Five hundred and eighty-five were interviewed, median age 40 (interquartile range 29-50); 323 (55%) were female. Ninety percent of all patients were non-White; 69% were uninsured or had Medicaid. Of 152 patients with smoking-related diagnoses, the median Fagerstrom score was 4.7 vs. 4.1 for patients with a non-smoking-related diagnosis (p = 0.02, 95% CI for the difference 0.2, 0.9). Patients with smoking-related and non-smoking-related diagnoses had similar levels of motivation to quit (Ladder score, respectively, 5.5 vs. 5.1, p = 0.03, 95% CI for difference 0.03, 0.8). Conclusions: Adult ED smokers exhibit mild-moderate levels of nicotine addiction and interest in quitting. ED-based tobacco control should target all smokers.

Bischof G; Reinhardt S; Grothues J; Dybek I; Meyer C; Hapke U et al. Effects of item sequence on the performance of the AUDIT in general practices. Drug and Alcohol Dependence 79(3): 373-377, 2005. (23 refs.)

Background: One important task in identifying subjects with alcohol use disorders (AUDs) in the general medical practice setting is the development of effective screening instruments. Sensitivity of screening questionnaires might differ according to the introductory items. This study compares two versions of the Alcohol Use Disorders Identification Test (AUDIT) with varied item sequence randomly applied to patients derived from a sample of general practitioners (GP) patients. Methods: Participants were recruited from general practices in two northern German cities; they received two different versions of the AUDIT, one group receiving the original version starting with three items addressing frequency and quantity of alcohol use (AUDIT1), and a second group receiving a version in which these items were put at the end of the questionnaire (AUDIT2). In total, 10.803 screenings were conducted (refusal rate: 5%). Alcohol use disorders were diagnosed using the Munich-Composite International Diagnostic Interview (M-CIDI). Results: Logistic regression analysis revealed that AUDIT1 subjects had higher scores in the consumption items of the AUDIT, whereas AUDIT2 subjects scored higher on items focussing on symptoms of alcohol dependence or abuse. Conclusion: The sequence upon which items of the AUDIT are presented influences the report of drinking patterns and symptoms of alcohol use disorders in GP patients.

Bradley KA; Williams EC; Achtmeyer CE; Volpp B; Collins BJ; Kivlahan DR. Implementation of evidence-based alcohol screening in the veterans health administration. American Journal of Managed Care 12(10): 597-606, 2006. (57 refs.)

Background: Despite evidence-based guidelines, brief alcohol screening and counseling have not been routinely integrated into most primary care practices in the United States. Objective: To describe the results of the implementation of evidence-based alcohol screening by the Veterans Health Administration (VA) in 2004, as the first step toward implementation of brief alcohol counseling. Study Design: This observational study of outpatients from all 21 VA networks relied on the following 2 data sources from the VA Office of Quality and Performance: (1) Medical record reviews, designed to compare VA networks quarterly, evaluated whether established VA patients had documented screening for alcohol misuse and documented follow-up assessment for alcohol use disorders among those who screened positive for alcohol misuse (January-March 2005); and (2) Mailed patient satisfaction surveys from 2004, which oversampled patients new to the VA (response rate, > 70%), included the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questions and asked about past-year advice "to drink less or not to drink alcohol" from a VA provider. Results: Based on 10,115 medical record reviews, 93% (range, 89%-96% across networks) of outpatients were screened for alcohol misuse, and 25% (range, 11%-36%) screened positive. Among screen-positive patients, 42% (range, 5%-84%) had documented follow-up assessment, but absolute numbers of screen-positive patients evaluated were small (27-80 patients per network). Based on 235,481 patient surveys, the prevalence of alcohol misuse was 22% (range, 15%-27% across networks), and 28% (range, 20%-36%) of screen-positive patients reported receiving alcohol-related advice. Alcohol-related advice increased as AUDIT-C scores increased. Conclusion: The VA successfully implemented evidence-based alcohol screening, but the rate of follow-up among screen-positive patients remained low.

Buckley TC; Mozley SL; Holohan DR; Walsh K; Beckham JC; Kassel JD. A psychometric evaluation of the Fagerstrom Test for Nicotine Dependence in PTSD smokers. (rapid communication). Addictive Behaviors 30(5): 1029-1033, 2005. (6 refs.)

Rates of smoking among individuals with psychiatric conditions are greater than rates seen in the general population, yet little is known about the psychometric properties of commonly used nicotine dependence instruments among psychiatric smokers. This study examined the reliability, validity, and factor structure of the Fagerstr�m Test for Nicotine Dependence (FTND) among psychiatric smokers. Results revealed that the FTND had good test-retest reliability, convergent validity, and discriminant validity. A factor-analytic examination converged on a two-factor solution, reflecting two correlated but separate processes related to nicotine dependence. In total, the results revealed that the FTND performs as well -- from a psychometric perspective -- with psychiatric smokers, as it does with nonpsychiatric smokers.

Burke PJ; O'Sullivan J; Vaughan BL. Adolescent substance use: Brief interventions by emergency care providers. (editorial). Pediatric Emergency Care 21(11): 770-776, 2005. (31 refs.)

Use of tobacco, alcohol and other drugs plays a major role in adolescent morbidity and mortality. When under the influence of alcohol or other drugs, adolescents are at increased risk for injuries, unprotected sex, or interpersonal violence. Alcohol and other drugs are major factors in adolescent deaths, contributing to motor vehicle crashes, homicides, and suicides. Adolescents tend to have shorter substance use histories therefore they often experience emergency/acute care health treatment resulting from Substance use related trauma and/or overdose. Substance use screening of adolescents who present to an Emergency Department (ED) is vitally important. The CRAFFT is a valid and reliable screening tool that was developed for use with adolescents. If an adolescent screens positive, then the next step is to determine their stage of use and readiness for change in preparation for doing a brief intervention. Helping patients to recognize the potential relation between their substance use and health related consequences, may motivate them to decrease their use for harm reduction. Motivational interviewing is an effective, evidence-based approach to helping people change their high risk behavior.

Campbell TC; Hoffmann NG; Hoffmann TD; Gillaspy JA. UNCOPE: A screen for substance dependence among state prison inmates. Prison Journal 85(1): 7-17, 2005. (16 refs.)

Efficient and accurate screening for alcohol and other drug dependences is critical if addictions are to be addressed hi correctional populations. The UNCOPE, a six-item screen developed on clinical and corrections populations, was evaluated for accuracy in a state inmate population. Results using receiver operating characteristics calculated the overall expected accuracy of the UNCOPE to approach 0.90, with 1.0 being a perfect prediction. The UNCOPE performed comparably on gender and ethnic subgroups as well as subgroups identified by education level. The findings suggest that the UNCOPE could be an effective aid in identifying treatment needs among state prison inmates.

Canagasaby A; Vinson DC. Screening for hazardous or harmful drinking using one or two quantity-frequency questions. Alcohol and Alcoholism 40(3): 208-213, 2005. (33 refs.)

Aims: To address the accuracy of quantity-frequency (QF) questions in screening for hazardous or harmful drinking. Methods: Three groups were interviewed: patients presenting to emergency departments for care of an acute injury (n = 1537) or a medical illness (n = 1151), and community controls interviewed by telephone (n = 1112). The first question about alcohol was a single alcohol screening question (SASQ), 'When was the last time you had more than X drinks in one day?', where X = 4 for women and 5 for men, with any time in the past 3 months considered a positive screen (1 drink = 14 g ethanol). The subsequent alcohol questions were a calendar-based review of recent drinking and the alcohol questions from the diagnostic interview schedule (DIS), which included questions about usual frequency and average quantity. Hazardous drinking was defined as drinking > 4 drinks in 1 day or > 14 drinks in 1 week for men (women 3 and 7) (Guidelines of the US National Institute on Alcohol Abuse and Alcoholism). Current alcohol use disorders were defined using DSM-IV criteria. The areas under the receiver operating characteristic (ROC) curves in identifying hazardous drinking or current alcohol use disorder were compared. Results: The area under the ROC curves in the three samples combined were 0.81 for SASQ (95% confidence interval (CI) 0.79-0.82), 0.80 for a question about average quantity alone (0.79-0.82) and 0.85 for the product of usual frequency times average quantity (0.84-0.86). The QF product and the question about average quantity performed consistently across the three groups. Conclusions: In clinical settings, one way to put these findings into practice is to screen first with a single question, such as the SASQ, a single question about typical quantity, or a question about the frequency of heavy drinking such as the third item of the alcohol use disorders test (AUDIT).

Chalder M; Elgar FJ; Bennett P. Drinking and motivations to drink among adolescent children of parents with alcohol problems. Alcohol and Alcoholism 41(1): 107-113, 2006. (30 refs.)

Aims: To study the influences of parental alcohol problems on adolescents' alcohol consumption and motivations to drink alcohol. Methods: A community sample of 1744 adolescents from schools in South Wales completed the 6-item Children of Alcoholics Screening Test, Drinking Motives Questionnaire, and survey measures of alcohol consumption. Results: Children of parents with alcohol problems constituted almost one-fifth of the sample group and were found to drink more frequently, more heavily, and more often alone than children of parents without alcohol problems. Parental alcohol problems were also related to internal motives to drink (e.g. coping) in their adolescent children. Across the entire sample, internal motives to drink interacted with parental alcohol problems in predicting alcohol consumption and drinking frequency. Conclusion: Parental alcohol problems appeared to co-exist with an asocial pattern of alcohol consumption in adolescents that involves drinking alone and drinking to feel intoxicated or to forget about problems. In addition to the external, social motives to drink, which are shared by most adolescents, nearly one in five of the adolescents studied reported salient internal motives to drink that tended to coexist with alcohol problems in their parents.

Chang G; McNamara T; Orav EJ; Wilkins-Haug L. Identifying risk drinking in expectant fathers. Birth: Issues in Perinatal Care 33(2): 110-116, 2006. (33 refs.)

Background: Identification of risk drinking in expectant fathers may be helpful as an important part of efforts to minimize maternal alcohol use, and as an opportunity to inform them about a problematic practice during a critical developmental stage for the couple. The purpose of this study was to evaluate the T-ACE screening questionnaire, which asks about tolerance to alcohol, being annoyed by other's comments about drinking, attempts to cut down, and having a drink first thing in the morning ("eye-opener"), in the male partners of pregnant women who themselves were T-ACE positive. Methods: Two hundred fifty-four male partners were asked to complete the T-ACE embedded in a health survey, the Alcohol Use Disorders Identification Test (AUDIT), and other questions about their alcohol use in the past 30 days when their pregnant partners had a median gestation of 11.5 weeks (T-1). After delivery, male partners again completed the T-ACE and quantity-frequency questions (T-2). The predictive ability of the T-ACE and AUDIT was compared, using risk drinking (> 4 drinks/day or > 14 drinks/week) as the criterion standard. Results: A substantial minority of male partners had risk drinking, 31 percent at T-1 and 25 percent at T-2. Although the AUDIT was better than the T-ACE as an independent predictor of risk drinking, the latter was most accurate when the tolerance threshold exceeded 2 drinks, the same established for pregnant women. The sensitivity (T-1 = 84.6%, T-2 = 82.8%) and specificity (T-1 = 43.8%, T-2 = 51.1%) of the T-ACE at this threshold compared favorably with those of the AUDIT at the standard cut point of 8. Conclusions: The T-ACE may be a practical way for clinicians to identify risk drinking in both pregnant women and expectant fathers.

Chang G; McNamara TK; Haimovici F; Hornstein MD. Problem drinking in women evaluated for infertility. American Journal on Addictions 15(2): 174-179, 2006. (41 refs.)

Clinicians may wish to use the T-ACE, a screening instrument for prenatal risk drinking, for their infertile patients. Twenty-eight T-ACE negative and 23 T-ACE positive women presenting to an academic infertility clinic completed two interviews about their drinking. The 23 T-ACE positive participants were also randomized to receive a brief intervention. The T-ACE distinguished between heavier and lighter patterns of alcohol use in this sample. Moreover, it appeared that although the average quantity of alcohol consumed per drinking day was unchanged, the overall mean percentage of days drinking declined significantly from the time of enrollment to follow-up in all groups.

Cherpitel CJ; Ye Y; Moskalewiez J; Swiatkiewicz G. Screening for alcohol problems in two emergency service samples in Poland: Comparison of the RAPS4, CAGE and AUDIT. Drug and Alcohol Dependence 80(2): 201-207, 2005. (37 refs.)

Prior research on alcohol-related problems among emergency service patients in Poland found Substantial alcohol involvement on the part of injured males. suggesting emergency services may be a productive venue for identifying patients who could benefit from a brief intervention or referral for treatment. Performance of the RAPS4, CAGE and AUDIT against ICD-10 and DSM-IV criteria for alcohol dependence and for alcohol abuse/harmful drinking was compared in probability samples of emergency service patients from two regions of Poland. Sensitivity of the RAPS4 and AUDIT was significantly better than the CAGE for alcohol dependence among males in Warsaw, but specificity was poorer. Among females, although numbers were small, sensitivity for alcohol abuse/harmful drinking and for alcohol dependence or abuse/harmful drinking was significantly better for the RAPS4-QF than for the CAGE or AUDIT at a cut point of 8 across both sites. Performance of the AUDIT at a cut point of 3 was similar to the RAPS4-QF for females. Among males, sensitivity was higher but specificity considerably lower for the RAPS4-QF compared to the CAGE at a Cut point of I or for the AUDIT at a cut point of 8. Alternate cut points for the AUDIT optimized performance. Findings suggest some regional and gender differences in performance of screening instruments in these Polish samples, but no instrument or cut point is optimal in identifying those with alcohol use disorders. Additional cross-cultural research is needed to evaluate the performance of instruments, especially among females with alcohol use disorders.

Chung T; Martin CS; Winters KC. Diagnosis, course, and assessment of alcohol abuse and dependence in adolescents. IN: Galanter M, ed. Recent Developments in Alcoholism. Volume 17: Alcohol Problems in Adolescents and Young Adults -- Epidemiology, Neurobiology, Prevention, Treatment. New York: Kluwer Academic, 2005. pp. 3-28. (56 refs.)

Risk for the onset of an alcohol use disorder (AUD) peaks during adolescence and the transition to young adulthood, highlighting the public health significance of alcohol use by adolescents. This chapter summarizes recent research on the diagnosis, course, and assessment of alolescent AUDs. This review focuses on developmental considerations in assessment of AUD criteria, the prevalence of DSM-IV AUDs among adolescents, typical alcohol symptom profiles in youth and limitations of DSM-IV criteria when applied to adolescents. In addition, studies of alcohol use disorders course in adolescents, as well as factors influencing the course of AUDs are summarized. The chapter also provides an overview of brief alcohol screening instruments and other measures used in more comprehensive assessment of AUDs in adolescents.

Clark DB; Wood DS; Martin CS; Cornelius JR; Lynch KG; Shiffman S. Multidimensional assessment of nicotine dependence in adolescents. Drug and Alcohol Dependence 77(3): 235-242, 2005. (26 refs.)

Despite the critical importance of adolescent smoking, the assessment of nicotine dependence during this developmental period has been the subject of relatively little research. In this study, 301 adolescents (ages 12 through 18 years) reporting daily smoking were recruited for a project on alcohol use disorders (AUDs). The sample included 140 females and 161 males, 251 subjects from clinical and 50 from community sources, and 176 subjects with AUDs at the baseline assessment. Subjects were evaluated with the Nicotine Dependence Syndrome Scale (NDSS), the Fagerstrom Test for Nicotine Dependence (FTND) and a determination of average number of cigarettes per day (cigarettes/day). A varimax. factor analysis of 27 NDSS items revealed four factors: (1) Drive/Tolerance (13 items; Cronbach alpha = 0.91); (2) Continuity (five items; Cronbach alpha = 0.67); (3) Priority (three items; Cronbach alpha = 0.64); (4) Stereotypy (five items; Cronbach alpha = 0.66). The NDSS total score, refined by the removal of four items, was also examined (23 items; Cronbach alpha = 0.90). Predicting cigarettes/day at follow-up, initial smoking rate was the best predictor, with the FIND and NDSS Total score showing significant and similar predictive validity. The NDSS Total showed incremental validity in the prediction of smoking progression in a model including demographic characteristics, initial smoking rate and FIND. The findings suggest that the NDSS has acceptable psychometric properties when applied to adolescents, complementing smoking rate and FIND in a multidimensional smoking assessment.

Cook RL; Chung T; Kelly TM; Clark DB. Alcohol screening in young persons attending a sexually transmitted disease clinic: Comparison of AUDIT, CRAFT, and CAGE instruments. Journal of General Internal Medicine 20(1): 1-6, 2005. (33 refs.)

OBJECTIVE: To compare the ability of 3 brief alcohol screens (Alcohol Use Disorders Identification Test [AUDIT], CRAFFT, and CAGE) to identify adolescents and young adults with a current alcohol use disorder (AUD) and to determine whether there are gender-based or race-based differences in screening performance. DESIGN, PARTICIPANTS AND SETTING: Cross-sectional study of 358 young persons (55% males; 49% blacks; age range, 15-24 years; mean age, 20.6 years) who were attending an urban clinic for sexually transmitted diseases and reported alcohol use during the past year. MEASUREMENTS: Receiver operating characteristic (ROC) curve analysis was used to determine the ability of the 3 screens to discriminate between participants with and without AUDs detected in the Structured Clinical Interview for DSM-IV (SCID). RESULTS: One third (33%) of participants met Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria for a current AUD (24% with alcohol abuse and 9% with alcohol dependence). The AUDIT performed best at a cut score of 9 (sensitivity, 0.76; specificity, 0.79), CRAFFT at a cut score of 2 (sensitivity, 0.94; specificity, 0.33), and CAGE at a cut score of 1 (sensitivity, 0.69; specificity, 0.63). The AUDIT had the best overall performance (area under the curve [AUC], 0.84), followed closely by CRAFFT (AUC, 0.79) and then CAGE (AUC, 0.70). Performance of screens did not differ by gender. The AUDIT performed slightly better in whites than blacks, but no race-based differences were observed for the CAGE or CRAFFT. CONCLUSIONS: Clinicians should use the AUDIT or CRAFFT, rather than the CAGE, to screen young persons for AUDs. The AUDIT performs best, but its length may limit its utility in this setting. The CRAFFT is a suitable alternative, with excellent sensitivity and no gender-based or race-based differences.

Cranford JA; McCabe SE; Boyd CJ. A new measure of binge drinking: Prevalence and correlates in a probability sample of undergraduates. Alcoholism: Clinical and Experimental Research 30(11): 1896-1905, 2006. (64 refs.)

Background: A standard measure defines binge drinking as the consumption of 5 or more drinks in a row for men (4 or more drinks for women) on at least 1 occasion during the past 2 weeks. A revised operational definition of binge drinking was developed by the National Institute on Alcohol Abuse and Alcoholism in 2004 and incorporated the duration of the drinking episode in addition to the quantity of alcohol consumed. This study compares the standard and new binge measures for overall and subgroup prevalence rates; associations with gender, race/ethnicity, and age of drinking onset; and associations with negative drinking consequences. Methods: A probability sample of 4,580 randomly selected college students (50.3% female, M age=19.9, SD=2.0) at a large Midwestern university in the United States completed a Web-based survey of alcohol and other drug use. Participants reported on past 2-week binge drinking using the standard measure and past-year binge drinking using the new measure. Results: The longer past-year time frame of the new measure yielded a higher prevalence estimate of binge drinking (63.6%) compared with the 2-week standard measure (53.2%). Approximately 9.9% of those who were classified as binge drinkers using the 2-week standard measure were classified as non-binge drinkers using the new measure specification of a 2-hour duration for the drinking episode. The past-year new binge measure was positively associated with negative drinking consequences even when the 2-week measure was statistically controlled. Conclusions: Using a longer time frame and incorporating the duration of the drinking episode, the new measure of binge drinking appears to capture an important element of risky alcohol involvement in college students that is not fully assessed by the standard measure.

Cunningham JA; Humphreys K; Kypri K; van Mierlo T. Formative evaluation and three-month follow-up of an online personalized assessment feedback intervention for problem drinkers. Journal of Medical Internet Research 8(2): article 5, 2006. (39 refs.)

Background: In recent years, online services for problem drinkers have been developed. This paper describes ongoing efforts to improve one of these services, the Alcohol Help Center. Objective: This report summarizes new modules added to the Check Your Drinking (CYD) screener, a component of the Alcohol Help Center, to make the CYD screener more useful to periodic heavy drinkers, as well as to regular alcohol consumers. Participants' initial reactions to the CYD screener and the changes in their drinking habits at a three-month follow-up are presented. Methods: The CYD screener provides a free personalized Final Report that compares the user's drinking to that of others in the general population of the same age, gender, and country of origin. Current alcohol consumption and demographic characteristics are collected as part of the CYD screening process. After users were presented with a customized Final Report, they were hot-linked to a volunteer feedback survey The voluntary feedback survey asked about impressions of the CYD Final Report. Respondents agreeing to participate were sent a follow-up survey after three months. Results: We recruited 388 volunteers (69% female) who were registered users of another free-to-consumer online cHealth service. Of the 343 respondents agreeing to participate in the three-month follow-up, 138 accessed the survey, and 97 provided complete data (participation rate = 40%; completion rate 70%). Compared to moderate drinkers, current problem drinkers judged the Final Report to be more useful (34% vs. 69%, chi(2) = 41.5, P <.001) and accurate (43% vs. 76%, chi(2) (1) =36.0,P <.001). Respondents who participated in the three-month follow-up displayed reductions in drinking compared to baseline (F-4,F-76 = 12.2, P=.001). Conclusions: Improvements can still be made to make the CYD screener more relevant to specific populations, particularly periodic heavy drinkers. There is a need to further tailor algorithms that can present questions only relevant to specific populations. There also appears to be a need to further customize the Final Report for respondents who identify themselves as infrequent heavy drinkers. These improvements will be made, and a randomized controlled trial is planned to conduct a rigorous evaluation of the CYD screener as an intervention to help problem drinkers.

Dawson DA; Grant BF; Stinson FS. The AUDIT-C: Screening for alcohol use disorders and risk drinking in the presence of other psychiatric disorders. Comprehensive Psychiatry 46(6): 405-416, 2005. (61 refs.)

This article examines the performance of the AUDIT-C, as embedded in a large national survey, as a screener for alcohol use disorders (AUDs) and risk drinking among individuals with past-year psychopathology. The analysis is based on data collected in personal interviews from a representative population sample of US adults. The Study population consisted of past-year drinkers with any past-year mood disorder (n = 2818), any past-year anxiety disorder (n = 3173), or any personality disorder (n = 4389). Screening performance was evaluated by means of sensitivity, specificity, and areas under receiver operating characteristic curves (AUCs). The AUCs for the AUDIT-C were from 0.888 to 0.893 for alcohol dependence, front 0.864 to 0.876 for any AUD, and from 0.941 to 0.951 for any AUD or risk drinking-all oil a par with those observed in the general population. Among men, cut points of either >= 5 or >= 6 points (the former favoring sensitivity and the latter favoring specificity) were optimal for detecting dependence, and cut points of >= 5 points were optimial for any AUD and for any AUD or risk drinking. Among women, a cut point of >= 4 points was optimal for the outcomes of both alcohol dependence and any AUD, whereas a cut point of >= 3 points was preferable for detecting any AUD or risk drinking.

Degenhardt L; Hall W; Korten A; Jablensky A. Use of Brief Screening Instrument for Psychosis: Results of a ROC analysis. NDARC Technical Report No. 210. Sydney: National Drug and Alcohol Research Centre, 2005. (13 refs.)

Psychotic disorders have a lower prevalence than other forms of mental illness such as depression and anxiety disorders, yet they impose a considerable public health burden because of their impact on sufferers and their families (Keith, Regier, & Rae, 1991). Persons with psychotic disorders also utilise a disproportionately high segment of health services. Valid and reliable assessment of any disorder is a necessary precursor to effective treatment. Lengthy interview instruments exist for the assessment of psychotic disorders, but they often require accredited training to administer, and their length means they may not be appropriate for all situations. Validated screening instruments provide a useful alternative to the full assessment of a disorder. They have been developed for the assessment of mental disorders such as depression (the Beck Depression Inventory; Beck, Ward, & Mendelson, 1961) and anxiety (the State-Trait Anxiety Inventory; Spielberger, 1983). However, there has been a lack of effective, validated instruments for screening individuals for psychotic illness. The aim of this study was to examine the validity of a 7-item Psychosis Screener (PS) compared to full diagnoses of psychotic disorders using clinician ratings (ICD-9 classification) and derived from the Diagnostic Interview for Psychosis (DIP) (ICD-10 and DSM-III-R). The Psychosis Screener (PS) uses elements of the Composite International Diagnostic Interview (CIDI) to assess the presence of characteristic psychotic symptoms. The Psychosis Screener comprises 7 items, three of which are asked only if the respondent endorses a previous question. The first 6 items cover the following features of psychotic disorders: delusions of control, thought interference and passivity (Question 1 and 1a); delusions of reference or persecution (Question 2 and 2a); and grandiose delusions (Question 3 and 3a). The final item records whether a respondent reports ever receiving a diagnosis of schizophrenia. Narrow and broad definitions of psychosis were used: the narrow definition of psychosis was limited to diagnoses of either schizophrenia or a schizoaffective disorder; and the broad definition of psychosis included diagnoses of affective psychoses in addition to schizophrenia and schizoaffective disorder. Receiver operating characteristic (ROC) analyses were conducted using data from two samples: the first (n=87) contained persons receiving inpatient treatment in Perth, Western Australia (WA); and the second (n=259) was drawn from the WA Study of Low Prevalence (Psychotic) Disorders. Two definitions of psychosis were used in the ROC analyses, and these affected the findings quite markedly. The broad definition of psychosis classed schizophrenia, schizoaffective disorder, and affective psychosis as psychotic disorders. When this broad definition of psychosis was used with ICD-9 diagnoses as the standard (in sample 1), the screener did not fare better than chance. However, this may have been related to the fact that diagnoses for sample 1 were obtained from clinical records which are coded using ICD-9-CM codes. This may have lead to some incorrect categorisation of patients as cases due to discrepancies between ICD-9 and ICD-9-CM codes, particularly for affective psychoses. This possibility is supported by the finding that when using two other diagnostic systems as 'gold standards', the screener was able to discriminate adequately between cases and non-cases, as assessed by the area under the ROC curve (the AUC). For both ICD-10 and DSM-III-R diagnostic systems (using sample 2), the optimal cut-off point was zero, indicating that a score of 1 or more on the screener indicated a case according to this definition of psychosis. Using the narrow definition of psychosis, in which only those with a diagnosis of schizophrenia or schizoaffective disorder were classified as cases, the screener was well able to discriminate between cases and non-cases using any of the three diagnostic systems as the standard. A score of three or more on the screener was the optimal score for indicating a case for all three 'gold standards'. The analyses carried out indicated that the psychosis screener developed as a brief screening instrument for the presence of psychosis has a moderate ability to discriminate between those who meet diagnostic criteria for psychotic disorders, and those who do not. This represents an advance in efforts to develop a measure that will be an effective screen for these low prevalence disorders. Consideration must be given to the nature of the population with which a screening test is to be used before a cut-off point is selected.

Dervaux A; Bayle FJ; Laqueille X; Bourdel MC; Leborgne M; Olie JP. Validity of the CAGE questionnaire in schizophrenic patients with alcohol abuse and dependence. Schizophrenia Research 81(2-3): 151-155, 2006. (35 refs.)

The objective of the study was to assess the sensitivity and the specificity of the CAGE questionnaire in 114 schizophrenic patients. The Composite International Diagnostic Interview was used to assess the DSM-III-R diagnosis of abuse of or dependence on alcohol. The CAGE questionnaire can be reliably used to assess alcohol use disorders in schizophrenic patients: with a cutoff score of I or more, the sensitivity of the CAGE questionnaire was 0.91 and the specificity was 0.83. With a cutoff score of 2 or more, the sensitivity of the CAGE questionnaire was 0.82 and the specificity was 0.94. The post test probabilities (PPV) were high (PPV1=0.74; PPV2=0.85) compared to the primary probability of alcoholism (29.8%).

Dewost AV; Michaud P; Arfaoui S; Gache P; Lancrenon S. FAST, acohol consumption evaluation: A screening instrument adapted for French general practitioners. Alcoholism: Clinical and Experimental Research 30(11): 1889-1895, 2006. (35 refs.)

Background: To meet the needs of French general practitioners (GPs), we created a short (5 questions) interview/screening test for alcohol-related problems that is similar to AUDIT in terms of (1) test values and (2) identification of 3 groups: (a) abstainers and low-risk drinkers; (b) heavy drinkers; and (c) alcohol abusers or showing dependence. Method: Nine questions (from AUDIT, CAGE, TWEAK, Five-shot Questionnaire) were given systematically to their patients (aged 18 or more) by 41 volunteer GPs. Before the consultation, patients confidentially completed the AUDIT questionnaire in the waiting room. After the consultation, an addiction specialist evaluated each patient's alcohol consumption and DSM-IV criteria for alcohol abuse and dependence and these were used as gold standards. Results: The analysis included 564 patient records and used stepwise logistic regression to select 7 questions, from which a second selection resulted in a 5-item questionnaire. These questions are: AUDIT questions 1 (Frequency) and 2 (Usual quantity), CAGE questions 2 (Annoyed) and 4 (Eye-opener), and TWEAK question 5 (Black-out), with each question scored 0 to 4. High levels of sensitivity and specificity were obtained for each diagnosis (sensitivity 75%-87.8%; specificity 74%-95.8%). Conclusions: FACE is an appropriate screening method for French general practitioners.

Dillie KS; Mundt M; French MT; Fleming MF. Cost-benefit analysis of a new alcohol biomarker, carbohydrate deficient transferrin, in a chronic illness primary care sample. Alcoholism: Clinical and Experimental Research 29(11): 2008-2014, 2005. (38 refs.)

Background: Carbohydrate Deficient Transferrin (CDT) is a new alcohol biomarker recently approved by the Food and Drug Administration for alcohol screening. Limited information is available on the economic benefits of alcohol biomarkers. Our objective was to conduct a cost-benefit analysis (CBA) of the CDT test in a primary care sample of patients being treated for diabetes and hypertension. Methods: A decision tree was created using data from national surveys, published literature, and two brief intervention trials conducted in primary care settings. The decision tree was used to estimate the costs and benefits of CDT under different scenarios. Results: For the base case, utilizing CDT in addition to patient self-report resulted in an increase from 28 to 53 problem drinking cases identified out of 70 cases screened. With increased detection and subsequent intervention, the average medical and legal costs were far lower in the CDT arm of the study. When these avoided costs were incorporated into the model, an overall savings of $212.30 per patient was realized with CDT testing. Monte Carlo analysis also indicated a trend toward cost savings, with a mean cost savings of approximately $353 and a range of $1,619 in savings to $450 in costs for 1,000 simulations of the decision tree model. Conclusion: This CBA suggests that the addition of routine CDT screening to patient self-report may provide positive net economic benefits in primary care settings.

Dolman JM; Hawkes ND. Combining the AUDIT Questionnaire and biochemical markers to assess alcohol use and risk of alcohol withdrawal in medical inpatients. Alcohol and Alcoholism 40(6): 515-519, 2005. (24 refs.)

Aims: Alcohol consumption is often under-reported in patients admitted to general hospitals with acute illness. For alcohol-dependent individuals hospital admission results in an enforced period of abstinence with potential alcohol withdrawal symptoms, and possible life threatening complications. Early detection of alcohol use is therefore beneficial to patients and health services. The purpose of this study was to investigate the performance of the alcohol use disorders identification test (AUDIT) questionnaire in the acute medical setting, and the effect of combining routine biological markers-glutamyltransferase, alanine aminotransferase, aspartate aminotransferase, and mean corpuscular volume (MCV) on its performance in the early identification of in-patients with alcohol use disorders and at risk of developing symptoms of alcohol withdrawal. Methods: Prospective study in consecutive patients admitted to an acute medical admissions ward. All patients were screened using the AUDIT questionnaire and routine blood tests. Patients were then monitored for symptoms of withdrawal using clinical institute withdrawal assessment for alcohol (CIWA-Ar). Results: Of the 874 patients screened using the AUDIT, 98 (11%) screened positive of whom 17 (2% of the 874) experienced clinically significant alcohol withdrawal symptoms, when using serial CIWA-Ar. The AUDIT and serial CIWA-Ar detected all patients who went on to manifest acute withdrawal symptoms. There was no loss of sensitivity at an AUDIT cut-off of 13 or more compared with the lower cut-off of 8 or more. A positive predictive value of 17.3% for an AUDIT score of 8 or more in the detection of withdrawal, increased to 47.1% when found in combination with at least two abnormal biological markers whilst maintaining a sensitivity of 94.1% and specificity of 97.9%. Conclusion: These findings confirm that AUDIT is a useful alcohol screen in general medical settings and that its ability to correctly predict which patients will experience alcohol withdrawal is increased when used in combination with biological markers.

Donovan DM; Marlatt GA, eds. Assessment of Addictive Behaviors, 2nd edition. New York: Guilford Press, 2005. (Chapter refs.)

This edited volume, with 13 chapters and 33 contributors, examines the assessment issues related to addictive disorders and compulsive behaviors. Interestingly it begins with consideration of relapse prevention and assessment issues to accomplish this. The following chapter deals with assessive of addictive disorders in racial and ethnic groups. The next six chapters focus upon assessment for those involved with a specific drug -- alcohol, nicotine, cocaine, amphetamines, opiodis, marijuana -- followed by one dealing with hallucinogens, inhalants and steroid use. The concluding four chapters deal with assesment, not of psychoactive drugs, but with compulsive behaviors -- gambling, disordered eating and obesity, sexual offender relapse, and high risk sexual behavior. Incorporated within the discussion is consideration of screening and assessment tools, as well as assessment of comorbid psychiatric disorders and other related medical co-occurring conditions.

Dybek I; Bischof G; Grothues J; Reinhardt S; Meyer C; Hapke U et al. The reliability and validity of the Alcohol Use Disorders Identification Test (AUDIT) in a German general practice population sample. Journal of Studies on Alcohol 67(3): 473-481, 2006. (22 refs.)

Objective: Our goal was to analyze the retest reliability and validity of the Alcohol Use Disorders Identification Test (AUDIT) in a primary-care setting and recommend a cut-off value for the different alcohol-related diagnoses. Method: Participants recruited from general practices (GPs) in two northern German cities received the AUDIT, which was embedded in a health-risk questionnaire. In total, 10,803 screenings were conducted. The retest reliability was tested oil a subsample of 99 patients, with in intertest interval of 30 days. Sensitivity and specificity at a number of different cut-off values were estimated for the sample of alcohol consumers (n = 8,23 7). For this Study, 1, 109 screen-positive patients received a diagnostic interview. Individuals who scored less than five points in the AUDIT and also tested negative in a second alcohol-related screen were defined as "negative" (n = 6,003). This definition was supported by diagnostic interviews of 99 screen-negative patients from which no false negatives could be detected. As the gold standard for detection of all alcohol-use disorder (AUD), we used the Munich-Composite International Diagnostic Interview (MCIDI), which is based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. Results: Oil the item level, the reliability, measured by the intraclass correlation coefficient (ICC), ranged between .39 (Item 9) and .98 (Item 10). For the total score, the ICC was .95. For cut-off values of eight points and five points, 87.5% and 88.9%, respectively, of the AUDIT-positives, and 98.9% and 95.1%, respectively, of the AUDIT-negatives were identically identified at retest, with kappa = .86 and kappa = .81. At the cut-off value of five points, we determined good combinations of sensitivity and specificity for the following diagnoses: alcohol dependence (sensitivity and specificity of .97 and .88, respectively), AUD (.97 and .92), and AUD and/or at-risk consumption (.97 and .91). Conclusions: Embedded in a health-risk questionnaire in primary-care settings, the AUDIT is a reliable and valid screening instrument to identify at-risk drinkers and patients with an AUD. Our findings strongly suggest a lowering of the recommended cut-off value of eight points.

Emmen MJ; Wollersheim H; Bleijenberg G; Schippers GM. How to optimise interventions for problem drinking among hospital outpatients? (review). Netherlands Journal of Medicine 63(11): 421-427, 2005. (48 refs.)

in this article several suggestions on how to optimise interventions for problem drinking among hospital outpatients are enumerated. These interventions are especially important for patients with diagnoses that are alcohol related. The intervention has to be brief and easy to integrate into medical specialist's routine practice; an active role for the medical specialist and flexible involvement of a specialised nurse are suggested. Key elements of the intervention are: early identification of problem drinking; raising the issue of problem drinking; assessment of the drinking behaviour; reaching an agreement about change; follow-up; evaluation of the change. A feasible and attractive option is integrating the intervention into a broader lifestyle intervention. Those who perform the brief alcohol intervention need to be specially educated and trained.

Etter JF. A comparison of the content-, construct- and predictive validity of the Cigarette Dependence Scale and the Fagerstrom Test for Nicotine Dependence. Drug and Alcohol Dependence 77(3): 259-268, 2005. (46 refs.)

Background: Research showed that the widely used Fagerstrom Test for Nicotine Dependence (FTND) does not cover important aspects of dependence. A new test, the Cigarette Dependence Scale (CDS-12), covers the main elements in DSM-IV and ICD-10 definitions of dependence. We compared the psychometrics of CDS-12, FTND, and CDS-5 and the heaviness of smoking index (HSI), which are short versions of CDS-12 and FTND, respectively. Methods: Internet survey in 2002-2003. Participants were invited one month after answering the first survey to answer a second survey on smoking status and withdrawal symptoms. Results: Eight hundred two smokers answered both surveys. Cronbach's alpha coefficients were higher for CDS-12 (0.91) and CDS-5 (0.77) than for FTND (0.68) and HSI (0.63). Among 231 smokers who quit smoking at follow-up, higher baseline CDS-12 scores predicted higher withdrawal ratings at follow-up, for all withdrawal symptoms except appetite. FTND and HSI predicted higher craving in quitters, but did not predict the intensity of other withdrawal symptoms. Neither CDS-5, FTND or HSI predicted smoking cessation, but higher CDS-12 scores marginally predicted smoking cessation at follow-up (area under the receiver operating characteristic (ROC) curve = 0.55, 95% confidence interval = 0.51-0.59). Conclusions: CDS-12 had better content validity and internal consistency than FTND and was a slightly better predictor of withdrawal symptoms. Unexpectedly, higher (not lower) CDS-12 scores predicted subsequent smoking cessation, perhaps because endorsement of some CDS-12 items implies accepting that one is dependent, which in turn could reflect motivation to quit. CDS-12 may represent an alternative to FIND for measuring cigarette dependence.

Gache P; Michaud P; Landry U; Accietto C; Arfaoui S; Wenger O et al. The Alcohol Use Disorders Identification Test (AUDIT) as a screening tool for excessive drinking in primary care: Reliability and validity of a French version. Alcoholism: Clinical and Experimental Research 29(11): 2001-2007, 2005. (43 refs.)

Background: Excessive drinking is a major problem in Western countries. AUDIT (Alcohol Use Disorders Identification Test) is a 10-item questionnaire developed as a transcultural screening tool to detect excessive alcohol consumption and dependence in primary health care settings Objectives: The aim of the study is to validate a French version of the Alcohol Use Disorders Identification Test (AUDIT) Methods: We conducted a validation cross-sectional study in three French-speaking areas (Paris, Geneva and Lausanne). We examined psychometric properties of AUDIT as its internal consistency, and its capacity to correctly diagnose alcohol abuse or dependence as defined by DSM-IV and to detect hazardous drinking (defined as alcohol intake > 30 g pure ethanol per day for men and > 20 g of pure ethanol per day for women). We calculated sensitivity, specificity, positive and negative predictive values and Receiver Operator Characteristic curves. Finally, we compared the ability of AUDIT to accurately detect "alcohol abuse/dependence" with that of CAGE and MAST Results: 1207 patients presenting to outpatient clinics (Switzerland, n = 580) or general practitioners' (France, n = 627) successively completed CAGE, MAST and AUDIT self-administered questionnaires, and were independently interviewed by a trained addiction specialist. AUDIT showed a good capacity to discriminate dependent patients (with AUDIT 13 for males, sensitivity 70.1%, specificity 95.2%, PPV 85.7%, NPV 94.7% and for females sensitivity 94.7%, specificity 98.2%, PPV 100%, NPV 99.8%); and hazardous drinkers (with AUDIT 7, for males sensitivity 83.5%, specificity 79.9%, PPV 55.0%, NPV 82.7% and with AUDIT >= 6 for females, sensitivity 81.2%, specificity 93.7%, PPV 64.0%, NPV 72.0%). AUDIT gives better results than MAST and CAGE for detecting "Alcohol abuse/dependence" as showed on the comparative ROC curves. Conclusions: The AUDIT questionnaire remains a good screening instrument for French-speaking primary care.

Gareri J; Chan D; Klein J; Koren G. Screening for fetal alcohol spectrum disorder. Canadian Family Physician 51: 33-34, 2005. (6 refs.)

QUESTION I have several patients whom I suspect are drinking during pregnancy. How can I find out for sure if they are? ANSWER You can use one of the validated tools to screen for problem drinking. Motherisk uses the TWEAK test, but others are just as good. Following birth, you can test infants' meconium for metabolites of ethanol to detect whether they were exposed in utero to excessive drinking.

Gerevich J; Baskai EB; Ko J; Rozsa SN. Reliability and validity of the Hungarian version of the European Addiction Severity Index: Results of a multi-focal research project. Psychopathology 38(6): 301-309, 2005. (40 refs.)

We attempted a Hungarian adaptation of the European version (EuropASI) of the widely used Addiction Severity Index (ASI) within the frame of a multi-stage quality development programme. The ASI is characterised by good reliability and validity indicators. The empirical background for our research was the data obtained from ASI ratings for 266 alcohol- and drug-using patients presenting for treatment in addiction medicine clinics in different regions of the country. The reliability indicators for measurement tool rating (interrater) and time (test-retest) were high, with the exception of the correlation value for employment and support. The internal consistency of the test was good. The degree of correlation between the individual items did not exceed that found internationally. The psychometric results corresponded to the results obtained in foreign investigations. The Hungarian version of the ASI can be regarded as a useful and reliable measuring tool that can be used to identify the problems of addiction patients and to assess treatment efficacy.

Giang KB; Spak F; Dzung TV; Allebeck P. The use of AUDIT to assess level of alcohol problems in rural Vietnam. Alcohol and Alcoholism 40(6): 578-583, 2005. (28 refs.)

Aims: To assess the accuracy and performance of AUDIT in detecting alcohol problems, as defined by ICD-10 and DSM-IV, in a rural district in Vietnam. Methods: The study was conducted in a rural district of Vietnam. Five hundred men and women aged 18-60 were randomly selected for interview with AUDIT and CIDI 2.1. The ICD-10 and DSM-IV criteria for harmful use/alcohol abuse and alcohol dependence were used to evaluate AUDIT. Results: Due to few cases of alcohol problems observed among women (1/282), we could only evaluate the validity of AUDIT in men. At cut-off point 7/8, AUDIT had a sensitivity of 81.8% and a specificity of 76.1% for detecting at-risk drinking. At this cut-off point, using ICD-10 criteria, the sensitivity was 100% for harmful use and 93.8% for alcohol dependence; the specificity was 69.9% for harmful use and 87.4% for alcohol dependence. The area under the ROC curve was 0.91 (0.84-0.98) for harmful use and 0.84 (0.74-0.94) for alcohol dependence (ICD-10). The agreement between ICD-10 and DSM-IV was higher for diagnosing alcohol dependence than alcohol abuse (Kappa coefficient: 0.98 vs 0.68). Conclusion: We confirmed that AUDIT is feasible to use in a rural community in a developing country. Different cut-off points are appropriate for different purposes, but for general population screening of at-risk drinking we found a cut-off point 7/8 to be optimal.

Gomez A; Conde A; Santana JM; Jorrin A. Diagnostic usefulness of brief versions of Alcohol Use Disorders Identification Test (AUDIT) for detecting hazardous drinkers in primary care settings. Journal of Studies on Alcohol 66(2): 305-308, 2005. (20 refs.)

Objective: The aim of this study was to evaluate the diagnostic usefulness of the brief versions of the Alcohol Use Disorders Identification Test (AUDIT) for detecting hazardous drinkers and to compare it with that of the full-AUDIT in primary care settings. Method: Five hundred patients were randomly selected in a primary care center. An interview on quantity-frequency was administered for assessment of weekly alcohol intake. The standard used for classification of hazardous drinkers was a weekly alcohol consumption of 280 g for men and 168 g for women. Cut-off points were 8 for the full-AUDIT, I for the AUDIT-3 (third item), 3 for the AUDIT-C (items 1, 2 and 3), 5 for the AUDIT-PC (items 1, 2, 4, 5 and 10) and 3 for the modified Fast Alcohol Screening Test (m-FAST; items 3, 5, 8 and 10). Sensitivity, specificity, positive and negative predictive values, and areas under the receiver operating characteristic (AUROC) curves were measured. Results: Diagnostic usefulness of the questionnaires for detecting hazardous drinkers was for the full-AUDIT: 81.4% sensitivity, 94.6% specificity and 0.97 AUROC curve; for the AUDIT-3: 83.1% sensitivity, 90.9% specificity and 0.89 AUROC curve; for the AUDIT-C: 100% sensitivity, 79.4% specificity and 0.97 AUROC curve; for the AUDIT-PC: 98.3% sensitivity 90.9% specificity and 0.97 AUROC curve; and for the m-FAST: 79.7% sensitivity, 93.7% specificity and 0.93 AUROC curve. Conclusions: The AUDIT-C and AUDIT-PC show a higher sensitivity, lower specificity and a similar AUROC curve than the full-AU-DIT, thus allowing their use as screening instruments that are as reliable as the original test for detecting hazardous drinkers. The AUDIT-3 and m-FAST, when compared with the full-AUDIT, performed less well, therefore limiting their use for this purpose.

Goransson M; Magnusson A; Heilig M. Identifying hazardous alcohol consumption during pregnancy: Implementing a research-based model in real life. Acta Obstetricia et Gynecologica Scandinavica 85(6): 657-662, 2006. (31 refs.)

Aims. It has been repeatedly demonstrated that hazardous alcohol use during pregnancy is rarely detected in regular antenatal care, and that detection can be markedly improved using systematic screening. A major challenge is to translate research-based strategies into regular antenatal care. Here, we examined whether a screening strategy using the Alcohol Use Disorder Test (AUDIT) and time-line follow-back (TLFB) could be implemented under naturalistic conditions and within available resources, and whether it would improve detection to the extent previously shown in a research context. Methods. Regular midwives at a large antenatal care clinic were randomized to receive brief training and then implement AUDIT and TLFB ("intervention"); or to a waiting-list control group continuing to deliver regular care ("control"). In the intervention condition, AUDIT was used to collect data about alcohol use during the year preceding pregnancy, and TLFB to assess actual consumption during the first trimester. Data were collected from new admissions over 6 months. Results. Drop out was higher among patients of the intervention group than control midwives, 14% (23/162) versus 0% (0/153), and p < 0.0001. A one-day training session combined with continuous expert support was sufficient to implement systematic screening with AUDIT and TLFB largely within resources of regular antenatal care. The use of these instruments identified patients with hazardous consumption during the year preceding pregnancy i.e. AUDIT score 6 or higher (17%, 23/139), and patients with ongoing consumption exceeding 70 g/week and/or binge consumption according to TLFB (17%, 24/139), to a significantly higher degree than regular antenatal screening (0/162). The AUDIT- and TLFB-positive populations overlapped partially, with 36/139 subjects screening positive with either of the instrument and 11/139 were positive for both. Conclusions. We confirm previous findings that alcohol use during pregnancy is more extensive in Sweden than has generally been realized. Systematic screening using AUDIT and TLFB detects hazardous use in a manner which regular antenatal care does not. This remains true under naturalistic conditions, following minimal training of regular antenatal care staff, and can be achieved with minimal resources. The proposed strategy appears attractive for broad implementation.

Groner JA; Hoshaw-Woodard S; Koren G; Klein J; Castile R. Screening for children's exposure to environmental tobacco smoke in a pediatric primary care setting. Archives of Pediatrics & Adolescent Medicine 159(5): 450-455, 2005. (36 refs.)

Background: The American Academy of Pediatrics (Elk Grove Village, Ill) has recommended that pediatricians assess their patients' environmental tobacco smoke (ETS) exposure, but the specific questions most likely to identify children with high ETS exposure are not known. Cotinine is a nicotine metabolite, present in hair, that can be used to quantify months of ETS exposure. Objective: To develop a brief screening tool that will accurately predict ETS exposure as defined by child hair cotinine level. Methods: We compared the performance of a series of easily administered screening questions regarding home ETS exposure to child hair cotinine levels. Subjects were a convenience sample of healthy children aged 2 weeks to 3 years of both self-reported smokers and nonsmokers. Results: Hair samples and questionnaire data were obtained from 291 children. Based on clinical applicability and statistical significance, 3 questions ("Does the mother smoke?", "Do others smoke?", and "Do others smoke inside?") were selected as a valid screening tool to determine children's ETS exposure risk. Maternal report of smoking outside only or smoking few cigarettes per day had no impact on child hair cotinine levels. Conclusions: It was possible to derive a simple, specific, and valid screening tool that can be used in pediatric offices to identify children at risk for ETS exposure. Further research is needed to test this tool prospectively.

Gunderson EW; Levin FR; Smith L. Screening and intervention for alcohol and illicit drug abuse: A survey of internal medicine housestaff. Journal of Addictive Diseases 24(2): 1-18, 2005. (51 refs.)

This study attempts to determine how internal medicine housestaff screen and intervene for problematic alcohol and illicit drug use, as well as identify factors correlating with favorable practices. A cross-sectional survey was administered to 93 medical housestaff. Of 64 (69%) respondents, 94% reported routinely screening new patients for alcohol or illicit drug use, while only 52% routinely quantified alcohol consumption and 28% routinely used a screening instrument. Housestaff were unfamiliar with national guidelines and felt unprepared to diagnose substance use disorders, particularly prescription drug abuse. Most routinely counseled patients with alcohol (89%) or illicit-drug problems (91 %), although only a third of these patients were referred for formal treatment. More thorough screening practices were associated with greater treatment optimism, while favorable referral practices were associated with greater optimism about 12-step program benefit and difficulty with management. These findings suggest areas to be addressed in residency curricula on substance abuse.

Harasymiw J; Seaberg J; Bean P. Using routine laboratory tests to detect heavy drinking in the general population. Journal of Addictive Diseases 25(2): 59-63, 2006. (15 refs.)

This article describes a new biomarker known as the Early Detection of Alcohol Consumption (EDAC) test, which has been steadily penetrating the U.S. market. The EDAC uses routine laboratory tests to make a prediction of heavy drinking in any given person. When tested in mainstream insurance populations, the EDAC has shown twice the specificity of the traditional liver enzyme tests and is significantly more sensitive than the CDT test, which is expected because the EDAC uses a combination of laboratory tests. Maximum diagnostic accuracy is achieved when the CDT test is used to confirm a positive EDAC test. Since brief interventions have proven successful, the early identification of alcohol problems becomes a vital role for physicians. Improved awareness of alcohol misuse can certainly be accomplished through an increased use of biomarkers, with and without concomitant self-report. The ultimate goal is to facilitate early intervention and the successful management of patients diagnosed with heavy drinking.

Heishman SJ; Singleton EG . Assessment of cannabis craving using the Marijuana Craving Questionnaire. IN: Onaivi ES, ed. Marijuana and Cannabinoid Research: Methods and Protocols. Totowa NJ: Humana Press, 2005. pp. 209-216

Cannabis is the most widely used illicit drug in the United States, with 14.6 million current users. Cannabis-dependent individuals presenting for treatment typically report cannabis craving; however, the phenomenon has received little research attention. In the absence of a valid, multidimensional questionnaire to assess cannabis craving, we developed the Marijuana Craving Questionnaire (MCQ). The MCQ consists of four constructs or factors that characterize cannabis craving: compulsivity, emotionality, expectancy, and purposefulness. A separate score is calculated for each factor. The MCQ can be used to measure cue-elicited craving in a research setting or natural craving in cannabis-dependent individuals presenting for treatment. Either the 47-item or 12-item version can be used, and standardized instructions for completion of the MCQ should be given. The MCQ can be administered using a paper and pencil form or a computerized version. In a research setting, the MCQ should be administered immediately after cue presentation and repeated frequently to capture the full time course. In a treatment setting, the MCQ should be administered at intake and during and at the end of treatment.

Huang C-L; Lin H-H; Wang H-H. The psychometric properties of the Chinese version of the Fagerstrom Test for Nicotine Dependence. Addictive Behaviors 31(12): 2324-2327, 2006. (8 refs.)

This study examined the psychometric properties of the Chinese version of the Fagerstrom Test for Nicotine Dependence (FTND). Criterion validity, factorial structure, and construct reliability were conducted using PRELIS 2 and LISREL 8.7 software. Two hundred and forty-five adult smokers were recruited from April to August 2005 in Taiwan. Because some items of the FTND are dichotomous and ordinal, biserial and polyserial correlations between the items and saliva cotinine levels were utilized. Confirmatory factor analyses (CFA) were performed to compare the relative fit of three competing models. Computation of the construct reliability was necessitated by a lack of tau-equivalence. The results demonstrated that the Chinese version has satisfactory validity and reliability. One item, "Smoke more in the morning," had low correlations with saliva cotinine. CFA found the items of the Chinese version were best modeled as two correlated factors without a cross-loading. These findings differ from the previous research testing the English version. Studies addressing the specific features of cigarette dependence in different socio-cultural contexts are needed.

Hungerford DW. Recommendations for trauma centers to improve screening, brief intervention, and referral to treatment for substance use disorders. Journal of Trauma 59(3 Supplement): S37-S42, 2005. (0 refs.)

This paper sets forth recommendations of a conference dealing with screening, brief intervention, and referral to treatment for substance use/high risk use/abuse/dependence in trauma center patients. The recommendations are as follows: (1.) Disseminate evidence about intervention efficacy and effectiveness; (2.) Make screening, brief interventions and treatment referral for substance use disorders including high risk use, routine practice in trauma centers even as appropriate implementation studies are being conducted; (3). Fund implementation research that involves the trauma community; (4.) Make screening, brief intervention and referral for substance use disorders an essential component of trauma care; (5.) Develop better systems of reporting substance use problems to improve surveillance; (6.) Change insurance regulations, to provide for adequate reimbursement. [Note: statutes in most states allow medical insurance to exclude coverage for treatment if a patient's injuries are alcohol or drug related. This poses a major barrier to route blood alcohol testing and screening. It also is seen as stigmatizing patients and impeding best practices for management; and (7.) Insurers should reimburse trauma center staff for services in relation to screening and brief interventions for the range of substance use disorders.

Johnson TP Hughes TL. Reliability and concurrent validity of the CAGE screening questions: A comparison of lesbians and heterosexual women. Substance Use & Misuse 40(5): 657-669, 2005. (27 refs.)

Although lesbians are believed to be at heightened risk for alcohol abuse and alcohol dependency, the reliability and validity of currently available screening measures have yet to be explored in this population group. In this paper, we report the psychometric properties of the CAGE in a diverse sample of 63 lesbians and comparisons with a control group of 57 heterosexual women. Data were collected in Chicago during 19971998 1 using face-to-face interviews. Findings suggest that the CAGE has good reliability and concurrent validity among lesbians. One CAGE item, concerned with drinking in the morning, however, was found to be only weakly associated with the other items among lesbians. Although this pilot study is limited by the nonprobability sample, we conclude that evaluating the appropriateness of other alcohol and drug abuse measures in high-risk populations, such as lesbians, should be a research priority.

Kimerling R; Trafton JA; Nguyen B. Validation of a brief screen for Post-Traumatic Stress Disorder with substance use disorder patients. Addictive Behaviors 31(11): 2074-2079, 2006. (21 refs.)

To evaluate a 4-item screen for Post-Traumatic Stress Disorder (PTSD) for use with patients diagnosed with substance use disorders, 97 patients were recruited from substance use disorder treatment clinics at a large medical center. Participants completed the self-administered 4-item PTSD screen. Psychologists interviewed patients using the Clinician Administered PTSD Scale (CAPS). Sensitivity and specificity were calculated using the CAPS as the criterion for PTSD. Results were compared to chart diagnoses. The prevalence of PTSD was 33%. The screen identified 91% of PTSD cases, where only 25% of PTSD cases were diagnosed in the medical chart. The screen demonstrated good test-retest reliability (r = .80) and yielded a sensitivity of .91 and specificity of .80 using a cut score of 3. Likelihood ratios indicate that the screen has good ability to detect PTSD in this population, and that patients with positive screens that do not meet criteria for PTSD are likely to report significant subthreshold symptoms. Screening for PTSD in SUD treatment settings is time efficient and may increase the detection of previously unrecognized PTSD.

Korzec A; de Bruijn C; van Lambalgen M. The Bayesian Alcoholism Test had better diagnostic properties for confirming diagnosis of hazardous and harmful alcohol use. Journal of Clinical Epidemiology 58(10): 1024-1032, 2005. (64 refs.)

Objective: Conventional tests for alcoholism fail to confirm hazardous and harmful alcohol use (HHAU) accurately and objectively. We validated a Bayesian Alcoholism Test (BAT) for confirming the diagnosis of HHAU. Study Design and Setting: BAT is based on studies on the prevalence of HHAU and other diseases causing similar abnormalities, and on conditional probabilities of these disorders and associated biochemical markers and clinical signs. BAT was compared to carbohydrate-deficient transferrin (CDT) and gamma-glutamyltransferase (GGT) in treatment-seeking alcoholics, non-treatment-seeking heavy drinkers, and controls. Main outcome measures were test sensitivity and specificity, likelihood ratios, and receiver-operating characteristic (ROC) curves. Results: Comparing alcoholics and controls, sensitivity of BAT (94%) was significantly higher than CDT (63%) and GGT (73%). The area under the ROC curve for BAT (.989) was significantly higher than the area under the curve for CDT (.909) and area under the curve for GGT (.902). Using pooled data of all 182 subjects included in the study, the amount of drinking had a significant better correlation coefficient with BAT (.795) than with CDT (.657), and GGT (.604). Conclusion: BAT has better diagnostic properties than CDT and GGT for confirming HHAU.

Krulewitch CJ. Alcohol consumption during pregnancy. Annual Review of Nursing Research 23: 101-134, 2005. (161 refs.)

Alcohol is a potent teratogen in humans, and prenatal alcohol exposure is a leading preventable cause of birth defects and developmental disabilities. The term fetal alcohol syndrome (FAS) refers to a pattern of birth defects found in children of mothers who drank during pregnancy. FAS has four criteria: maternal drinking during pregnancy, a characteristic pattern of facial abnormalities, growth retardation, and brain damage (often manifested by intellectual difficulties or behavioral problems). As surveillance and research have progressed, it has become clear that FAS is but a rare example of a wide array of defects that can occur from exposure to alcohol in utero. At least 1 in 10 women will continue to consume alcohol during pregnancy, putting their fetuses at risk for the effects of alcohol exposure. Nurses are in a key position to provide care and conduct research that will contribute to the prevention of the adverse effects of prenatal alcohol exposure during the preconception and perinatal periods, as well as deal with the negative outcomes of exposure in the developing infant. Many areas have yet to be evaluated. Screening tools and interventions have been developed and tested, mostly in majority cultures. Culturally sensitive instruments must be generated and validated for high-risk groups such as Native Americans. Fetal alcohol biomarkers and genetic research are new and need considerably more work. Effective "no drinking during pregnancy" campaigns for high-risk groups must be created and tested. Nurses are well placed to conduct research that will describe the effects at social, behavioral, and biological levels; develop middle-range theories targeted at preventing the drinking behavior and optimizing care of affected children after birth; and generate and test effective interventions that enhance prevention strategies in the 21st century.

Lappalainen-Lehto R; Seppa K; Nordback I. Cutting down substance abuse: Present state and visions among surgeons and nurses. (rapid communication). Addictive Behaviors 30(5): 1013-1018, 2005. (19 refs.)

Background. Although substance abuse is variably common among surgical patients, detection of the problem and brief interventions are seldom undertaken. The aim of the present study was to assess surgeons' and nurses' activity in screening substance abuse among their patients and obstacles concerning intervention of patients with substance abuse. Methods: Surgeons and nurses of The Department of Surgery, Tampere University Hospital were asked to predict if the surgical patients treated during a 24-h period (n=211) had a substance abuse disorder. This was compared to the patients' self-reports based on the Alcohol Use Disorders Identification Test (AUDIT) and questions about use of other substances. The surgeons and the nurses were also asked to complete a questionnaire related to interventions of patients with substance abuse; perceived knowledge, skills, attitudes and obstacles. Results: Of the surgical patients, 47 (22%) proved to be substance abusers. Out of them, 23% were detected by surgeons and nurses. Of the surgeons (n=44) 83% and of the nurses (n=332) 84% perceived responsibility for intervention but claimed many obstacles. Nurses reported the lack of knowledge as the main obstacle. Of the nurses 18% reported enough knowledge to conduct the whole brief intervention compared to 34% of surgeons (p=0.021). The main obstacle reported by surgeons was the lack of time. Conclusions: Surgeons and nurses detect only minority of the substance abusing surgical patients. Lack of knowledge and time prevent intervening in patients' substance abuse. These results may be utilized when developing a program to better involve surgeons and nurses in detection and intervention of surgical patients' substance abuse.

Leonardson GR; Kemper E; Ness FK; Koplin BA; Daniels MC; Leonardson GA. Validity and reliability of the AUDIT and CAGE-AID in northern plains American Indians. Psychological Reports 97(1): 161-166, 2005. (18 refs.)

According to the Indian Health Service, substance abuse and Type 2 diabetes are serious problems among Native Americans. To assess substance use in a medical setting, valid screening tests are needed so the Alcohol Use Disorders Identification Test (AUDIT), a simple brief screen for excessive drinking, and the CAGE-adapted to Include Drugs (CAGE-AID) for identifying primary care patients with alcohol and drug disorders were given 50 Northern Plains American Indians with diabetes. Both are short, easy to administer, have good sensitivity and specificity, and can be easily incorporated into a medical history protocol or intake procedure. Reliability coefficients were above .90 and appeared to have sufficient concurrent and divergent validity indicated by moderate correlations with the General Well-being Schedule (rs = -.39 and -.36), the Family-Adaptation, Partnership, Growth, Affection, & Resolve (r = -.47 and -.36), and the Beck Depression Inventory-II (r = .36 and .29).

Lieberman DZ. Clinical characteristics of individuals using an online alcohol evaluation program. American Journal on Addictions 14(2): 155-165, 2005. (26 refs.)

Access to treatment for substance abuse disorders is limited, and practical strategies are needed to expand opportunities for individuals to receive effective interventions. Automated or semi-automated treatments have shown promise in other disorders. Identifying the characteristics of patients who will be able to benefit from this unconventional approach will increase the likelihood of success. The current study examined 9,297 individuals using an online alcohol evaluation program. Subjects had high scores on the Alcohol Use Disorders Identification Test (AUDIT) and a substantial amount of ambivalence about the possible harm that their drinking caused, but they also had very low levels of self-identification as actual problem drinkers.

Lima CT; Friere ACC; Silva APB; Teixeira RM; Farrell M; Prince M. Concurrent and construct validity of the AUDIT in an urban Brazilian sample. Alcohol and Alcoholism 40(6): 584-589, 2005. (36 refs.)

Aims: To assess the concurrent and the construct validity of the Alcohol Use Disorders Identification Test (AUDIT) in an urban Brazilian sample. Methods: A random sample of 166 clients of a health management organization, participated in this study. They were visited in their households and completed a self-report questionnaire, which included the AUDIT. Later, they answered the alcohol-related disorders (ARDs) Section of the Composite International Diagnostic Interview. The receiver operating curve (ROC) was used to find the best cut-off point for ICD-10 diagnosis of ARDs. Confirmatory factor analysis was run to assess the construct validity. Results: The ROC analysis showed the same cut-off point (7/8) for ICD-10 diagnosis of ARDs found in previous studies carried out in primary care settings, including in Brazil, with a sensitivity of 100% and a specificity of 76%. The confirmatory factor analysis suggested a two-factor structure. The first factor measured consumption and the second factor alcohol-related problems. Conclusions: The results supported the use of the self-reported version of the AUDIT in epidemiologic studies, and showed a similar cut-off point for detection of ARDs and hazardous drinking.

Malet L; Schwan R; Boussiron D; Aublet-Cuvelier B; Llorca PM. Validity of the CAGE questionnaire in hospital. European Psychiatry 20(7): 484-489, 2005. (32 refs.)

Objective. - The CAGE questionnaire is considered a useful screening and case-finding tool for alcohol use disorders in clinical populations. Our objectives were to validate the French version of the CAGE against DSM-IV criteria and to assess performance of each item of the scale. Method. - Data were extracted from a hospital morbidity study conducted in central France. It concerned 5452 patients-48.5% men-in short and medium-stay units. Patients answered the CAGE questionnaire as a past-year assessment. The alcohol use disorders were diagnosed by the physicians using DSM-IV alcohol abuse or dependency criteria. Results. - The CAGE questionnaire for a cut-off of 2 had a sensitivity of 77% and a specificity of 94%. The CAGE test was more sensitive for patients diagnosed as alcohol-dependent than for alcohol abusers (61 % vs. 84%) with the same specificity (94%). These values are close to those for the English-language CAGE. The first three items (CAG) were very similar, with sensitivity 70% and specificity 94%. The eye-opening question (E) differentiated sharply between abuse and dependency, with sensitivities of 18% and 46%, respectively. A questionnaire comprising only the CAG questions of the CAGE had properties similar to the full questionnaire. Conclusion. - CAGE is a good screening tool for alcohol abuse or alcohol dependency. Given the frequent-and insufficiently diagnosed-alcohol problems among inpatients, CAGE is indicated as a first-line tool for screening for the most severe alcohol use disorders in hospital. It should ideally be used systematically. A positive reply to any of the first three items should alert the clinician and prompt further investigation.

Martin G; Copeland J; Gilmour S; Gates P; Swift W. The Adolescent Cannabis Problems Questionnaire (CPQ-A): Psychometric properties. Addictive Behaviors 31(12): 2238-2248, 2006. (27 refs.)

Despite the widespread use of cannabis among young people, little research attention has been given to the development of psychometrically sound measures specific to cannabis related problems in this group. The aim of this study was to explore the reliability, validity and factor structure of a multi-dimensional measure of cannabis-related problems among adolescents. The Adolescent Cannabis Problems Questionnaire (CPQ-A) was developed as an assessment tool and treatment outcome measure. A stratified sample of 100 young people (aged 14-18 years) who had used cannabis in the past 90 days were administered the CPQ-A on two occasions 1 week apart. Exploratory factor analysis revealed three factors accounting for 63% of total variance with alpha coefficients of 0.88, 0.72 and 0.73. The CPQ-A was reliable with test-retest correlation for the total CPQ-A being 0.91. CPQ-A score correlated significantly with frequency of cannabis use and number of DSM-IV dependence criteria reported. The findings show promise for the CPQ-A as a reliable, valid and potentially clinically useful measure of cannabis related problems among young people.

Martin G; Copeland J; Gates P; Gilmour S. The Severity of Dependence Scale (SDS) in an adolescent population of cannabis users: Reliability, validity and diagnostic cut-off. Drug and Alcohol Dependence 83(1): 90-93, 2006. (15 refs.)

The Severity of Dependence Scale (SDS) is a five-item scale that has been reported to be a reliable and valid screening instrument for dependence and a measure of dependence severity in adults across several substance classes. To date no data have been reported on its performance in a population of adolescent cannabis users. The current study assessed the psychometric properties of the SDS in a community sample of 14-18-year-old adolescent cannabis users (n = 100). Internal consistency (alpha = 0.83) and test-retest coefficients (ICC = 0.88) were high and a principal components analysis of the scale found all items to load on a single factor. Total SDS score correlated significantly with frequency of cannabis use and number of DSM-IV dependence criteria met, indicating good concurrent validity. Receiver Operating Characteristic curve analysis was used to determine the most appropriate SDS cut-off score for use as an indicator of cannabis dependence, with optimal discrimination at an SDS score of 4. These findings indicate that the SDS is a reliable and valid measure of severity of cannabis dependence among adolescents, has high diagnostic utility, and that an SDS score of 4 may be indicative of cannabis dependence.

Massey GM; Dodds HN; Roberts CS; Servoss TJ; Blondell RD. Toxicology screening in orthopedic trauma patients predicting duration of prescription opioid use. Journal of Addictive Diseases 24(4): 31-41, 2005. (18 refs.)

Following hospitalization for orthopedic trauma, some patients continue to use opioids following fracture healing. This retrospective cohort Study of 50 patients with high-energy fractures was conducted to determine if toxicology screening tests upon admission can predict subsequent opioid use. Data were collected from clinical records and a statewide electronic database of prescription records. Six months following hospital discharge, those with positive toxicology used more opioids (730 mg vs. 364 mg; P = .04) expressed as morphine equivalents than those with negative toxicology and were more likely to continue using opiates at the end of the 3rd, 4th, 5th, and 6th month after discharge. Patients hospitalized for high-energy fractures with positive admission toxicology are at risk for prolonged opiate use during the initial six months following discharge.

McCabe SE; Boyd CJ; Cranford JA; Morales M; Slayden J. A modified version of the Drug Abuse Screening Test among undergraduate students. Journal of Substance Abuse Treatment 31(3): 297-303, 2006. (50 refs.)

The present study assesses the prevalence of items from a modified version of the Drug Abuse Screening Test, Short Form (DAST-10) for substances other than alcohol among undergraduate students. More than 4,500 undergraduate students at a large Midwestern research university completed a web-based survey in 2005. Nearly 1 every 10 undergraduate students experienced three or more DAST- 10 items in the past 12 months. Although the prevalence of illicit drug use did not differ by gender, undergraduate men were significantly more likely than women to report DAST-10 items. Less than 6% of individuals who reported three or more drug DAST-10 items had ever used treatment services for substance use. As a brief screening instrument, the DAST-10 offers promise for detecting possible drug abuse among college students. Based on the prevalence of drug use, colleges and universities are encouraged to provide screening opportunities to identify and to provide services for students at high risk for drug abuse.

McDaniel AM; Benson PL; Roesener GH; Martindale J. An integrated computer-based system to support nicotine dependence treatment in primary care. Nicotine & Tobacco Research 7(Supplement 1): S57-S66, 2005. (20 refs.)

The purpose of this study was to develop, implement, and evaluate the feasibility of an integrated computer-based system for tobacco-user identification and smoking cessation intervention for primary care patients in a medically indigent, managed care population. Interactive voice response (IVR) technology was used to screen for tobacco use prior to scheduled primary care visits at two inner-city clinics. The IVR system placed calls to 2,039 patients scheduled for clinic visits, and 1,086 (53%) patients completed the automated tobacco-use question set. Current smokers were identified in 421 (39%) of the calls. Computer-gene rated reminders for clinicians that incorporated information obtained from the automated calls were placed on all smokers' encounter forms. In a postvisit interview of 120 smokers, 58 participants (48%) reported that they discussed smoking cessation with their provider. Some 71% of participants agreed that use of the IVR system to obtain information was a "good way for patients to give information about their health to doctors." Automated capture of patient-reported data via IVR technology is a potentially useful strategy for tobacco-use screening in primary care.

Mengel MB; Searight HR; Cook K. Preventing alcohol-exposed pregnancies. (review). Journal of the American Board of Family Medicine 19(5): 494-505, 2006. (103 refs.)

Fetal alcohol exposure affects approximately 1% to 3% of live births in the United States. Family physicians are in a unique position to reduce the incidence of alcohol-exposed pregnancy. Fetal alcohol exposure can be minimized through 2 general approaches: reducing alcohol consumption or increasing effective contraception among childbearing-aged women who engage in "at-risk" drinking and encouraging pregnant women to abstain from alcohol. Although no safe level of alcohol consumption during pregnancy is established, women who binge drink are more likely to deliver infants with physical and cognitive-developmental anomalies. Screening tools, such as quantity/frequency questions, the TWEAK and the T-ACE, developed specifically for prenatal care, are more useful with women than the CAGE and Michigan Alcohol Screening Test (MAST). Screening alone seems to reduce alcohol use among pregnant women. Brief interventions, including education about alcohol's effects on the developing fetus, are effective among women not responding to screening. Unfortunately, many barriers exist to effective implementation of alcohol-exposed pregnancy (AEP) prevention in the clinical setting. Designing effective office base systems so the entire burden of implementing AEP prevention activities doesn't fall solely on the family physician is critical.

Meyer AA. Operational feasibility of interventions in trauma centers. Journal of Trauma 59(3 Supplement): S102-S103, 2005. (0 refs.)

This article, by the moderator for discussions for one session at a conference on substance use issues, addresses the role of brief interventions in the trauma department for alcohol/drug problems. Drawing upon the topics covered, there is reference to the feasability of brief interventions in terms of cost, staff training, the clinical demands in the emergency trauma setting, as well as the need for protocols, relationships with community treatment programs and the ease of referral, and their ability to accept referrals in a timely manner.

Miller NS; Kipnis SS. Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) 45. Rockville MD: Center for Substance Abuse Treatment, 2005. (828 refs.)

This Treatment Improvement Protocol (TIP) dealing with detoxification and its place in substance abuse treatment is a revision of TIP 19. Detoxification is considered as one component in the continuum of healt care services of substance-related disorder. Detoxification is seen as having three major govjectives: evaluation, medical stabilization, and fostering readiness for and entry into substance abuse treatment. The report is organized into six chapters. Chapter 1: Provides an overview, essential concepts, and guiding prinicples for detoxification services. There is also a brief description of the history of detoxfication services. Chapter 2: This addresses settings, levels of care and patient placement criteria. The ASAM (Amerian Society of Addiction Medicine) criteria for patient placement are used. Chapter 3: This chapter discusses the psychosocial and biomedical issues arising during detoxification. Special attention is paid to assessment and strategies for engaging and retaining patients in treatment. Chapter 4: This deals with physical/medical detoxification services with separate sections for specific drugs.Substances included are alcohol, opioids, benzodiazepines, stimulants, inhalants, nicotine, mairjuana,nabolic steroids, club drugs, and considerations related to polydrug use. Chapter 5: In this chapter there is consideration of special issues and concerns that accompany detoxification for those with co-occurring medical or psychiatric disorders. Chapter 6: Organizational issues and funding of detoxification services are considered. Appendices include signs and symptoms of withdrawal for different drug classes, as well as screening/assessment tools. There are 29 illustrative figures.

Moraes CL; Viellas EF; Reichenheim ME. Assessing alcohol misuse during pregnancy: Evaluating psychometric properties of the CAGE, T-ACE and TWEAK in a Brazilian setting. Journal of Studies on Alcohol 66(2): 165-173, 2005. (73 refs.)

Objective: The present article evaluates the psychometric properties of the Portuguese-language versions of the CAGE, TWEAK and T-ACE questionnaires when used to identify alcohol misuse during pregnancy and compares these to historical data from the English-language versions. Also, construct validity of the Portuguese versions of those instruments was assessed. Method: Data were collected from March to September 2000 in three large public maternity wards in Rio de Janeiro, Brazil. Sample size varied according to the analysis. An intra-observer reliability evaluation involved 95 replications carried out within a 24-48 hour period. Kappa was used as an estimator. Cronbach's alpha coefficient, whether or not each item from the analysis was excluded, and the item-rest point-biserial correlations addressed internal consistency (N = 786). For the appraisal of construct validity (n = 528), the relationship between alcohol misuse (evaluated by each instrument according to different cutoff points) and several putative underlying theoretically related dimensions (schooling, age, smoking, marital status, social support, illicit drug use, domestic violence and per capita household income) were evaluated. Results: All kappas were above 0.70. The alpha coefficients for the Portuguese versions ranged from 0.48 to 0.68, a finding consistent with studies assessing the original instruments in English. Yet, irrespective of the instrument concerned, a systematic increase was observed whenever the item on morning alcohol use ("Eye-opener") was removed from the analysis. Regarding construct validity, most tested hypotheses were corroborated, except for the CAGE using the cut-off point of 2. Conclusions: This study confirms other authors' findings that all but the aforementioned CAGE may be recommended to identify heavy alcohol use during pregnancy in general as well as in Portuguese-speaking populations in particular.

National Institute on Alcohol Abuse and Alcoholism. Helping the Patient Who Drinks Too Much. A Clinician's Guide. 2005 edition. Bethesda MD: National Institute on Alcohol Abuse and Alcoholism, 2005. (38 refs.)

About one-third of adults drink at levels that elevate risk for physical, mental health social problems. However, studies indicate that too often primary care providers and mental health clinicians fail to recognize alcohol problems. This guide is directed to primary care providers and mental health clinicians with suggestions as to how to incorporate alcohol screening into clinical care. Procedures are described for assessments, brief interventions and referral for treatment. It identifies clinical indications for screening, provides guidelines for discussing alcohol use, sets forth an assessment procedure that allows easily distinguishing at-risk drinking, alcohol abuse, and alcohol dependence from one another, and provides provides suggestions for intervention. A series of appendices includes the suggested screening instrument (AUDIT), referral resources, an overview of US drinking patterns, definitions of a standard drink, and information on medications used in alcohol treatment.

Nevitt JR; Lundak J; Galardi G. Profile of adolescent alcohol offenders in two rural midwestern counties. Psychological Reports 98(2): 379-384, 2006. (25 refs.)

Screening tools specifically developed for use with adolescents may be more sensitive predictors of relapse or recidivism than self-report inventories typically used to screen adults. 70 adolescents in a program for drunk drivers in two counties in southeastern Nebraska were given both the CRAFFT and the Alcohol Use Disorder Identification Test questionnaires during routine alcohol-dependency evaluations. The Michigan Alcoholism Screening Test was also given to 28 subjects selected at random. 11 boys and 6 girls did not successfully complete the program. Significant correlations obtained for AUDIT scores for both the CRAFFT (r(69) = .65, p < .01) and failure to complete diversion (r(69) = .23, p < .05). Subjects were grouped by age (18 and younger and over 18 years) and by sex. A 2 x 2 analysis of variance for scores on the AUDIT indicated significant main effects for both age (F-1,F-66 = 4.86, p < .05) and sex (F-1.66 = 5.96, p < .01). MAST and CRAFFT scores showed no age or sex differences. The AUDIT might be included in drug and alcohol assessments with similar samples of adolescents.

Newcombe DAL; Humeniuk RE; Ali R. Validation of the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): Report of results from the Australian site. Drug and Alcohol Review 24(3): 217-226, 2005. (16 refs.)

The concurrent, construct, discriminative and predictive validity of the World Health Organization's Alcohol Substance Involvement Screening Test (ASSIST) were examined in an Australian sample. One hundred and. fifty participants, recruited from drug treatment (n = 50) and primary health care (PHC) settings (n = 100), were administered a battery of instruments at baseline and a modified battery at 3 months. Measures included the ASSIST; the Addiction Severity Index-Lite (ASI-Lite); the Severity of Dependence Scale (SDS); the MINI International Neuropsychiatric Interview (MINI-Plus); the Rating of Injection Site Condition (RISC); the Drug Abuse Screening Test (DAST); the Alcohol Use Disorders Identification Test (AUDIT); the Revised Fagerstrom Tolerance Questionnaire (RTQ); and the Maudsely Addiction Pro. le (MAP). Concurrent validity was demonstrated by significant correlations between ASSIST scores and scores from the ASI-lite, SDS, AUDIT and DAST; and significantly greater ASSIST scores for those with diagnoses of abuse or dependence. Construct validity was established by significant correlations between ASSIST scores and measures of risk factors for the development of drug and alcohol problems. Participants diagnosed with attention deficit/hyperactivity disorder or antisocial personality disorder had significantly higher ASSIST scores than those not diagnosed as such. Discriminative validity was established by the capacity of the ASSIST to discriminate between substance use, abuse and dependence. ROC analysis was able to establish cut-off scores for an Australian sample, with suitable specificities and sensitivities for most substances. Predictive validity was demonstrated by similarity in ASSIST scores obtained at baseline and at follow-up. The. findings demonstrated that the ASSIST is a valid screening test for psychoactive substance use in individuals who use a number of substances and have varying degrees of substance use.

Nochajski TH; Stasiewicz PR. Assessing stages of change in DUI offenders: A comparison of two measures. Journal of Addictions Nursing 16(1-2): 57-67, 2005. (45 refs.)

The current study considered motivation and self-efficacy to change in a sample of 458 convicted DUI offenders who were court mandated to complete a clinical evaluation to determine if further treatment was necessary. The sample was from a Northeastern metropolitan area of the United States. The URICA and SOCRATES measures of stage of change and the abstinence self-efficacy scale were evaluated. A factor analysis showed two independent factors for self-efficacy and three meaningful factors for the motivation to change items. There was only modest agreement between the stage assignments from the University of Rhode Island Change Assessment (URICA) and Stage of Change Readiness and Treatment Eagerness Scale (SOCRATES). Regression results for concurrent drinking-driving indicated that none of the motivation to change measures were significantly associated with drinking-driving, while self-efficacy showed a significant negative association. For binge drinking, the ambivalence and recognition subscales of the SOCRATES both showed significant associations, as did self-efficacy. Results suggest caution when interpreting stage of change measures for DUI offenders.

Nonnemaker JM; Homsi G. Measurement properties of the Fagerstr�m Test for nicotine dependence adapted for use in an adolescent sample. Addictive Behaviors 32(1): 181-186, 2007. (10 refs.)

This study uses confirmatory factor analysis to test the factor structure of a modified version of the Fagerstr�m Test for Nicotine Dependence (FTND) in an adolescent sample. Specifically, we test the fit of a two-factor model specification as well as a single-factor solution. This study uses methods that are appropriate to the categorical nature of the items making up the FTND and is the first study to examine the measurement properties of the FTND in a large adolescent sample. Both the two-factor and single-factor model specifications achieved acceptable model fit. It should be noted that these study results speak to the dimensionality of the FTND and not to the dimensionality of a general nicotine dependence construct in adolescents.

Nordqvist C; Johansson K; Lindqvist K; Bendtsen P. Attitude changes among emergency department triage staff after conducting routine alcohol screening. Addictive Behaviors 31(2): 191-202, 2006. (39 refs.)

Excessive alcohol consumption is common among injury patients, but routine alcohol interventions seem to be difficult to implement in emergency departments. An obstacle seen in previous studies is the limited time available in a real-world setting for staff to participate in routine alcohol screening and interventions. In the present study, ordinary staff participated in a simple alcohol screening procedure. The aim of the study was to evaluate the feasibility of this procedure and if there was any change in attitudes and practices among triage staff after the implementation. We analyzed interviews with six staff members and questionnaires completed by 29 nurses and medical secretaries before and after a period of systematic routine screening. The staff reported that the routine worked well and that few patients reacted negatively. A positive change was seen in attitudes towards alcohol preventive measures in general. However, this seems not to be sufficient for the staff to spontaneously engage more actively. In fact, more of the staff were uncertain after the study period whether the emergency department is an appropriate place for alcohol screening and intervention despite an increased role legitimacy and perceived competence. There is a need for further development of alcohol prevention models that are acceptable for the staff to implement as part of the daily routine.

O'Brien MC; Mccoy TP; Champion H; Mitra A; Robbins A; Teuschlser H et al. Single question about drunkenness to detect college students at risk for injury. Academic Emergency Medicine 13(6): 629-636, 2006. (81 refs.)

Objectives: To examine the frequency of injuries reported by college students who replied affirmatively to the question, "In a typical week, how many days do you get drunk?" Methods: In Fall 2003, a Web-based survey was administered to a stratified random sample of 3,909 college students from ten North Carolina (NC) universities. Students answered questions regarding alcohol use and its consequences. Data were analyzed using multiple logistic regression, controlling for within-school clustering of drinking behaviors and adjusting for other significant covariates. Adjusted odds ratios (AORs) and 95% confidence intervals (CI) were calculated for significant predictors (p < 0.05). Results: Two thousand four hundred eighty-eight students reported that they are current drinkers; 1,353 (54.4%) reported getting drunk at least once in a typical week. Compared with students who did not report getting drunk at least once a week, these students had higher odds of being hurt or injured at least once as a result of their own drinking (AOR = 4.97; 95% Cl = 3.47 to 7.09), experiencing a fall from a height that required medical treatment (AOR = 2.16; 95% Cl = 1.36 to 3.43), and being taken advantage of sexually as a result of another's drinking (AOR = 2.59; 95% Cl = 1.72 to 3.89). Students who reported getting drunk at least one day in a typical week also were more likely to cause an injury requiring medical treatment to someone else. They had higher odds of causing injury in an automobile crash (AOR = 1.84; 95% Cl = 1.01 to 3.40), of causing a burn that required medical treatment (AOR = 2.85; 95% Cl = 1.51 to 5.39), and of causing a fall from a height that required medical treatment (AOR = 2.02; 95% Cl = 1.01 to 4.04). Getting drunk was a better indicator of "self-experienced injury" and of "injury caused to someone else" than was binge drinking, for all outcomes (p < 0.05). Conclusions: The single question, "In a typical week, how many days do you get drunk?" identifies college students who are at higher than normal risk of injury as a result of their own drinking and the drinking of others. Future research should assess this question's effectiveness as a screening tool in campus health centers and in emergency departments.

Orford J; Templeton L; Velleman R; Copello A. Family members of relatives with alcohol, drug and gambling problems: A set of standardized questionnaires for assessing stress, coping and strain. Addiction 100(11): 1611-1624, 2005. (79 refs.)

To describe a set of standard questionnaire measures for the assessment of the needs of family members of relatives with alcohol, drug or gambling problems, and to present evidence of their reliability and validity from a series of related studies. Includes cross-sectional and repeated-measurement studies. Family members affected by and concerned about the problem drinking or drug-taking of close relatives in treatment and non-treatment samples in the United Kingdom (white and Sikh) and Mexico City; family members of untreated heavy drinkers; and family members of problem gamblers. Four measures derived from a stress-strain-coping-support model of alcohol, drugs and gambling problems and the family: Family Member Impact scale (FMI), Symptom Rating Test (SRT), Coping Questionnaire (CQ), and Hopefulness-Hopelessness scale (HOPE). FMI, SRT and CQ assess stress, strain and coping, respectively. The exact role of HOPE in the model remains to be determined. The support component remains unmeasured. Results from a number of studies support the internal reliability, discriminant and construct validity and sensitivity to change of the SRT and its two constituent scales (psychological and physical symptoms) and at least two subscales of the CQ (engaged and tolerant-inactive coping). Although showing evidence of satisfactory reliability and some evidence of discriminant validity, further work may be required on the CQ withdrawal c