Serving Substance Abuse Professionals Since 1993

Last Update: 30.05.09

C O R K O N L I N E

powerpoint presentations
CORK database search
resource materials
bibliographies
clinical tools
user services
newsletters
about cork
home

CORK Bibliography: Screening Tests

86 citations. January 2007 to present

Prepared: June 2009

Anderson JF. Screening and brief intervention for hazardous alcohol use within indigenous populations: Potential solution or impossible dream? Addiction Research & Theory 15(5): 439-448, 2007. (37 refs.)

Despite the increasing popularity of screening and brief intervention (SBI) for hazardous drinking within the wider population, there is a paucity of SBI research directed at Indigenous populations. In Canada, Aboriginal drinkers are less than half as likely to drink on a weekly/daily basis but more than twice as likely to binge drink compared to the general drinking population. As a result, there is a high rate of alcohol related deaths and hospitalisations compared to the non-Aboriginal population. Modification of these patterns and levels of hazardous drinking - especially binge drinking - among Aboriginal drinkers should markedly improve health outcomes. Although the efficacy of SBI has been demonstrated across a range of health care settings and sociocultural groups, there are potential systemic and cultural barriers to implementation of SBI for Aboriginal hazardous drinkers including the historic impact of alcohol on Aboriginal communities. Implementation of SBI must address these barriers and be sensitive to the historic relationship between Aboriginals and alcohol.

Aseltine RH; DeMarco FJ; Wallenstein GV; Jacobs DG. Assessing barriers to change in drinking behavior: Results of an online employee screening program. Work: A Journal of Prevention, Assessment & Rehabilitation 32(2): 165-169, 2009. (20 refs.)

Background: The impact of alcohol abuse on worker productivity is considerable and appears to be increasing over time. Although early screening and intervention may help prevent or reduce the damaging health and productivity effects of problem drinking, barriers to behavioral change may render broad-based prevention efforts ineffectual. This study examined the correlates of two potential barriers to changes in drinking behavior - underestimation of drinking and lack of knowledge of helping resources - using data from web-based employee alcohol screenings. Methods: Anonymous screening data from 1185 employees of ten companies participating in the 2003 National Alcohol Screening Day were analyzed. The AUDIT, a 10-item screening instrument developed by the World Health Organization, was used to measure drinking behavior; employees' subjective assessments of their drinking were also obtained. Results: Over 53% of participants subjectively underestimated their drinking relative to their AUDIT results, and 58% of respondents did not know whether their medical insurance included benefits for alcohol treatment. Logistic regression analysis revealed that younger and male respondents tended to have the highest AUDIT scores and also ( along with married respondents) were most likely to underestimate their drinking. Younger, unmarried respondents were least likely to be aware of their alcohol treatment insurance benefits. Conclusions: Current corporate efforts to curtail problem drinking among employees may not adequately address barriers to change. Targeting at-risk employee groups for alcohol screening and dissemination of information about health insurance benefits and treatment options is recommended, as is providing personalized feedback based on screening results to raise awareness of at-risk drinking and available helping resources.

Aspy CB; Mold JW; Thompson DM; Blondell RD; Landers PS; Reilly KE et al. Integrating screening and interventions for unhealthy behaviors into primary care practices. American Journal of Preventive Medicine 53(5, Supplement S): S373-S380, 2008. (65 refs.)

Background: Four unhealthy behaviors (tobacco use, unhealthy diet, physical inactivity, and risky alcohol use) contribute to almost 37% of deaths in the U.S. However, routine screening and interventions targeting these behaviors are not consistently provided in primary care practices. Methods: This was an implementation study conducted between October 2005 and May 2007 involving nine practices in three geographic clusters. Each cluster of practices received a multicomponent intervention sequentially addressing the four behaviors in three G-month cycles (unhealthy diet and physical inactivity were combined). The intervention included baseline and monthly audits with feedback; five training modules (addressing each behavior plus stages of change [motivational interviewing]); practice facilitation; and bimonthly quality-circle meetings. Nurses, medical assistants, or both were taught to do screening and very brief interventions such as referrals and handouts. The clinicians were taught to do brief interventions. Outcomes included practice-level rates of adoption, implementation, and maintenance. Results: Adoption: Of 30 clinicians invited, nine agreed to participate (30%). Implementation: Average screening and brief-intervention rates increased 25 and 10.8 percentage points, respectively, for all behaviors. However, the addition of more than two behaviors was generally unsuccessful. Maintenance: Screening increases were maintained across three of the behaviors for up to 12 months. For both unhealthy diet and risky alcohol use, screening rates continued to increase throughout the study period, even during the periodswhen the practices focused on the other behaviors. The rate of combined interventions returned to baseline for all behaviors 6 and 12 months after the intervention period. Conclusions: it appears that the translational strategy resulted in increased screening and interventions. There were limits to the number of interventions that could be added within the time limits of the project. Inflexible electronic medical records, staff turnover, and clinicians' unwillingness to allow greater nurse or medical-assistant involvement in care were common challenges.

Babor TF; McRee BG; Kassebaum PA; Grimaldi PL; Ahmed K; Bray J. Screening, Brief Intervention, and Referral to Treatment (SBIRT): Toward a public health approach to the management of substance abuse. Substance Abuse 28(3): 7-30, 2007

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a comprehensive and integrated approach to the delivery of early intervention and treatment services through universal screening for persons with substance use disorders and those at risk. This paper describes research on the components of SBIRT conducted during the past 25 years, including the development of screening tests, clinical trials of brief interventions and implementation research. Beginning in the 1980s, concerted efforts were made in the US and at the World Health Organization to provide an evidence base for alcohol screening and brief intervention in primary health care settings. With the development of reliable and accurate screening tests for alcohol, more than a hundred clinical trials were conducted to evaluate the efficacy and cost effectiveness of alcohol screening and brief intervention in primary care, emergency departments and trauma centers. With the accumulation of positive evidence, implementation research on alcohol SBI was begun in the 1990s, followed by trials of similar methods for other substances (e.g., illicit drugs, tobacco, prescription drugs) and by national demonstration programs in the US and other countries. The results of these efforts demonstrate the cumulative benefit of translational research on health care delivery systems and substance abuse policy. That SBIRT yields short-term improvements in individuals' health is irrefutable; long-term effects on population health have not yet been demonstrated, but simulation models suggest that the benefits could be substantial.

Bentele M; Kriston L; Clement HW; Harter M; Mundle G; Berner MM. The validity of the laboratory marker combinations DOVER and QUVER to detect physician's diagnosis of at-risk drinking. Addiction Biology 12(1): 85-92, 2007. (36 refs.)

Especially in situations where it might be favorable for the patient to dissimulate the existing alcohol problem, 'objective' laboratory tests can be helpful. In this study we report validation of the two combinations DOVER (DOctor VERified) and QUVER (QUestionnarie VERified) of the biological markers percent carbohydrate-deficient transferrin (%CDT) and gamma-glutamyl-transferase (gamma-GT) to detect patients that have been identified by their physicians with at-risk drinking behavior. Fifty-eight general practitioners (GPs) participated at two study sites in South-West Germany. Patients filled in a questionnaire that included the alcohol use disorders identification test (AUDIT) and gave a blood sample. The GP recorded his/her assessment about the presence of an alcohol-related disorder in the patient. Receiver operating characteristics (ROC) analyses of the marker combinations DOVER and QUVER were performed. A total of 2940 patients participated in the study, of which 2496 completed data sets that could be used for further analysis. The area under the curve (AUC) of 79.5% for DOVER and 77.2% (QUVER) are in a higher range than the values for gamma%CDT (75.7%) or gamma-GT (72.5%) and %CDT (64.5%) and suggest superiority of the proposed marker combinations. Cross-validation results were almost identical with 76.6% and 73.3% for DOVER and QUVER, respectively. Our analysis demonstrated that the combination of the markers gamma-GT and %CDT with the physician's judgement of the condition as reference was superior to the use of single markers.

Berks J; McCormick R. Screening for alcohol misuse in elderly primary care patients: A systematic literature review. (review). International Psychogeriatrics 20(6): 1090-1103, 2008. (45 refs.)

Background: Alcohol problems in the elderly are common and frequently undetected, and therefore a potential target for a screening program. Method: Using Medline, Psychinfo and reference lists from relevant publications, articles were identified testing pen-and-paper screens in the primary care population aged over 60 years. Results: Using standard definitions of alcohol problems, conventional screens adapted for use in the elderly have performances similar to screens in the younger primary care population. However, it can be argued that special screens perform better for the elderly. Conclusions: The Alcohol Use Disorders Identification Test is a useful screen for detecting harmful and hazardous drinking in the elderly while the CAGE is valuable when screening for dependence. In the future, the Alcohol-Related Problems Survey, a computer-based screen, may prove to be superior if practical implementation problems can be overcome.

Bernards S; Graham K; Demers A; Kairouz S; Wells S. Gender and the assessment of at-risk drinking: Evidence from the GENACIS Canada (2004-2005) telephone survey version of the AUDIT. Drug and Alcohol Dependence 88(2/3): 282-290, 2007. (33 refs.)

The alcohol use disorders identification test (AUDIT) is widely used in general population surveys as a method of determining prevalence of hazardous drinking. However, its interpretation has been questioned particularly regarding the unequal contribution of the items to the total score, specifically, that the drinking frequency item contributes disproportionately to the score and may lead to inappropriate identification of some drinkers as hazardous drinkers. To explore these issues further as well as possible gender differences in the applicability of the AUDIT, we conducted analyses using a modified version of the AUDIT (AUDIT(M)) as part of a general population survey that used random digit dialing and computer-assisted telephone interviewing. Item and factor analyses were performed separately for men and women, and the impacts of excluding the frequency of drinking item in the measurement of mean scores, percentages and types of problems for men and women were examined. We found that the AUDIT(M) items loaded onto three distinct dimensions for both men and women: frequency of drinking; usual quantity and frequency of heavy-episodic drinking; problem consequences from drinking. In addition, we found that excluding the frequency question may give a more meaningful estimate of the percent of drinkers actually at risk of experiencing problems from drinking for both men and women. Finally, although our analyses identified only minor gender differences in the structure of the AUDIT and good sensitivity for identifying problem drinkers among both men and women, significant gender differences in the types of problems experienced suggest that use and interpretation of the AUDIT should routinely take gender into consideration.

Berner MM; Kriston L; Bentele M; Harter M. The Alcohol Use Disorders Identification Test for detecting at-risk drinking: A systematic review and meta-analysis. Journal of Studies on Alcohol and Drugs 68(3): 461-473, 2007. (65 refs.)

Objective: The purpose of this study was to perform a systematic review of the diagnostic accuracy of the Alcohol Use Disorders Identification Test (AUDIT) for detecting at-risk drinking. Method: The MEDLINE, PsycINFO, Science Citation Index Expanded, BIOSIS Previews, Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDION, and Cochrane Library databases were searched for relevant studies. The criteria for inclusion were a valid reference standard, AUDIT consisting of 10 items, avoiding bias that may result from how the reference standard was obtained, and when and how many participants were tested. Data were extracted independently by two reviewers. Data synthesis was performed by applying direct pooling of proportions and random effects model for likelihood ratios and diagnostic odds ratio. Results: Twenty-three studies were included in the a cutoff of 8 points, sensitivity ranged from .31 to .89 and specificity ranged from .83 to .96 across the eight studies conducted in primary care. A single trial in general hospital inpatients found a sensitivity of .93 and a specificity of .94; another trial in emergency-department patients found a sensitivity of .72 and a specificity of .88. A study in university students found a sensitivity of .82 and a specificity of .78. Three studies in elderly patients found sensitivities between .55 and .83 at a pooled specificity of .96. There was large heterogeneity between study results, which could only partly be explained by setting diversity. The analysis of results with population-specific cutoff points led to similar findings. Conclusions: Findings on the diagnostic performance of the AUDIT proved to be largely heterogeneous. Its use should be restricted to primary care populations, inpatients, and elderly patients.

Braaten K; Briegleb C; Hauke S; Niamkey N; Chang G. Screening pregnant young adults for alcohol and drug use: A pilot study. Journal of Addiction Medicine 2(2): 74-78, 2008. (45 refs.)

This study. ascertained the feasibility of offering a self-report alcohol and drug screen embedded in a general health habits survey to patients attending the Young Adult Reproductive Medicine Clinic and compared those who screened positive for a substance use problem with those who did not. An anonymous convenience sample of 100 young adults completed the Health Habits Survey, which included the CRAFFT screening test, designed specifically to identify substance-related problems in adolescent populations and recently recommended as a potential tool to reduce adverse outcomes from prenatal alcohol exposure. Eighty of the 100 respondents were pregnant and younger than aged 25 years, and they are the focus of the study. With a mean age of 18.2 years and 23.5 weeks gestation, most were single (75%) and had a high school education or less (75%). The majority (81%) was CRAFFT screen negative, but 15 answered yes to at least 1 CRAFFT question. There were no systematic differences between those with positive or negative CRAFFT screens. The CRAFFT, when embedded in a general health habits survey, seems to be a feasible option for pregnant young adults, but further studies to assess reliability, sensitivity, and specificity are recommended.

Bradley KA; DeBenedetti AF; Volk RJ; Williams EC; Frank D; Kivlahan DR. AUDIT-C as a brief screen for alcohol misuse in primary care. Alcoholism: Clinical and Experimental Research 31(7): 1208-1217, 2007. (50 refs.)

Background: The Alcohol Use Disorders Identification Test Consumption (AUDIT-C) questions have been previously validated as a 3-item screen for alcohol misuse and implemented nationwide in Veterans Affairs (VA) outpatient clinics. However, the AUDIT-C's validity and optimal screening threshold(s) in other clinical populations are unknown. Methods: This cross-sectional validation study compared screening questionnaires with standardized interviews in 392 male and 927 female adult outpatients at an academic family practice clinic from 1993 to 1994. The AUDIT-C, full AUDIT, self-reported risky drinking, AUDIT question #3, and an augmented CAGE questionnaire were compared with an interview primary reference standard of alcohol misuse, defined as a Diagnostic and Statistical Manual, 4th ed. alcohol use disorder and/or drinking above recommended limits in the past year. Results: Based on interviews with 92% of eligible patients, 128 (33%) men and 177 (19%) women met the criteria for alcohol misuse. Areas under the receiver operating characteristic curves (AUROCs) for the AUDIT-C were 0.94 (0.91, 0.96) and 0.90 (0.87, 0.93) in men and women, respectively (p=0.04). Based on AUROC curves, the AUDIT-C performed as well as the full AUDIT and significantly better than self-reported risky drinking, AUDIT question #3, or the augmented CAGE questionnaire (p-values < 0.001). The AUDIT-C screening thresholds that simultaneously maximized sensitivity and specificity were >= 4 in men (sensitivity 0.86, specificity 0.89) and >= 3 in women (sensitivity 0.73, specificity 0.91). Conclusions: The AUDIT-C was an effective screening test for alcohol misuse in this primary care sample. Optimal screening thresholds for alcohol misuse among men (>= 4) and women (>= 3) were the same as in previously published VA studies.

Branson BM; Handsfield HH; Lampe MA; Janssen RS; Taylor AW; Lyss SB et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. (review). Journal of the National Medical Association 100(1): 131-147, 2008. (116 refs.)

These recommendations for human immunodeficiency virus (HIV) testing are intended for all health-care providers in the public and private sectors, including those working in hospital emergency departments, urgent care, clinics, inpatient services, substance abuse treatment clinics, public health clinics, community clinics, correctional health-care facilities, and primary care settings. The recommendations address HIV testing in health-care settings only. They do not modify existing guidelines concerning HIV counseling, testing, and referral for persons at high risk for HIV who seek or receive HIV testing in nonclinical settings (e.g., community-based organizations, outreach settings, or mobile vans). The objectives of these recommendations are to increase HIV screening of patients, including pregnant women, in health-care settings; foster earlier detection of HIV infection; identify and counsel persons with unrecognized HIV infection and link them to clinical and prevention services; and further reduce perinatal transmission of HIV in the United States. These revised recommendations update previous recommendations for HIV testing in health-care settings and for screening of pregnant women (CDC Recommendations for HIV testing services for inpatients and outpatients in acute-care hospital settings. MMWR 1993;42[No. RR-2]:1-10; CDC. Revised guidelines for HIV counseling, testing, and referral. MMWR 2001;50[No. RR-19]:1-62; and CDC. Revised recommendations for HIV screening of pregnant women. MMWR 2001;50[No. RR-19]:63-85). Major revisions from previously published guidelines are as follows: For patients in all health-care settings HIV screening is recommended for patients in all health-care settings after the patient is notified that testing will be performed unless the patient declines (opt-out screening). Persons at high risk for HIV infection should be screened for HIV at least annually. Separate written consent for HIV testing should not be required; general consent for medical care should be considered. sufficient to encompass consent for HIV testing. Prevention counseling should not be required with HIV diagnostic testing or as part of HIV screening programs in healthcare settings. For pregnant women HIV screening should be included in the routine panel of prenatal screening tests for all pregnant women. HIV screening is recommended after the patient is notified that testing will be performed unless the patient declines (opt-out screening). Separate written consent for HIV testing should not be required, general consent for medical care should be considered sufficient to encompass consent for HIV testing. Repeat screening in the third trimester is recommended in certain jurisdictions with elevated rates of HIV infection among pregnant women.

Cassidy CM; Schmitz N; Malla A. Validation of the Alcohol Use Disorders Identification Test and the Drug Abuse Screening Test in first episode psychosis. Canadian Journal of Psychiatry 53(1): 26-33, 2008. (26 refs.)

Objective: To determine the validity and reliability of the Alcohol Use Disorders Identification Test (AUDIT) and Drug Abuse Screening Test (DAST) for detecting alcohol and drug use disorders, respectively, in a population with first-episode psychosis (FEP). Method: Subjects with FEP completed the AUDIT and DAST and were divided into groups according to the presence or absence of a Structured Clinical Interview for DSM-IV (SCID) diagnosis of either current alcohol or drug misuse. The data were analyzed to see whether AUDIT and DAST scores were predictive of SCID diagnosis. Results: Patients with alcohol-related SCID diagnoses and those with drug-related SCID diagnoses scored significantly higher on the AUDIT and DAST, respectively, than the group without the respective SCID diagnosis (P < 0.001 in both cases). The AUDIT functioned best with a problem drinking cut-off score of 10 (sensitivity, 85%; specificity, 91%). The DAST functioned best with a problem drug use cut-off score of 3 (sensitivity, 85%; specificity, 73%). The area under the receiver operating characteristic curve was 0.86 for the AUDIT and 0.83 for the DAST. Conclusion: The DAST and AUDIT may reliably identify FEP patients with substance abuse.

Caviness CM; Hatgis C; Anderson BJ; Rosengard C; Kiene SM; Friedmann PD et al. Three brief alcohol screens for detecting hazardous drinking in incarcerated women. Journal of Studies on Alcohol and Drugs 70(1): 50-54, 2009. (28 refs.)

Objective: Screening methods for hazardous drinking have not been evaluated in a population of incarcerated women. This study examines abbreviated versions of the Alcohol Use Disorders Identification Test (AUDIT) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) heavy episodic drinking criterion in a sample of female detainees. Method: A total of 2,079 women at the Adult Correctional Institute in Rhode Island were approached for screening between February 2004 and June 2007. The AUDIT-consumption (AUDIT-C), AUDIT-3, and the NIAAA heavy episodic drinking criterion (four or more drinks on one occasion for women) were compared with the full AUDIT at different cut points. Results: More than 55% of the sample endorsed an AUDIT score of 4 or greater-the NIAAA recommended threshold for detecting hazardous drinking. The three-item AUDIT-C with a cut score of 3 yielded a classification most consistent with the AUDIT score of 4 or more; sensitivity and specificity exceeded .9, and 91.5% of participants were correctly classified. The AUDIT-3 and NIAAA episodic drinking criteria were less sensitive measures. We found no evidence of interactions between the screening instruments and age or ethnicity. Conclusions: The three-item AUDIT-C has robust test characteristics for detecting hazardous drinking in female inmates. Universal screening for hazardous drinking is recommended for incarcerated women, given their high rates of alcohol misuse.

Chasnoff IJ; Wells AM; McGourty RF; Bailey LK. Validation of the 4P's Plus (c) screen for substance use in pregnancy validation of the 4P's Plus. Journal of Perinatology 27(12): 744-748, 2007. (29 refs.)

Objective: The purpose of this study is to validate the 4P's Plus screen for substance use in pregnancy. Study Design: A total of 228 pregnant women enrolled in prenatal care underwent screening with the 4P's Plus and received a follow-up clinical assessment for substance use. Statistical analyses regarding reliability, sensitivity, specificity, and positive and negative predictive validity of the 4Ps Plus were conducted. Result: The overall reliability for the five-item measure was 0.62. Seventy-four ( 32.5%) of the women had a positive screen. Sensitivity and specificity were very good, at 87 and 76%, respectively. Positive predictive validity was low ( 36%), but negative predictive validity was quite high ( 97%). Of the 31 women who had a positive clinical assessment, 45% were using less than 1 day per week. Conclusion: The 4P's Plus reliably and effectively screens pregnant women for risk of substance use, including those women typically missed by other perinatal screening methodologies.

Cremonte M; Cherpitel CJ. Performance of screening instruments for alcohol use disorders in emergency department patients in Argentina. Substance Use & Misuse 43(1): 125-138, 2008. (32 refs.)

The performance of the Alcohol Use Disorders Identification Test (AUDIT), CAGE, Brief Michigan Alcohol Screening Test (Brief MAST), Rapid Alcohol Problems Screen ( RAPS), Rapid Alcohol Problems Screen-Quantity and Frequency (RAPS4-QF), and TWEAK was evaluated against a diagnosis of alcohol dependence and harmful drinking or alcohol abuse from ICD-10 and DSM-IV criteria. Data were collected from a probability sample of 779 patients admitted to the emergency department of a public general hospital in Mar del Plata, Argentina, during the year 2001. The majority of the patients sampled were male. The age range was 18 to 89 years, with a mean value of 36 years and a median of 31 years. Almost half of the sample had an elementary school education or less. All instruments were more sensitive for alcohol dependence than for harmful drinking or abuse and more sensitive for men than for women. Findings suggest the RAPS4 and RAPS4-QF may be preferred when screening for alcohol use disorders in the emergency department in Argentina. The study's limitations are noted.

Cronk C; Weiss M. Diagnosis, surveillance and screening for fetal alcohol syndrome spectrum disorders: Methods and dilemmas. (review). International Journal on Disability and Human Development 6(4): 343-359, 2007. (82 refs.)

Fetal Alcohol Spectrum Disorder (FASD) is a prevalent preventable disorder with a significant societal burden related to the cognitive and behavioral disabilities associated with this disorder. This paper reviews the published work on FASD diagnosis, surveillance, and screening programs. Challenges inherent to FASD diagnosis remain and complicate attempts to estimate FAS prevalence. In addition, the drive toward diagnostic accuracy has led to the formulation of screening children at school ages after many disabilities associated with FASD are established. We present the design and selected findings from a regional multi-stage screening project piloted in Wisconsin. Small for gestational age (SGA) newborns with birth head circumference less than 10(th) percentile were selected in the first screening stages. Those meeting these criteria were evaluated for growth, development and FAS facial features at about 2 years of age. Of newborns meeting the initial screening criteria, 30% demonstrated growth deficits and developmental delays at about 2 years of age. Children with any FAS facial feature (of 177 children assessed, n=13 with 2 or 3 facial findings, n=77 with one facial finding) showed greater deficits in growth and a greater proportion were developmentally delayed. The findings demonstrate the potential value of embedding screening for FAS within a multistage screening method to identify infants at risk for any developmental delay. Because this model would be a part of larger population screening for developmental delay, cost efficiencies could be achieved. Problems relating to protection and confidentiality that inevitably accompany screening to identify FASD would also be reduced.

Cruce G; Nordstrom LG; Ojehagen A. Risky use and misuse of alcohol, drugs and cigarettes detected by screening questionnaires in a clinical psychosis unit. Nordic Journal of Psychiatry 61(2): 92-99, 2007. (44 refs.)

The use of screening instruments has been proposed to facilitate identification of risky substance use and misuse. This study aims to investigate the use of a screening procedure to identify hazardous or harmful use of alcohol, drug-related problems and riskful use of cigarettes in a clinical psychosis setting. The use of alcohol, drugs and cigarettes was examined by three self-reporting instruments: Alcohol Use Disorders Identification Test (AUDIT), Drug Use Disorders Identification Test (DUDIT) and Fagerstrom Test for Nicotine Dependence (FTND). Two hundred and forty-one out of 374 patients (64%) took part in the investigation. Eighteen per cent had a hazardous or harmful alcohol use, 9% drug-related problems and 49% were smokers. Multivariate analyses showed that women, as well as smokers had an increasing risk of having drug-related problems. The use of screening questionnaires increases the awareness that risky use of alcohol, drugs and cigarettes is common among persons with psychosis. Many persons with psychosis used alcohol, drugs and cigarettes in a risky way. It is important to identify these problems to make proper interventions due to the negative medical and social consequences of this use. Such identification may be facilitated by use of screening instruments.

De Silva P; Jayawardana P; Pathmeswaran A. Concurrent validity of the Alcohol Use Disorders Identification Test (AUDIT). Alcohol and Alcoholism 43(1): 49-50, 2008. (5 refs.)

Aims: To determine cut-offs for the Alcohol Use Disorders Identification Test (AUDIT) 10-item questionnaire, differentiating hazardous drinking (HZD) and alcohol use disorders (AUD) from low risk drinking (LRD), and AUD from HZD and LRD among married men in a Sri Lankan sample. Methods: Using 62 low risk drinkers and 88 each from hazardous drinkers and AUD, the AUDIT instrument was compared with adapted and translated versions of a beverage-specific, quantity-frequency questionnaire, and the alcohol use module of the Composite International Diagnostic Interview (CIDI), and two receiver operating characteristic (ROC) curves were plotted. Results: The area under the ROC curves to differentiate HZD + AUD from LRD and AUD from HZD + LRD were 0.96 (95% CI: 0.94-0.99) and 0.97 (95% CI: 0.95-0.99) respectively. The cut-off values of 7 and 16 were observed to have the best trade-offs between sensitivity, specificity, the ratio of positive likelihood to negative likelihood ratios, and positive predictive values. Conclusion: The AUDIT could be used to screen for LRD, HZD, and AUD among Sinhalese married men in Sri Lanka.

Diemert L; Bondy S; Victor JC; Cohen J; Brown KS; Ferrence R et al. Efficient screening of current smoking status in recruitment of smokers for population-based research. Nicotine & Tobacco Research 10(11): 1663-1667, 2008. (28 refs.)

Population-based samples of smokers are necessary for tobacco behavior monitoring and surveillance and for evaluating tobacco control programs and policies. We evaluated the sensitivity and specificity of a simple, one-question screener as a tool to maximize efficiency of obtaining a population representative sample of current smokers. This analysis was based on 5,002 respondents from the Ontario Tobacco Survey (OTS), a regionally stratified longitudinal survey of adult smokers and cross-sectional survey of nonsmokers in Ontario, Canada. Overall, the question Have you smoked one or more cigarettes in the past six months? achieved at least 99.7% sensitivity and 87.1% specificity when compared with several standard definitions of current smoking status. The brief screening question minimized respondent burden and data collection costs, and may have had a positive influence on response rate. Having a more conservative measure of smoking status permitted atypical smokers to be included in the survey which will allow us to track their behavior change and evaluate the performance of accepted smoking status definitions. We recommend that studies, which specifically sample smokers, utilize any past 6-month smoking as a brief screener for smoking status.

do Amaral RA; Malbergier A. Effectiveness of the CAGE questionnaire, gamma-glutamyltransferase and mean corpuscular volume of red blood cells as markers for alcohol-related problems in the workplace. Addictive Behaviors 33(6): 772-781, 2008. (28 refs.)

Objective: To evaluate the usefulness of gamma-glutamyltransferase (GGT) and mean corpuscular volume (MCV), as well as that of the CAGE questionnaire, in workplace screening for alcohol abuse/dependence. Methods: A total of 183 male employees were submitted to structured interviews (Structured Clinical Interview for DSM-IV 2.0 and CAGE questionnaire). Blood samples were collected. Diagnostic accuracy and odds ratio were determined for the CAGE, GGT and MCV. Results: The CAGE questionnaire presented the best sensitivity for alcohol dependence (91%; specificity, 87.8%) and for alcohol abuse (87.5%, specificity, 80.9%), which increased when the questionnaire was used in combination with GGT (sensitivity, 100% and 87.5%, respectively; specificity, 68% and 61.5, respectively). CAGE positive results and/or alterations in GGT were less likely to occur among employees not presenting alcohol abuse/ dependence than among those presenting such abuse (OR for CAGE = 13, p < 0.05; OR for CAGE-GGT = 11, p < 0.05) or dependence (OR for CAGE = 76, p < 0.0 1; OR for GGT = 5, p < 0.0 1). Employees not presenting alcohol abuse/dependence were also several times more likely to present negative CAGE or GGT results. Conclusions: The use short, simple questionnaires, combined with that of low-cost biochemical markers, such as GGT, can serve as an initial screening for alcohol-related problems, especially for employees in hazardous occupations. The data provided can serve to corroborate clinical findings.

Etter JF. Comparing the validity of the Cigarette Dependence Scale and the Fagerstrom test for Nicotine Dependence. Drug and Alcohol Dependence 95(1/2): 152-159, 2008. (45 refs.)

Background: We compared the validity of the Cigarette Dependence Scale (CDS-12) and of the Fagerstrom Test for Nicotine Dependence (FTND) in daily cigarette smokers. Methods: Internet survey in 2004-2007. Eight days and 6 weeks after answering these two dependence questionnaires, participants indicated their smoking status and answered the Cigarette Withdrawal Scale and the Smoking Self-Efficacy Questionnaire. We used the Mini International Neuropsychiatric Interview (MINI) to assess nicotine dependence as defined in DSM-IV. Results: There were 13,697 participants at baseline, 1113 (8%) after 8 days and 435 (3%) after 6 weeks. CDS-12, but not FIFND, predicted smoking cessation after 8 days (odds ratio = 1.20 per standard deviation unit, p = 0.03) and 6 weeks (odds ratio = 1.34, p = 0.01). In participants who had quit smoking after 8 days, CDS- 12 was a better predictor of craving (beta = 0.30, p < 0.001), than FTND (beta = 0.14, p < 0.01). After 8 days, self-efficacy in quitters was predicted by CDS- 12 (beta = -0.16, p = 0.02), but not by FIFND (beta = -0.05, p = 0.3). CDS-12 was more strongly associated than FTND with DSM-defined dependence measured by MINI: area under the Receiver Operating Characteristic (ROC) curve = 0.72 (95% confidence interval = 0.70-0.73). For FTND, the area under ROC = 0.64 (0.63-0.66). Conclusions: CDS-12 performed better than FTND on tests of predictive and construct validity.

Farrell SP; Zerull LM; Mahone IH; Guerlain S; Akan D; Hauenstein E et al. Electronic screening for mental health in rural primary care: Feasibility and user testing. CIN: Computers, Informatics, Nursing 27(2): 93-98, 2009. (34 refs.)

Despite attention to prevention and screening for depression and alcohol use, Healthy People 2010 objectives continue to include goals to increase the detection of depression and decrease the rates of alcohol abuse. These problems remain significant. The overall goal of this study was to develop a computer-based electronic screening (eScreening) tool and determine the feasibility of implementing computer-based eScreening technology for rural visitors to a primary care clinic. The study called specifically for an electronic touch screen with voice prompts. This tool, called the eScreening tool, screens for alcohol abuse and depression among rural patients in a primary care setting. The screening was offered to rural adults who are not in acute distress and not at end of life, regardless of their stated reason for seeking medical care. Phase 1 of the pilot was used to determine the perceptions of nurses, other providers, and consumers regarding the acceptability and perceived usefulness of an eScreening tool. Phase 2 involved user testing of the eScreening tool. The longer term goals of the research program are to work with rural nurses to improve patient outcomes and develop interventions and for educational, consultation, and/or direct clinical care.

Fear NT; Iversen A; Meltzer H; Workman L; Hull L; Greenberg N et al. Patterns of drinking in the UK Armed Forces. Addiction 102(11): 1749-1759, 2007. (66 refs.)

Aims: To examine patterns of drinking in the UK Armed Forces, how they vary according to gender and other demographics, and to make comparisons with the general population. Design Large cross-sectional postal questionnaire study (response rate 60%). Setting United Kingdom. Participants: A random representative sample of the regular UK Armed Forces who were in service in March 2003 (n = 8686; 7937 men, 749 women). Comparisons were made with the general population of Great Britain. Measurements: Alcohol consumption was assessed using the Alcohol Use Disorders Identification Test (AUDIT). Findings: Sixty-seven per cent of men and 49% of women in the UK Armed Forces had an AUDIT score of 8+ (defined as hazardous drinking), compared to 38% of men and 16% of women in the general population. In both sexes, for all ages, the military have a higher prevalence of hazardous drinking. Binge drinking was associated with being younger, being in the Army, being single, being a smoker and being white. Among military men, heavy drinking (AUDIT score 16+) was associated with holding a lower rank, being younger, being single, being in the Naval Service or Army, being deployed to Iraq, not having children, being a smoker, having a combat role and having a parent with a drink or drug problem. Conclusions: Excessive alcohol consumption is more common in the UK Armed Forces than in the general population. There are certain socio-demographic characteristics associated with heavy drinking within the military; for example, young age, being single and being a smoker, which may allow the targeting of preventive interventions.

Fernald DH; Froshaug DB; Dickinson LM; Balasubramanian BA; Dodoo MS; Holtrop JS et al. Common measures, better outcomes (COMBO): A field test of brief health behavior measures in primary care. American Journal of Preventive Medicine 53(5, Supplement S): S414-S422, 2008. (47 refs.)

Background: Primary care offices have been characterized as underutilized settings for routinely addressing health behaviors that contribute to premature death and unnecessary suffering. Practical tools are needed to routinely assess multiple health risk behaviors among diverse primary care patients. The performance of a brief set of behavioral measures used in primary care practice is reported here. Methods: Between August 2005 and January 2007, 75 primary care practices assessed four health behaviors, using a 21-item patient self-report questionnaire for adults or a 16-item questionnaire for adolescents. Data were collected via telephone, paper, or electronic means, either with or without assistance. The performance of these measures was evaluated by describing risk-behavior prevalences, combinations of risk behaviors, and missing data. Results: Of 227 adolescents and 5358 adults, most patients completed all of the survey questions. Two or more unhealthy behaviors were reported by 47.1% of adolescents and 69.2% of adults. Percentages of adults who completed all the survey items varied by health behavior: tobacco use, 98.5%; diet, 98.2%; physical activity, 96.2%; alcohol use, 85.1%. Missing data rates were higher for unassisted patient self-reporting. Conclusions: A relatively brief set of health behavior measures was usable in a variety of primary care settings with adults and adolescents. The performance of these measures was uneven across behaviors and administration modes, but yielded estimates of unhealthy behaviors consistent overall with what would be expected based on published population estimates. Further work is needed on measures for alcohol use and physical activity to bring practical assessment tools for key health behaviors to routine primary care practice.

Fitzsimons GJ; Moore SG. Should we ask our children about sex, drugs and rock & roll? Potentially harmful effects of asking questions about risky behaviors. Journal of Consumer Psychology 18(2): 82-95, 2008. (93 refs.)

Research shows that asking questions can fundamentally change behavior. We review literature on this question-behavior effect, which demonstrates that asking questions changes both normal and risky behaviors. We discuss potential explanations for the effect and review recent findings that reveal interesting moderators of the influence of questions on behavior. We then highlight the potential impact of the question-behavior effect in an important public health context: screening adolescents for risky behavior. While medical guidelines emphasize the importance of asking adolescents questions about substance (drug, alcohol) use and sexual behaviors, research on the question-behavior effect suggests that asking adolescents about risky behaviors has the potential to increase the frequency with which they engage in these behaviors. We argue that the act of screening or measuring risky behavior is potentially counterproductive. We emphasize the importance of interventions beyond screening, and suggest ways in which screening can be carried out to minimize its impact. in short, asking questions about behaviors can change behavior, and asking questions about risky behaviors may itself be a risky undertaking.

Ghitza UE; Epstein DH; Preston KL. Self-report of illicit benzodiazepine use on the Addiction Severity Index predicts treatment outcome. Drug and Alcohol Dependence 97(1-2): 150-157, 2008. (56 refs.)

The relationship between pre-treatment illicit benzodiazepine use (days of use in the last 30) assessed on the Addiction Severity Index (ASI) and treatment outcome was investigated by retrospective analysis of data from two controlled clinical trials in 361 methadone maintained cocaine/opiate users randomly assigned to 12-week voucher- or prize-based contingency management (CM) or control interventions. Based on screening ASI, participants were identified as non-users (BZD-N; 0 days of use) or users (BZD-U; >0 days of use). Outcome measures were: urine drug screens (thrice weekly): quality of life and self-reported HIV-risk behaviors (every 2 weeks): and current DSM-IV diagnosis of cocaine and heroin dependence (study exit). In the CM group, BZD-U had significantly worse outcomes on in-treatment cocaine use, quality-of-life scores, needle-sharing behaviors, and current heroin dependence diagnoses at study exit compared to BZD-N. In the control group. BZD-U had significantly higher in-treatment cocaine use but did not differ from BZD-N on psychosocial measures. Thus, in a sample of non-dependent BZD users, self-reported illicit BZD use on the ASI, even at low levels, predicted worse outcome on cocaine use and blunted response to CM.

Gordon AJ; Sullivan LE; Alford DP; Arnsten JH; Gourevitch MN; Kertesz SG et al. Update in addiction medicine for the generalist. Journal of General Internal Medicine 22(8): 1190-1194, 2007. (39 refs.)

Generalist physicians can play a critical role in identifying and treating patients with addictions to alcohol, nicotine, and/or other drugs of abuse. In the United States, nicotine dependence and unhealthy alcohol use are the first (18.1%) and third (3.5%) leading causes, respectively, of preventable deaths.1 Primary care physicians have not traditionally treated substance use. This column "Update" provides a summary of 10 rececent review articles in in the categories of screening strategies for patients with alcohol problems and use of specific pharmacotherapies for patients with alcohol, nicotine, and opioid dependence.

Graham A; Goss C; Xu S; Magid DJ; Diguiseppi C. Effect of using different modes to administer the AUDIT-C on identification of hazardous drinking and acquiescence to trial participation among injured patients. Alcohol and Alcoholism 42(5): 423-429, 2007. (26 refs.)

Aims: We compared the effect of three different modes of questionnaire administration on screening for hazardous drinking and acquiescence to trial participation. Methods: A quasi-randomized controlled trial among injured patients seen in acute care clinics compared self-administered paper-and-pencil, self-administered electronic, and orally-administered interview questionnaires. Outcomes included positive AUDIT-C screens for hazardous drinking, willingness to participate in a (hypothetical) lifestyle intervention trial, and recruitment success. Differences were analyzed with nonlinear mixed models, controlling for age, sex, and facility. Structured interviews with staff explored levers and barriers to screening. Results: Of the 370 participants, 22.7% scored >= 4 and 7.8% >= 6 on the AUDIT-C. Electronic questionnaires were more likely than paper questionnaires to identify an AUDIT-C >= 6 (OR=1.96; 95% CI 1.10-3.48), but not >= 4 (OR=0.83; 95% CI 0.43-1.62). Oral questionnaires were as likely as paper questionnaires to identify an AUDIT-C >= 4 (OR=1.00; 95% CI 0.40-2.51) or >= 6 (OR=1.94; 95% CI 0.83-4.50). Electronic and oral questionnaires were more likely to elicit acquiescence to trial participation (OR=1.59; 95% CI 1.23-2.07, and OR=1.66; 95% CI 1.22-2.26, respectively). Oral questionnaires created problems with confidentiality, privacy, and disruption of patient flow, and reduced recruitment success (OR=0.51; 95% CI 0.42-0.62). Conclusions: Among acutely injured patients in clinics who consented to screening, nearly one-fourth reported hazardous drinking. Compared to paper questionnaires, electronic screening produced less social desirability bias and greater acquiescence to trial participation. Oral questionnaires produced greater acquiescence, but barriers to use adversely affected recruitment. Electronic questionnaires may be preferable for screening for hazardous drinking and recruitment into intervention trials in acute care clinics.

Habis A; Tall L; Smith J; Guenther E. Pediatricsric emergency medicine physicians' current practices and beliefs regarding mental health screening. Pediatric Emergency Care 23(6): 387-393, 2007. (36 refs.)

Background: Only 20% of children with mental health issues are identified and receiving appropriate treatment nationally. The emergency department (ED) may represent a significant opportunity to provide selective pediatric mental health screening to an at-risk population. Objective: To describe the current standard of care and perceived limitations among pediatric emergency medicine (PEM) physicians regarding mental health screening. Methods: A 23-question survey on screening practices for pediatric mental illness (PMI) was sent to PEM physician participants identified through the American Academy of Pediatricsrics Section on Emergency Medicine mailing list. Results: Of the 576 physicians meeting our inclusion criteria, 384 (67%) surveys were returned. Eighty-six percent of respondents indicated screening for PMI in 10% or less of their eligible patients. Overall, 43% of respondents indicated screening only if the chief complaint was psychiatric in nature. The remaining 217 physicians most commonly screened for depression (83%), suicidality (76%), and substance abuse (67%). Only 9% of physicians stated that they used evidence-based medicine in determining their screening practices. Women physicians (odds ratio, 1.94; 95% confident interval, 1.08-3.47) and those using evidence-based medicine (odds ratio, 3.88; 95% confidence interval, 1.92-7.85) were more likely to conduct screening. Significant limitations to screening identified by respondents include the following: time limitations (93%), absence of a validated screening tool (62%), limited resources (46%), and lack of training (44%). Eighty-eight percent of physicians believe that a validated and standardized screening tool would improve their ability to identify PMI. Conclusions: Routine PMI screening is conducted infrequently by most PEM physicians. Improved physician education/training and the development of a validated ED-specific mental health screening tool would assist PEM physicians in the early detection of PMI.

Hawkins EJ; Kivlahan DR; Williams EC; Wright SM; Craig T; Bradley KA. Examining quality issues in alcohol misuse screening. Substance Abuse 28(3): 53-65, 2007

The Veterans Health Administration (VHA) has successfully implemented evidence-based alcohol misuse screening with the AUDIT-C. The purpose of this study was to evaluate clinical alcohol screening during the first year after implementation. Using medical record review and mailed patient surveys collected during 2004 by VHA Office of Quality and Performance, this study analyzed concordance of screening results among patients with AUDIT-Cs in both data sources. Among 1,637 patients with AUDIT-C from both sources within 90 days, the medical record screening prevalence rate of alcohol misuse, 24.6% (95% CI: 22.5% to 26.7%), was significantly lower than the survey rate, 33.4% (31.1% to 35.7%). Of 8,312 patients identified as nondrinkers in medical records, 24% reported past year alcohol use and 5% screened positive for alcohol misuse on surveys. Lower rates of alcohol use and misuse documented in medical records compared to mailed surveys suggest further investigation and standardization of clinical screening are necessary.

Heather N. A long-standing World Health Organization collaborative project on early identification and brief alcohol intervention in primary health care comes to an end. Addiction 102(5): 679-681, 2007. (15 refs.)

This article describes the World Health Organization's "Collaborative Project on Detection and Management of Alcohol-related Problems in Primary Health Care" which was conducted over a 25 year period. The author describes the various phases of the project. The final phase, just completed, evaluated country-wide strategies for the broad, routine and continuing implementation of early identification and brief intervention. Australia and 11 European countries were involved in this phrase.

Heinernann AW; Lazowski LE; Moore D; Miller F; McAweeney M. Validation of a substance use disorder screening instrument for use in vocational rehabilitation settings. Rehabilitation Psychology 53(1): 63-72, 2008. (50 refs.)

Objective: The study objectives were to develop and validate a substance use disorder screening instrument for vocational rehabilitation customers. Beginning with the Substance Abuse Subtle Screening Inventory-3 (SASSI-3), the authors developed items pertaining to prescription medication misuse and modified other items. Research Method/Design: Data were collected for the cross-sectional cohort study through interviews with a random subsample reinterviewed 14 days later. Complete data sets were collected from 948 customers recruited in Ohio, Illinois, and West Virginia; 128 completed a second interview. Women composed 52% of the sample and 58% were African American; the mean age was 40 years ( 12 years). Customers completed a preliminary version of the new instrument, called the Substance Abuse in Vocational Rehabilitation Screener (SAVR-S), and the Diagnostic Interview Schedule. The authors used Rasch analyses to reduce the instrument to 43 items then, divided the sample into a development subsample (used to formulate a scoring routine) and a validation subsample. Results: Sensitivity in detecting substance use disorders was 82% and specificity was 85% in the validation subsample. Conclusions/Implications: The SAVR-S appears to be a valid instrument and minimizes respondent burden while maximizing sensitivity and specificity to substance use disorders. It can assist vocational rehabilitation staff in identifying customers who need professional assessment and help support efforts toward self-sufficiency.

Hesse M; Thiesen H. The CAGE as a measure of hazardous drinking in the homeless. American Journal on Addictions 16(6): 475-478, 2007. (25 refs.)

The aim of this study was to test the validity of the CAGE questions as a measure of severe drinking in subjects at drop-in centers for the homeless, using biological markers of acute liver reaction to alcohol as the "gold standard.'' A sample of homeless men and women in Copenhagen were invited to participate in a study of health problems. Subjects were interviewed and blood samples were taken and screened for indicators of liver dysfunction (gamma-glutamyltransferase [gamma GT], mean corpuscular volume [MCV], alanine aminotransferase [ALAT], and alkaline phosphatase [Alpase]), and hepatitis C [HCV]. Scores on CAGE correlated strongly with years of heavy drinking ( rho 0.43, p < 0.001), and while years of drinking did not correlate with biomarkers after controlling for multiple hypothesis testing, CAGE correlated with gamma GT, Alpase and ALAT, but not MCV. The correlations held even among those without HCV, but subjects with HCV+ and CAGE > 1 had quite extreme values on liver markers. Findings suggested that the CAGE was able to identify homeless drinkers whose drinking was signifantly associated with increases in biomarkers associated with heavy drinking.

Hill KP; Chang G. Brief screening instruments for risky drinking in the outpatient psychiatry clinic. American Journal on Addictions 16(3): 222-226, 2007. (33 refs.)

In this pilot study, we compared two brief screening instruments, the T-ACE ( Tolerance, Annoyed, Cut down, Eye-opener) and the Alcohol Use Disorders Identification Test (AUDIT), with a clinician interview and structured clinical interview (SCID) to determine if they improved identification of risky drinking in a psychiatry clinic compared to clinician interviews. Sixteen of 50 subjects satisfied DSM-IV criteria for lifetime alcohol abuse or dependence on the SCID, and four, all T-ACE positive, were listed "correctly'' in the chart as having an alcohol problem. With a SCID gold standard, risky drinking was identified with sensitivities and specificities of 0.88 and 0.59 for the T-ACE and 0.63 and 0.85 for the AUDIT. Brief screening instruments improved the identification of risky drinking in a psychiatry clinic.

Holling H; Bohning D; Bohning W. Meta-analysis of binary data based upon dichotomized criteria. Zeitschrift fur Psychologie 215(2): 122-131, 2007. (45 refs.)

This paper considers meta-analysis of binary data that use a dichotomized continuous score. Classification into two categories, e.g., qualified or not qualified, is often based upon a threshold or cut-off value. This threshold might vary between studies since intentionally different values are used. However, conventional meta-analysis methodology analyzing sensitivity and specificity separately might then be confounded by a potentially unknown variation of the cut-off value. In order to cope with varying thresholds, an overall estimate of the misclassification error is suggested instead, which is equivalent to the well-known Youden index. It is argued that this index is less prone to between-study variation of cut-off values. To adjust for potential study effects a Mantel-Haenszel estimator of the overall misclassification error is suggested. Arguments are illustrated using, as an example, the diagnosis of alcoholism using the Alcohol Use Disorders Identification Test (AUDIT).

Horgan CM; Garnick DW; Merrick EL; Hoyt A. Health plan requirements for mental health and substance use screening in primary care. Journal of General Internal Medicine 22(7): 930-936, 2007. (31 refs.)

Background: Screening for substance abuse and mental health in primary care can improve detection. One way to advance screening is for health plans to require it. Objectives: We developed national estimates of the prevalence and type of mental and substance-use condition screening health plans require of primary care practitioners. Design: In 1999 (N = 434, response rate = 92%) and 2003 (N = 368, response rate = 83%), we conducted a nationally representative health plan survey regarding alcohol, drug, and mental health services, including screening requirements. Participants: Health plans reported on screening requirements of their top three private insurance products. Products were categorized by type (HMO, POS, or PPO), behavioral health contracting arrangements, tax status, market area population, and region. Measurements: We asked whether primary care practitioners are required to use a general health screening questionnaire (including mental health, alcohol, or drugs items) and/or a screening questionnaire focused on mental health, alcohol, or drug problems. Results: By 2003, 34% of products had any behavioral health screening requirements. Although there was no increase from 1999 to 2003 in requirements for any kind of behavioral health screening, requirements for using a standard screening instrument declined for mental health but increased for alcohol and drug screening. PPOs showed the largest increase in prevalence of behavioral health screening requirements. Products contracting with managed behavioral health organizations were more likely to require screening. Conclusions: Most products do not require behavioral health screening in primary care. More screening could help to improve identification of behavioral health conditions, a first step towards effective treatment.

Jewell JD; Hupp SDA; Segrist DJ. Assessing DUI risk: Examination of the Behaviors & Attitudes Drinking & Driving Scale (BADDS). Addictive Behaviors 33(7): 853-865, 2008. (25 refs.)

Despite research findings indicating attitudinal differences among drivers with and without a history of driving under the influence (DUI) offenses, there are no well-established instruments specifically designed to clinically assess drinking and driving attitudes and behaviors among adults. The purpose of this current series of three studies was to investigate the psychometric properties of the Behaviors & Attitudes Drinking & Driving Scale (BADDS). The BADDS was developed in previous studies by the authors and assesses respondents' rationalizations for drinking and driving, likelihood of future drinking and driving, drinking and driving behaviors, and riding with a drinking driver behavior in the previous month. Study 1 (N = 179) and Study 2 (N = 338) assessed college participants, while Study 3 gathered data from adult DUI offenders (N = 160) and non-DUI offenders (N = 166). Results indicate good to excellent test-retest reliability and internal consistency estimates for BADDS scale scores. Support for the construct validity as well as concurrent and predictive criterion validity of BADDS scores was also demonstrated. Potential applications for the measure, as well as need for future research are described.

Johnson EO; Morgan-Lopez AA; Breslau N; Hatsukami DK; Bierut LJ. Test of measurement invariance of the FTND across demographic groups: Assessment, effect size, and prediction of cessation. Drug and Alcohol Dependence 93(3): 260-270, 2008. (37 refs.)

Background: Measurement non-invariance of the Fagerstrom Test for Nicotine Dependence (FTND) across demographic groups could significantly bias group comparisons and screening for recruitment into treatment and genetic studies. Here clinically meaningful bias in the FTND across European-American and African-American men and women was assessed by: (1) testing measurement invariance; (2) estimating effect sizes of non-invariance; and (3) assessing impact of adjusting for bias on the association between FTND and cessation. Methods: European-American and African-American current and former smokers (it = 8301) were identified from a community-based telephone screening of 25,265 individuals from metropolitan Detroit, MI and St. Louis, MO. The FTND was administered to measure current dependence and lifetime dependence when smoking the most. Cessation was measured as having smoked 100 or more cigarettes but not smoked in the past 30 days. Results: Statistically significant measurement non-invariance for the FTND was found and more pronounced for lifetime than current dependence. However, the magnitude of effects appeared negligible. The largest variance in item response explained by measurement non-invariance was 3.1%. Adjusting for measurement non-invariance made no difference in the associations between nicotine dependence and quitting smoking across groups. Conclusions: Although European-American and African-American men and women often report different scores on the FTND and have different response patterns to items on the FTND, it does not appear that such differences result from meaningful item-level measurement bias.

Kaariainen J; Aalto M; Kaariainen M; Seppa K. Audit questionnaire as part of community action against heavy drinking. Alcohol and Alcoholism 43(4): 442-445, 2008. (13 refs.)

Aims: The purpose of the present study was to find out how well the alcohol questionnaire, AUDIT, as part of a wide community action was noticed, and if it had any effects especially among heavy drinkers. Methods: As part of local community action campaign ('Booze Weeks'), the AUDIT pamphlet was delivered to all households (90,000) in Tampere, Finland, and 500 randomly selected inhabitants were interviewed on telephone. Results: More than three quarters of those consuming alcohol had noticed the 'Booze Weeks' campaign and considered it necessary. Inhabitants who drank most frequently were also the most likely to have noticed the campaign and the AUDIT pamphlet. Conclusions: As part of a wide community action, home-delivered self-help material is often noticed especially by heavy drinkers. They might come to realize their own heavy drinking and seek professional treatment.

Kaminer Y. The Teen Addiction Severity Index around the globe: the Tower of Babel revisited. Substance Abuse 29(3): 89-94, 2008

The objectives of this article are, first, to provide a brief review of screening and assessment of adolescents substance use and substance use disorders; second, to describe the work done with the Teen Addiction Severity Index (T-ASI) in different countries; and third, to address challenges and opportunities in order to improve international collaboration between health professionals responsible for providing substance abuse services for youth and families. It is recommended that the International Society of Addiction Medicine (ISAM) sponsor and coordinate the efforts to disseminate the benefits accrued from already developed assessment and treatment of substance use disorders of youth into different countries and regions. Addiction professionals representing a myriad of cultures, ethnic, and racial groups would be encouraged to translate the assessments into relevant languages and dialects and with the support of the original authors conduct reverse translation and then test the psychometric properties before a wider use commences.

Kinder LS; Bryson CL; Sun H; Williams EC; Bradley KA. Alcohol screening scores and all-cause mortality in male Veterans Affairs patients. Journal of Studies on Alcohol and Drugs 70(2): 253-260, 2009. (39 refs.)

Objective: Extensive research demonstrates a J- or U-shaped association between in-depth interview measures of alcohol consumption and mortality. Little is known about the relationship between alcohol screening questionnaires and mortality. This study examined the association between scores (ranging from 0 to 12) on the three-item Alcohol Use Disorder Identification Test-Consumption Questionnaire (AUDIT-C) and mortality. Method: This cohort study included male outpatients from seven Veterans Affairs (VA) medical centers who completed the AUDIT-C on mailed surveys (1997-2000; n = 34,292) and who were followed for a mean of 2.5 years. Death was ascertained from VA databases. Results: In analyses adjusted for demographics, a U-shaped relationship was observed between AUDIT-C scores and all-cause mortality. Nondrinkers (AUDIT-C 0) and heavy drinkers (AUDIT-C 8-9 and 10-12) had increased risk of death compared with drinkers who screened negative for alcohol misuse (AUDIT-C 1-3): hazard ratios (HR) = 1.41 (95% confidence interval [Cl]: 1.29-1.54), 1.32 (1.03-1.69), and 1.47 (1.14-1.91), respectively. This association differed across age groups (p = .003). For men younger than 50 years, AUDIT-C scores 10-12 were associated with increased mortality (HR = 2.21, 95% Cl: 1.29-3.77), whereas for men age 50 or older, self-reported abstinence (AUDIT-C 0) was associated with increased mortality; compared with drinkers with AUDIT-C scores 1-3: HR for men 50-64 = 1.45 (1.19-1.77); HR for men 65 or older = 1.42 (1.28-1.58). Conclusions: A U-shaped association between the AUDIT-C and mortality was observed, with important differences by age group. This is the first study to demonstrate that a clinical scaled screening measure of alcohol use has a similar association with mortality to that observed in epidemiological research with lengthier measures.

Kip MJ; Spies CD; Neumann T; Nachbar Y; Alling C; Aradottir S et al. The usefulness of direct ethanol metabolites in assessing alcohol intake in nonintoxicated male patients in an emergency room setting. Alcoholism: Clinical and Experimental Research 32(7): 1284-1291, 2008. (43 refs.)

Background: A major part of medical pathology in internal medicine is associated with chronic alcoholism. The aim of the current study was to investigate whether screening for Alcohol Use Disorders (AUD) can be improved through determination of direct ethanol metabolites compared to traditional biological state markers, the Alcohol Use Disorders Identification Test (AUDIT) and additional self-reports beyond the detection time period of a positive blood alcohol concentration (BAC). Methods: A total of 74 blood alcohol negative male patients who presented at the emergency room with either thoracic or gastrointestinal complaints were included. Phosphatidylethanol (PEth) was determined in whole blood, and ethyl glucuronide (EtG) in serum and urine samples. Traditional biological state markers [carbohydrate deficient transferrin (%CDT), gamma glutamyl transpeptidase (GGT), mean corpuscular volume (MCV)] were determined. The AUDIT was obtained and furthermore, all patients completed an additional self-report of alcohol consumption. Patients were divided into two (2) groups: AUDIT scores < 8 and AUDIT scores >= 8. Results: After assessment of the AUDIT, patients were allocated to one of the following groups: patients with AUDIT scores < 8 (n = 52) and with AUDIT scores >= 8 (n = 22). Twenty-five percent of the patients with AUDIT scores below the cut-off (n = 13/52) were tested positive for both PEth and UEtG. Of the patients who declared to be sober during the past 12 months, 38.5% were tested positive for PEth and UEtG. PEth discriminated similarly as %CDT for AUDIT scores >= 8 (AUC: 0.672; 95%CI 0.524 to 0.821). Self-reports of alcohol consumption were unreliable. Conclusion: Determination of direct ethanol metabolites such as PEth and UEtG provides additional evidence in screening for AUD in an ER setting. Determination of PEth might be considered complementary with or alternatively to %CDT.

Knight JR; Harris SK; Sherritt L; Van Hook S; Lawrence N; Brooks T et al. Adolescents' preference for substance abuse screening in primary care practice. Substance Abuse 28(4): 107-117, 2007

OBJECTIVE: To assess adolescents' preferences for substance abuse screening in primary medical care settings. DESIGN/METHODS: Twelve- to 18-year-old patients (N = 2133) arriving for routine care at a network of primary care sites completed an interview that included demographic items, the CRAFFT screen, and a questionnaire assessing preferences for screening method (paper questionnaire, computer, oral interview by nurse or doctor). A subgroup (n = 222) completed the CRAFFT directly on the computer. RESULTS: Across the entire sample, paper was the screening administration method most preferred (mean rank (MR) = 2.92, 95%CI 2.87-2.96) vs. computer (MR = 2.38, 2.33-2.43), nurse (MR = 2.43, 2.39-2.47), and doctor (MR = 2.30, 2.25-2.35). Among the participants who received the screening on the computer, however, computer (MR = 3.08, 95%CI 2.42-2.52) was statistically tied with paper (MR = 2.88, 2.75-3.02) and both were ranked significantly higher than nurse (MR = 2.06, 1.94-2.17) and doctor (MR = 1.98, 1.82-2.14). The findings were similar for participants' reports of being "very likely" to be honest when answering substance abuse screening questions. CONCLUSIONS: Adolescents should ideally be screened for substance abuse using paper or computer questionnaires.

Koren G; Hutson J; Gareri J. Novel methods for the detection of drug and alcohol exposure during pregnancy: Implications for maternal and child health. Clinical Pharmacology and Therapeutics 83(4): 631-634, 2008. (31 refs.)

Despite extensive evidence of fetal and neonatal risk, a large number of pregnant women are involved in excessive alcohol and drug abuse, such as with cocaine, methamphetamine, opioids, and cannabinoids.

Kuehn BM. Rethinking drinking. (news). Journal of the American Medical Association 301(16): 1647-1647, 2009. (0 refs.)

Description of new web site of NIAAA that helps individuals identify whether their levels of alcohol consumption put them at risk of developing alcohol dependence and help such persons develop a plan to change their drinking habits.

Kunze U; Scholer E; Schoberberger R; Dittrich C; Aigner K; Bolcskei P et al. Lung cancer risk measured by the Fagerstrom Test for Nicotine Dependence? (letter). Nicotine & Tobacco Research 9(5): 625-626, 2007. (8 refs.)

Lane WG; Dubowitz H; Feigelman S; Kim J; Prescott L; Meyer W et al. Screening for parental substance abuse in pediatric primary care. Ambulatory Pediatrics 7(6): 458-462, 2007. (34 refs.)

Objective.-Parental alcohol and drug abuse may have significant deleterious effects on children. Although screening in the pediatric office is recommended, few screening measures have been evaluated for use in this setting. We sought to validate a 2-question screening tool for parental substance abuse. Methods.-A total of 216 caregivers bringing children to a primary care clinic completed a brief screening for psychosocial problems that contained 2 substance abuse questions. To assess reliability and validity of the questionnaire, recruited caregivers returned within 2 months to complete a computerized study protocol that contained the brief screening questions and the substance abuse sections of the Composite International Diagnostic Inventory (CIDI). Results.-Sixteen percent of caregivers acknowledged a problem with drugs or alcohol on the CIDI. A "yes" response to either screening question had a sensitivity of 29%, specificity of 95%, positive predictive value of 17%, and negative predictive value of 98% for drug abuse. Values were 13%, 96%, 33%, and 87%, respectively for predicting alcohol abuse. Conclusions.-Brief screening in pediatric primary care can identify many, but not all, parents who may need intervention for problems with drugs and/or alcohol. Children should benefit from such screening if it enables parents to acknowledge and receive treatment for substance abuse. Further research is needed to assess whether sensitivity of screening can be improved without sacrificing brevity.

McCambridge J; Day M. Randomized controlled trial of the effects of completing the Alcohol Use Disorders Identification Test questionnaire on self-reported hazardous drinking. Addiction 103(2): 241-248, 2008. (25 refs.)

Aims The direct effects of screening on drinking behaviour have not previously been evaluated experimentally. We tested whether screening reduces self-reported hazardous drinking in comparison with a non-screened control group. Design: Two-arm randomized controlled trial (RCT), with both groups blinded to the true nature of the study. Setting and participants A total of 421 university students aged 18-24 years, recruited in five London student unions. Interventions Both groups completed a brief pen-and-paper general health and socio-demographic questionnaire, which for the experimental group also included the 10-item Alcohol Use Disorders Identification Test (AUDIT) screening questionnaire. Measurements: The primary outcome was the between-group difference in AUDIT score at 2-3-month follow-up. Eight secondary outcomes comprised other aspects of hazardous drinking, including dedicated measures of alcohol consumption, problems and dependence. Findings: A statistically significant effect size of 0.23 (0.01-0.45) was detected on the designated primary outcome. The marginal nature of the statistical significance of this effect was apparent in additional analyses with covariates. Statistically significant differences were also obtained in three of eight secondary outcomes, and the observed effect sizes were not dissimilar to the known effects of brief interventions. Conclusions: It is unclear to what extent these findings represent the effects of screening alone, a Hawthorne effect in which drinking behaviour has changed in response to monitoring, or whether they indicate reporting bias. These possibilities have important implications both for the dissemination of screening as an intervention in its own right and for behavioural intervention trials methodology.

McCambridge J; Thomas BA. Short forms of the AUDIT in a Web-based study of young drinkers. Drug and Alcohol Review 28(1): 18-24, 2009. (25 refs.)

Introduction. The Alcohol Use Disorders Identification Test (AUDIT) is under-studied among young drinkers, as are the contributions of individual items to total AUDIT scores, and online performance of the existing briefer versions of this instrument. Design and Methods. This study examined individual items of the AUDIT, and various combinations, including the existing briefer versions, in relation to total AUDIT scores in a Web-based study of young drinkers. A total of 167 young people aged 16-24 years old who had consumed any alcohol within the previous 7 days were recruited by both offline and online methods. Results. Considered individually, items 3, 4, 5 and 8 were predictive of the majority of the variance in total AUDIT scores in this Web-based study. Existing briefer versions of the AUDIT do not better predict total scores than possible alternative combinations of items, for which acceptable levels of sensitivity and specificity for screening have been demonstrated. Conclusions. Short forms of the AUDIT, particularly those based only on consumption questions, require further validation study in online applications with young people.

Messiah A; Encrenaz G; Sapinho D; Gilbert F; Carmona E; Kovess-Masfety V. Paradoxical increase of positive answers to the Cut-down, Annoyed, Guilt, Eye-opener (CAGE) questionnaire during a period of decreasing alcohol consumption: Results from two population-based surveys in Ile-de-France, 1991 and 2005. Addiction 103(4): 598-603, 2008. (59 refs.)

Aims: To describe trends of responses to the Cut-down, Annoyed, Guilt, Eye-opener (CAGE) questionnaire during a period of declining alcohol consumption, in a country with no temperance history. Design: Two random-sample surveys, conducted in 1991 and 2005, respectively. Setting The adult population of Ile-de-France. Participants: A total of 1183 subjects in 1991 and 5382 subjects in 2005. Measurements Responses to CAGE questions, obtained by face-to-face interviews in 1991 and by telephone in 2005. Results were standardized on the 2005 population structure. Findings The proportion of subjects giving at least two positive answers has increased by 4.2 times; the biggest increase was observed for the Guilt question (4.8 times) and the smallest for the Eye-opener question (2.6 times). Several increases were higher for women than for men: 12.9 times versus 3.3 times for two or more positive answers, 9.8 times versus 3.8 times for the Guilt question. Increases did not vary consistently by age. Conclusions These paradoxical trends do not support the use of CAGE in general population surveys. They confirm previous reports suggesting that CAGE was sensitive to community temperance level. They might reflect the emergence of a temperance movement in France, with stronger impact among women. This movement might be responsible for the fall in alcohol consumption.

Miller M; Stockdell R; Nemeth L; Feifer C; Jenkins RG; Nietert PJ et al. Initial steps taken by nine primary care practices to implement alcohol screening guidelines with hypertensive patients: The AA-TRIP Project. Substance Abuse 27(1/2): 61-70, 2007

Many medical conditions are caused or exacerbated by heavy drinking, necessitating alcohol screening and discussion in primary care practices. This is particularly true of hypertension, the most common primary diagnosis in the United States, which has been linked to the regular consumption of 3 or more standard alcoholic beverages a day. The Accelerating Alcohol Screening-Translating Research into Practice (AA-TRIP) project was designed to improve detection and management of alcohol problems in primary care patients with hypertension. Medical providers are being trained using the Practice Partner Research Network'sTranslating Research into Practice (PPRNet-TRIP) quality improvement model. This includes a multi-method intervention (electronic medical records, on-site academic detailing, practice feedback reports and annual network meetings) to help practices increase adherence to clinical guidelines. Qualitative analyses of initial steps taken by nine primary care practices toward the routine implementation of alcohol screening guidelines are presented. Organizational factors and provider and patient characteristics all influenced the method and consistency of alcohol screening and intervention. Perceived time constraints, patient sensitivity to questions about alcohol, and possible stigma associated with a diagnosis of alcoholism were also relevant barriers requiring problem solving.

Moos RH. Context and mechanisms of reactivity to assessment and treatment. (editorial). Addiction 103(2): 249-250, 2008. (18 refs.)

This is a commentary on the report by McCambridge and Day (this issue) on changes in drinking behavior which occured following the administration of the AUDIT.

Naegle MA. Screening for alcohol use and misuse in older adults. American Journal of Nursing 108(11): 50-58, 2008. (23 refs.)

The Short Michigan Alcoholism Screening Test-Geriatric Version (SMAST-G) is often used in outpatient settings to detect "at-risk" alcohol use, alcohol abuse, or alcoholism in older adults. As the number of older adults in the United States grows, those who develop problems of abuse and a dependence on alcohol will grow as well. The availability of accurate, easy-to-use screening tools to detect people in need of counseling can increase the number of older adults whose lives can be improved and even lengthened. To watch a free online video of a nurse administering the SMAST-G, go to http: links.lww.com/A271.

Nelson KG; Oehlert ME. Evaluation of a shortened South Oaks Gambling Screen in veterans with addictions. Psychology of Addictive Behaviors 22(2): 309-312, 2008. (24 refs.)

Rates of pathological gambling have increased with the availability of legalized gambling. Substance-abuse units increasingly recognize the need to assess for gambling problems. The South Oaks Gambling Screen (SOGS; H. R. Lesieur & S. B. Blume, 1987) has filled this need. Previous research (M. Oehlert & K. Nelson, 2004) has considered the feasibility of reducing the length of the SOGS while maintaining its ability to identify people at risk for problematic gambling. In this study, the authors examined the utility of a shortened SOGS (SSOGS) in a 2nd sample of veterans with addictions. The authors used data analysis to explore SSOGS psychometric properties and to provide additional support for use of the shorter instrument.

Nevitt JR; Lundak J; Codr J; Adams R. An analysis of AUDIT scores of adolescent offenders in two midwestern counties. Psychological Reports 100(3, Part 1): 700-706, 2007. (26 refs.)

The Alcohol Use Disorder Identification Test provides an accurate measure of risk associated with alcohol-related problems across sex, age, and cultures. As a recommended screening tool to detect patients who are appropriate candidates for brief, preventive alcohol interventions, it was given to 78 adolescents in a diversion program for drunk drivers in two southeastern Nebraska counties during routine alcohol-dependency evaluations. The subjects were grouped by age (18 and younger and over 18 years) and by sex. Based on a previous study, it was hypothesized that the responses to the first three AUDIT questions, related to alcohol consumption, would reflect sex and age differences. A 2 x 2 analysis of variance of scores on separate items indicated significant main effects for age (F-1,F-74 = 10.40, p <.002) for Question 1 with older boys' and girls' groups reporting they have drinks containing alcohol more frequently, for sex (F-1,F-74 = 14.65, p <.00 1) on Question 2 with the older boys' group reporting more frequent drinking on a typical day, and for age (F-1,F-74 = 7.74, p >.01), and sex (F-1,F-74 = 4.12, p <.05) OD Question 3 with the older boys' group indicating that they more frequently consumed six or more drinks on one occasion. It is recommended that the AUDIT-C be included in drug and alcohol assessments with adolescents similar to those tested here, and professionals be alert to the possibilities of sex and age differences in response to questions related to consumption.

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.

O'Brien CP. The CAGE Questionnaire for detection of alcoholism: A remarkably useful but simple tool (Reprinted from JAMA, vol 252, pg 1905-1907, 1984) reprint. Journal of the American Medical Association 300(17): 2054-2056, 2008. (12 refs.)

This is a reprint of the article outlining the use of four questions to screen for alcohol dependence, a tool known as the CAGE. "Four clinical interview questions, the CAGE questions, have proved useful in helping to make a diagnosis of alcoholism. The questions focus on Cutting down, Annoyance by criticism, Guilty feeling, and Eye-openers. The acronym 'CAGE' helps the physician to recall the questions. How these questions were identified and their use in clinical and research studies are described." (from the original article)

Okulicz-Kozaryn K; Sieroslawski J. Validation of the "problematic use of narcotics" (PUN) screening test for drug using adolescents. Addictive Behaviors 32(3): 640-646, 2007. (13 refs.)

The aim of the study was to examine psychometric properties of the PUN screening test concerning illicit drug problem use by adolescents. The criterion standard for the test's validity was a diagnostic interview conducted by trained specialists. Respondents were reached by snowball sampling in 58 randomly chosen Polish local communities. A total of 1344 adolescent (37% female) aged 13 to 18 years, who used any illicit drug at least once in the past 12 months, participated. The majority (89%) had no contacts with any drug therapy facilities. 41% were diagnosed as occasional drug users and 59% as problematic users or dependents. Logistic regression analysis showed that 10 out of the basic set of 25 test items were most powerful in differentiating occasional and problematic users. A test score of 2 or higher was optimal for identifying problem drug use (sensitivity: 0.88, specificity: 0.79, PPV: 0.86, NPV: 0.81). Validity was not affected by age or sex. These results confirmed the PUN test potential as a brief screening tool.

Osterman RL; Ribak J; Bohn CM; Fargo JD; Sommers MS. Screening for hazardous/harmful drinking and depressive symptoms in an at-risk emergency department population. Journal of Addictions Nursing 20(1): 34-40, 2009. (47 refs.)

Although co-occurring alcohol use and depression have been identified in many populations, wide-spread screening for these disorders has not occurred in many Emergency Departments (EDs). Co-morbidity of alcohol use and mood disorders places a person at increased risk for psychosocial and medical-physical problems. The purpose of this study was to investigate the association between hazardous/harmful alcohol use and depressive symptoms in an urban ED population of problem drinkers and risky drivers. Cross-sectional data from the baseline interview of a randomized controlled trial of a brief intervention protocol to reduce problem drinking and risky driving in the ED population were used to test the study hypothesis. Data were collected using the Health Interview Schedule, a modification of the WHO Composite Interview Schedule, with addition of the AUDIT questionnaire and the Center for Epidemiologyogic Studies Short Depression Scale (CES-D 10). Data from a sample of 255 individuals (68% male) were used in the present study (age: M = 28.38, CES-D 10: M = 9.79, SD = 6.22, AUDIT: M = 8.10, SD = 4.13). Multiple regression analyses indicated that total CES-D 10 scores were significantly associated with total AUDIT scores, drinks per week, income, and gender [F (4, 242) = 3.81, p = .005, R2 = .06]. Total AUDIT scores were positively associated with CES-D 10 scores (p .001). Due to co-morbidities associated with co-occurring depressive symptoms and hazardous/harmful drinking, it is imperative to assess ED patients for both of these conditions to provide expedient, optimal referral and treatment for patients at risk, particularly for patients injured in vehicular collisions because of their risky driving.

Pahwal P; Hyman SM; Sinha R. Craving predicts time to cocaine relapse: Further validation of the Now and Brief versions of the Cocaine Craving Questionnaire. Drug and Alcohol Dependence 93(3): 252-259, 2008. (42 refs.)

Background The 10-item version of the cocaine craving questionnaire (CCQ-Brief) has not been validated in a mixed-gender sample, and predictive validity of the CCQ-Now and CCQ-Brief in terms of their relationship with cocaine relapse has not been demonstrated. Objective: To further validate the CCQ-Brief in a mixed gender sample and to determine the predictive validity of the CCQ-Now and CCQ-Brief. Method: Seventy-two men and 51 women (Total N = 123) seeking inpatient cocaine dependence treatment were administered assessments upon admission, and a prospective design was employed to assess cocaine relapse outcomes during a 90-day follow-up period after discharge from inpatient treatment. Data were analyzed using Pearson's correlation, Cox proportional hazards regression, and multiple regression. Findings: The CCQ-Brief demonstrated good internal consistency and construct and concurrent validity. Both the CCQ-Now and the CCQ-Brief summary scores predicted time to cocaine relapse. In addition, the anticipation of a positive outcome from cocaine use, and intent and planning to use cocaine subscales of the CCQ-Now also predicted time to cocaine relapse. Conclusions: The CCQ-Brief was found to be a reliable and valid measure in a mixed gender sample, and both the CCQ-Now and CCQ-Brief were predictive of cocaine relapse risk. Craving assessments that go beyond desire and take into account intent and planning to use cocaine and the patient's anticipation of a positive outcome from using cocaine are likely to provide a sensitive index of cocaine relapse susceptibility. However, fear of social and clinical consequences could impact accurate reporting of cocaine craving and intent to use cocaine.

Polednak AP. Are patients at U.S. hospitals routinely screened for alcohol use? Journal of Addiction Medicine 2(1): 51-53, 2008

Rash C; Copeland A. The Brief Smoking Consequences Questionnaire-Adult (BSCQ-A): Development of a short form of the SCQ-A. Nicotine & Tobacco Research 10(11): 1633-1643, 2008. (35 refs.)

A brief form of the Smoking Consequences Questionnaire-Adult (SCQ-A) was developed as an economical alternative to the 55-item SCQ-A in assessing smoking outcome expectancies in adult, heavy smokers. A total of 25 items (two to three items per each of the 10 SCQ-A scales) were administered to current smokers and ex-smokers. Confirmatory factor analysis was used to determine whether the brief form was better accounted for by a 4- or 10-factor model. Several variants of 9- and 8-factor models also were compared. The 10-factor model, representing the 10 subscales of the full-length SCQ-A, fit the data more adequately than the other models. The Brief SCQ-A (BSCQ-A) scales demonstrated good internal consistency (mean coefficient =.79) and convergent validity. The BSCQ-A also showed promising validity in distinguishing among current smokers and ex-smokers. In a separate sample of smokers, strong and positive associations were present between corresponding pairs of the SCQ-A and BSCQ-A subscales.

Rash CJ; Coffey SF; Baschnagel JS; Drobes DJ; Saladin ME. Psychometric properties of the IES-R in traumatized substance dependent individuals with and without PTSD. Addictive Behaviors 33(8): 1039-1047, 2008. (49 refs.)

Posttraumatic stress disorder (PTSD) is common among treatment-seeking substance abusers. Despite the high prevalence of these co-occurring conditions, few PTSD screening tools have been evaluated for their utility in identifying PTSD in substance use disorder (SUD) populations. The present study evaluated the psychometric properties of the Impact of Event Scale-Revised (IES-R) in a sample of 124 substance dependent individuals. All participants had a history of a DSM-IV Criterion A traumatic event, and 71 individuals met diagnostic criteria for PTSD. Participants with comorbid PTSD reported significantly more symptoms of anxiety, depression, and PTSD compared to substance dependent individuals without PTSD. Acceptable internal consistency and convergent validity of the IES-R were established among a Substance dependent sample. Examination of diagnostic effectiveness suggested a cutoff value of 22 as optimal for a substance using population, resulting in adequate classification accuracy, sensitivity, and specificity.

Regules JMA; Vilchez PM; Villalba AG; Sanchez F; del Castillo JDL. Validity of smoking measurements during pregnancy: Specificity, sensitivity and cut-off points (Spanish). Revista Espanola de Salud Publica 82(5): 535-545, 2008. (23 refs.)

Background: Non disclosure by pregnant women smokers of their smoking habit questions the validity of self-declarations. The purpose of this research is to determine the rate of non-sdisclosure and to establish the validity of exhaled CO as a method of biochemical validation. Method: Data obtained in a Randomised Clinical Trial in 12 Health Centres in Malaga. 454 pregnant women smokers, of whom 104 declared that they had stopped smoking at the start. Measurement of the habit: self-declaration, carbon monoxide (CO) and cotinine in the urine in those subjects who declared that they no longer smoked. The ROC curve was obtained for the CO, calculating the area under the curve and the sensitivity and specificity for different cui-off points. Using the CID as the gold standard, the validity of the self-declarations was determined in terms of sensitivity and specificity. Results: Cotinine/self-declaration comparison: rate of Non disclosure 15.4% (IC 95% 9.3-24.1). Cotinine/CO comparison: Area under the ROC curve of 0.838 (IC 95% 0.740-0.935). For a cut-off point of 9, recommended in the relevant bibliography, we achieved 100% specificity with 12.5% sensitivity. CO/self-declaration comparison (cut-off point 9): False negations 0.8%, prevalence of spontaneous abandonment of smoking habit 58.1%. Conclusions: A percentage of Non disclosure similar to other studies and the validity of CO as a method for the identification of women smokers are confirmed. At cut-off point 9, the validity of CO and self-declaration would be similar, with the prevalence of spontaneous abandonment increasing up to unreal figures. At the present time, the evidence is not sufficient in order to recommend 9 as the CO cut-off point. The results suggest that this should be lower. More extensive research is necessary in pregnant women who state that they do not smoke, using an appropriate methodology.

Rose HL; Miller PM; Nemeth LS; Jenkins RG; Nietert PJ; Wessell AM et al. Alcohol screening and brief counseling in a primary care hypertensive population: A quality improvement intervention. Addiction 103(8): 1271-12801, 2008. (41 refs.)

Aims: To determine the effect of an intervention to improve alcohol screening and brief counseling for hypertensive patients in primary care. Design: Two-year randomized, controlled trial. Setting/participants: Twenty-one primary care practices across the United States with a common electronic medical record. Intervention To promote alcohol screening and brief counseling. Intervention practices received site visits from study personnel and were invited to annual network meetings to review the progress of the project and share improvement strategies. Measurements: Main outcome measures included rates of documented alcohol screening in hypertensive patients and brief counseling administered in those diagnosed with high-risk drinking, alcohol abuse or alcohol dependence. Secondary outcomes included change in blood pressure among patients with these diagnoses. Findings: Hypertensive patients in intervention practices were significantly more likely to have been screened after 2 years than hypertensive patients in control practices [64.5% versus 23.5%; adjusted odds ratio (OR) = 8.1; 95% confidence interval (CI) 1.7-38.2; P < 0.0087]. Patients in intervention practices diagnosed with high-risk drinking, alcohol abuse or alcohol dependence were more likely than those in control practices to have had alcohol counseling documented (50.5% versus 29.6%; adjusted OR = 5.5, 95% CI 1.3-23.3). Systolic (adjusted mean decline = 4.2 mmHg, P = 0.036) and diastolic (adjusted mean decline = 3.3 mmHg, P = 0.006) blood pressure decreased significantly among hypertensive patients receiving alcohol counseling. Conclusions: Primary care practices receiving an alcohol-focused intervention over 2 years improved rates of alcohol screening for their hypertensive population. Implementation of alcohol counseling for high-risk drinking, alcohol abuse or alcohol dependence also improved and led to changes in patient blood pressures.

Roy M; Dum M; Sobell LC; Sobell MB; Simco ER; Manor H et al. Comparison of the Quick Drinking Screen and the Alcohol Timeline Followback with outpatient alcohol abusers. Substance Use & Misuse 43(14): 2116-2123, 2008. (15 refs.)

Objective: A recent study comparing the Quick Drinking Screen (QDS) with the Timeline Followback (TLFB) found that in a nonclinical population of problem drinkers both measures produced reliable summary measures of drinking. The current study was designed to replicate these findings with a clinical population of alcohol abusers. The data were collected over three years (2004-2006). Method: Participants were 124 alcohol abusers who voluntarily enrolled for outpatient treatment. Over half (52.4%) were female with an average age of almost 40 years. About a third were married, had completed university, and a quarter were unemployed and nonwhite. Participants reported having a drinking problem for an average of 8.3 years, and reported drinking on about 5 days per week, averaging six drinks per drinking day. On two different occasions, they responded to two different sets of questions about their alcohol use. The instruments were: (a) the Quick Drinking Screen (QDS), a summary drinking measure, administered by telephone prior to the assessment; and (2) the TLFB self-administered by computer at the assessment. Results: As in a previous study, this study found that the QDS and the TLFB, two very different drinking measures, collected similar aggregate drinking data for four drinking variables in a clinical sample of alcohol abusers. Conclusions: When it is not necessary or not possible to gather detailed drinking data, the QDS produces reliable brief summary measures of drinking for problem drinkers. Generalization to nonclinical samples awaits further research.

Saitz R. Introduction: Screening and brief intervention. Substance Abuse 28(3): 1-2, 2007
Copyright 2007, Association for Medical Education & Research in Substance Abuse

Satre D; Wolfe W; Eisendrath S; Weisner C. Computerized screening for alcohol and drug use among adults seeking outpatient psychiatric services. Psychiatric Services 59(4): 441-444, 2008. (16 refs.)

Objective: This study examined routine computerized screening for alcohol and drug use of men and women seeking outpatient psychiatric services (excluding chemical dependency treatment) and prevalence based on electronic medical records of consecutive admissions. Methods: The sample of 422 patients, ages 18 - 91, completed a self- administered questionnaire. Measures included 30- day, one- year, and lifetime substance use and alcohol-related problems. Results: Seventy-five percent of patients completed electronic intakes during the study period. Prior- month alcohol use was reported by 90 men ( 70%) and 180 women (62%). Of these patients, heavy drinking (five or more drinks on one occasion) was reported by 37 men (41%) and 41 women (23%). Prior-month cannabis use was reported by 17 men (13%) and 32 women (11%). Conclusions: Computerized intake systems that include alcohol and drug screening can be integrated into outpatient psychiatric settings. Heavy drinking and use of nonprescribed drugs are commonly reported, which provides an important intervention opportunity.

Schleicher HE; Harris KJ; Catley D; Harrar SW; Golbeck AL. Examination of a brief Smoking Consequences Questionnaire for college students. Nicotine & Tobacco Research 10(9): 1503-1509, 2008. (16 refs.)

This study examined the factor structure of a brief version of the Smoking Consequences Questionnaire-Adult (SCQ-A) among 315 college freshman and sophomore smokers. A comparison of results from two confirmatory factor analyses demonstrated that a nine-factor model provided superior fit to a four-factor model. Furthermore, results revealed a lack of factorial invariance of factor loadings for daily and nondaily smokers, and of latent mean structures for smoking category and gender. In addition, concurrent validity tests demonstrated that positive expectancies increased with smoking rate and nicotine dependence. These results and their implications are discussed.

Schlesinger CM; Ober C; McCarthy MM; Watson JD; Seinen A. The development and validation of the Indigenous Risk Impact Screen (IRIS): a 13-item screening instrument for alcohol and drug and mental health risk. Drug and Alcohol Review 26(2): 109-117, 2007. (18 refs.)

The study aimed to assess the psychometric properties of the Indigenous Risk Impact Screen (IRIS) as a screening instrument for determining ( i) the presence of alcohol and drug and mental health risk in Indigenous adult Australians and (ii) the cut- off scores that discriminate most effectively between the presence and absence of risk. A cross- sectional survey was used in clinical and nonclinical Indigenous and non-Indigenous services across Queensland Australia. A total of 175 Aboriginal and Torres Strait Islander people from urban, rural, regional and remote locations in Queensland took part in the study. Measures included the Indigenous Risk Impact Screen (IRIS), the Severity of Dependence Scale (SDS), the Alcohol Use Disorders Identification Test (AUDIT) and the Leeds Dependence Questionnaire (LDQ). Additional Mental Health measures included the Depression Anxiety and Stress Scale (DASS- 21) and the Self- Report Questionnaire (SRQ). Principle axis factoring analysis of the IRIS revealed two factors corresponding with (i) alcohol and drug and (ii) mental health. The IRIS alcohol and drug and mental health subscales demonstrated good convergent validity with other well- established screening instruments and both subscales showed high internal consistency. A receiver operating characteristics (ROC) curve analysis was used to generate cut- offs for the two subscales and t- tests validated the utility of these cut- offs for determining risky levels of drinking. The study validated statistically the utility of the IRIS as a screen for alcohol and drug and mental health risk. The instrument is therefore recommended as a brief screening instrument for Aboriginal and Torres Strait Islander people.

Seale JP; Guyinn MR; Matthews M; Okosun I; Dent MM. Vital signs screening for alcohol misuse in a rural primary care clinic: A feasibility study. Journal of Rural Health 24(2): 133-135, 2008. (15 refs.)

Context: Alcohol misuse is more common in rural areas, and rural problem drinkers are less likely to seek alcohol treatment services. Rural clinics face unique challenges to implementing routine alcohol screening and intervention. Purpose: To assess the feasibility of using the single alcohol screening question (SASQ) during routine nursing vital signs in a rural clinic, and to determine its effect on alcohol screening and intervention rates. Methods: Patient exit interviews were used to identify alcohol misuse and to measure changes in screening and intervention rates. Chi-square tests were used to compare rates of screening across study phases, while odds ratios from logistic regression analyses were used to quantify association between nurse screening and clinician intervention. Findings: Exit interviews were completed by 126 current drinkers (41 before vital signs screening implementation and 85 afterward). Screening rates for alcohol misuse rose from 14.6% at baseline to 20.0% (P = .027) after screening implementation. Clinician intervention rates among alcohol misusers rose from 6.3% to 11.8% (P = .039). Nurse screening increased the odds of clinician intervention (OR 1.47; 95% CI 1.10-1.95). Conclusions: Vital signs screening proved to be feasible in this rural clinic and produced modest but significant increases in alcohol screening by nurses and brief interventions by clinicians. Additional studies are needed to define effective strategies for further increasing these rates.

Sheridan J; Wheeler A; Chen LJH; Huang ACY; Leung INY; Tien KYC. Screening and brief interventions for alcohol: Attitudes, knowledge and experience of community pharmacists in Auckland, New Zealand. Drug and Alcohol Review 27(4): 380-387, 2008. (31 refs.)

Introduction. Screening and brief intervention (SBI) for alcohol consumption in primary care have been shown to be effective in reducing drinking. This role has not been taken up by community pharmacists. This study aimed to explore attitudes, knowledge, barriers and incentives towards involvement of community pharmacists in New Zealand with problem drinkers. Method. A postal survey (three mailshots) of community pharmacies was undertaken in Auckland, New Zealand, followed by a 10% random sample non-responder-follow-up. Results. A response rate of 39.1% to the postal survey was obtained. In general, knowledge of alcohol content of drinks and recommended safe drinking limits was poor. Respondents were generally well motivated towards undertaking this role, but lacked knowledge, skills and confidence. On follow-up, non-responders were found to be less knowledgeable, but had similar attitudes to respondents, indicating potential for extrapolation with regard to beliefs and views on this subject. Discussion. This novel study has found that there is potential for involvement of community pharmacists in New Zealand in SBI for problem drinkers. Lack of knowledge can be remedied relatively easily; greater hurdles such as lack of skills, and lack of confidence may be offset by the high level of motivation of this group. This is an area where community pharmacists can further their professional scope of practice by being in an essential position to provide this service.

Shevlin M; Smith GW. The factor structure and concurrent validity of the Alcohol Use Disorder Identification Test based on a nationally representative UK sample. Alcohol and Alcoholism 42(6): 582-587, 2007. (44 refs.)

Aims: To assess the psychometric structure and construct validity of the alcohol use disorder identification test (AUDIT) in a Great Britain population sample. Methods: A stratified multi-stage random sample of 7849 participants completed the AUDIT as part of a computer assisted interview. Confirmatory factor analyses were conducted testing one to three factor models. The factors in these models were correlated with demographic variables and scores relating to perceived wellbeing, verbal IQ, and neurotic and psychosis symptoms to assess construct validity of the factor solutions. Results: A two factor solution was deemed to appropriately fit the data, measuring alcohol consumption and alcohol related problems. Correlations between the two factors on demographic, wellbeing, neurosis and psychosis symptomology were significantly different. Conclusions: The two factor solution suggests an advantage to investigating factor specific cut off scores for both consumption and alcohol related problems given their difference in predictive validity on both health and demographic variables.

Shields AL; Campfield DC; Miller CS; Howell RT; Wallace K; Weiss RD. Score reliability of adolescent alcohol screening measures: A meta-analytic inquiry. Journal of Child & Adolescent Substance Abuse 17(4): 75-97, 2008. (64 refs.)

This study describes the reliability reporting practices in empirical studies using eight adolescent alcohol screening tools and characterizes and explores variability in internal consistency estimates across samples. Of 119 observed administrations of these instruments, 40 (34%) reported usable reliability information. The Personal Experience Screening Questionnaire-Problem Severity scale generated average reliability estimates exceeding 0.90 (95% CI = 0.90-0.96) and the Adolescent Alcohol Involvement Scale generated average score reliability estimates below 0.80 (95% CI = 0.67-0.85). Average reliability estimates of the remaining instruments were distributed between these extremes. Sample characteristics were identified as potentially important predictors of variability in the reliability estimates of all the instruments and all instruments under evaluation generated more reliable scores in clinical settings (M = 0.89) as opposed to nonclinical settings (M = 0.82; r effect size (38) = 0.29, p < 10). Clinicians facing instrument selection decisions can use these data to guide their choices and researchers evaluating the performance of these instruments can use these data to inform their future studies.

Shields AL; Howell RT; Potter JS; Weiss RD. The Michigan Alcoholism Screening Test and its shortened form: A meta-analytic inquiry into score reliability. Substance Use & Misuse 42(11): 1783-1800, 2007. (83 refs.)

Meta-analytic methods provide a framework around which an inquiry into MAST and SMAST score reliability was completed. Of the 470 measurement opportunities observed between 1971 and 2005, 62 (13.2%) were coupled with accurate reliability information. Weighted reliability estimates centered on 80 suggesting that the MAST and SMAST generally produce scores of similar and adequate reliability for most research purposes. However, the variability of internal consistency estimates shows that at times these tools will not produce reliable scores, particularly among female and nonclinical respondents. Multiple regression equations provide practical guidelines to improve reliability estimates for the future use of these instruments.

Smith GW; Shevlin M. Patterns of alcohol consumption and related behaviour in Great Britain: A latent class analysis of the Alcohol Use Disorder Identification Test (AUDIT). Alcohol and Alcoholism 43(5): 590-594, 2008. (22 refs.)

Aims: Attempts have been made to develop typologies to classify different types of alcoholism. However, limited research has focused on classifications to describe general patterns of alcohol use in general population samples. Methods: Latent class analysis was used to create empirically derived behaviour clusters of alcohol consumption and related problems from the Alcohol Use Disorder Identification Test (AUDIT) based on data from a large stratified multi-stage random sample of the population of Great Britain. Multinomial logistic regression was performed to describe these resultant classes using both demographic variables and mental health outcomes. Results: Six classes best described responses in the sample data. Three were heavy consumption groups, one with multiple negative consequences, one experiencing alcohol-related injury and social pressures to cut down and an additional class with memory loss. There was one moderate class with few negative consequences, and finally two mild consumption groups, one with alcohol-related injury and social pressure to cut down and one with no associated problems. Conclusions: Alcohol use in Great Britain can be hypothesized as reflecting six distinct classes, four of which follow a continuum of increased consumption leading to increased dependence and related problems and two that do not. Differences between alcohol use classes are apparent with reduced risk of depressive episode in moderate classes and an increased risk of anxiety disorders for the highest consumers of alcohol.

Stewart SH; Miller PM. Detecting alcohol use disorders in recently hospitalized persons: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Addiction Medicine 1(1): 40-43, 2007. (16 refs.)

Pharmacotherapy combined with medical management, an increasingly viable option for treating alcohol use disorders in health care settings, requires rapid and reliable diagnosis. This study explored a simple screening approach in persons with recent general hospital admission who participated in the National Epidemiologic Survey on Alcohol and Related Conditions reporting hospitalization during the past year (n = 4537). The survey included detailed assessment of alcohol consumption and full diagnostic assessment for alcohol use disorders. The sensitivity and specificity of 1 heavy drinking day question were estimated by using methods appropriate for complex survey data. Results showed that, among recently hospitalized persons consuming any alcohol in the past year, a response of at least 1 heavy drinking day during that time was 86% sensitive and 77% specific for current alcohol use disorders. The item performed better for alcohol dependence than abuse. False-negative screens were associated with older age and less alcohol consumption. Because of its brevity and compatibility with a typical admission history, the heavy drinking day item should be considered for screening current drinkers at the time of hospitalization. However, future research also should validate this screen at the point of care.

Thomas BA; McCambridge J. Comparative psychometric study of a range of hazardous drinking measures administered online in a youth population. Drug and Alcohol Dependence 96(1-2): 121-127, 2008. (37 refs.)

Aims: To compare the psychometric performance of a range of existing alcohol measures when data are collected online with young people, and thereby to gain insights into the reliability and validity of this mode of data collection. Method: One hundred and sixty-seven U.K. resident young people aged 16-24 who had drunk alcohol within the past week participated in a cross-sectional psychometric study with a test-retest reliability component. Eight hazardous drinking measures were used: the alcohol use disorders identification test (AUDIT) summary instrument and dedicated assessments of consumption (timeline follow-back and diary-format recall of alcohol drunk in the last 7 days), dependence (Leeds Dependence Questionnaire and severity of dependence scale) and problems (Rutgers Alcohol Problem Index, alcohol problems scale and academic role expectations and alcohol scale). Results: Internal consistency and test-retest correlation statistics were generally satisfactory, providing evidence of reliability. Validation data obtained in principal components analyses, investigation of the correlation matrix and in a multiple regression model of total AUDIT score were also supportive of the online use of these measures. Evidence was weakest for the alcohol problems scale. Conclusions: A range of hazardous drinking measures exhibit sound psychometric properties when administered online. Further comparative study of the relationships between different measures is needed.

Tuunanen M; Aalto M; Seppa K. Binge drinking and its detection among middle-aged men using AUDIT, AUDIT-C and AUDIT-3. Drug and Alcohol Review 26(3): 295-299, 2007. (17 refs.)

Binge (heavy episodic) drinking is common, but there is little knowledge on how this drinking pattern could be detected. This study compares three structured questionnaires among binge drinking middle-aged men. All 45-year-old men in the city of Tampere, Finland, were asked to fill in the Alcohol Use Disorders Identification Test (AUDIT). Based on the interview on their drinking the men were divided into non-binging moderate drinkers (n = 352), binging moderate drinkers (n = 130), non-binging heavy drinkers (n = 10) and binging heavy drinkers (n = 63). The complete AUDIT, AUDIT-C (first three AUDIT questions inquiring quantity-frequency) and AUDIT-3 (the third binging-frequency question of AUDIT) in detecting binge drinking were compared. The complete AUDIT was effective in detecting binge drinkers by a cut-off score of >= 8 or >= 7. The optimal cut-off score for AUDIT-C was >= 6 and that for AUDIT-3 >= 2. The area under the curve (AUC) among all risky drinkers (binging moderate and binging heavy and non-binging heavy drinkers) for AUDIT was 0.824 (95% CI 0.789-0.859), for AUDIT-C 0.829 (95% CI 0.795-0.864) and for AUDIT-3 0.779 (0.739-0.818). The complete AUDIT and its short versions are applicable in populations where binging is the dominant drinking pattern, but the cut-off scores should be tailored to individual cultures.

Von Der Pahlen B; Santtila P; Witting K; Varjonen M; Jern P; Johansson A et al. Factor structure of the Alcohol Use Disorders Identification Test (AUDIT) for men and women in different age groups. Journal of Studies on Alcohol and Drugs 69(4): 616-621, 2008. (34 refs.)

Objective: Our main aim was to investigate the factor structure of the Alcohol Use Disorders Identification Test (AUDIT) in a Finnish population sample. Method: The AUDIT was completed by 3,125 men (mean age = 26.2 years) and 6,006 women (mean age = 26.1 years). Results: At a cutoff score of 8 or more, 49.8% of the men and 23.9% of the women would be identified as potentially engaged in excessive alcohol use. Exploratory factor analyses suggested a two-factor solution for both men and women. However, the factor structure was not invariant between men and women or in the different age groups among men. Conclusions: This is one of the largest known general population studies on alcohol use in recent years in Finland. The findings support a two-factor solution, and it is suggested that the AUDIT cutoff scores should be tailored according to age, gender, and drinking culture.

Wilens TE; Vitulano M; Upadhyaya H; Adamson J; Parcell T; Westerberg D et al. Concordance between cigarette smoking and the modified Fagerstrom Tolerance Questionnaire in controlled studies of ADHD. American Journal on Addictions 17(6): 491-496, 2008. (26 refs.)

Our objective was to compare scores on a smoking questionnaire to a diagnosis of cigarette smoking. As part of follow-ups in studies of ADHD, we assessed for cigarette smoking using structured interviews and the modified Fagerstrom Tolerance Questionnaire (mFTQ). Data were obtained from 162 subjects (mean = 19.2 yrs). ROC analysis and kappa coefficients revealed that a cutoff score of 3 on the mFTQ showed the strongest agreement with a full diagnosis of cigarette smoking (kappa = 0.68). Clinicians and researchers using the mFTQ in adolescents and young adults should consider a cutoff score of 3 to be indicative of cigarette smoking.

Williams G; Daly M; Proude EM; Kermode S; Davis M; Barling J et al. The influence of alcohol and tobacco use in orthopaedic inpatients on complications of surgery. Drug and Alcohol Review 27(1): 55-64, 2008. (28 refs.)

Introduction and Aims. Tobacco use and heavy alcohol consumption are associated with increased morbidity and mortality. There is limited research on the correlation between tobacco and risky levels of alcohol use and the possible complications associated with a hospital admission. The underestimation of problem drinking, in particular, has obvious repercussions for the management of patients in hospital. If alcohol-related problems go undetected or unrecorded, treatment may be inadequate or inappropriate. The aims of the project were to assess the prevalence of high-risk alcohol and tobacco use in orthopaedic in-patients and to examine any relationship between alcohol and tobacco use and the number and type of complications, management and length of stay. Design and Method. One hundred and fifty-three consecutive orthopaedic admissions to the Orthopaedic Ward at Lismore Base Hospital were screened using the Drinkcheck questionnaire, which is based on the Alcohol Use Disorders Identification Test (AUDIT), but which also screens for tobacco use. Nursing staff on the ward completed a Complications Evaluation Questionnaire (CEQ). The risk status of the subjects was compared to the number and type of complications, to assess any effects of alcohol and tobacco on post-surgical complications. Results. Significant correlations were found between tobacco use, hazardous and harmful alcohol use and numerous medical complications and behavioural problems. Behavioural problems associated with risky alcohol use included verbal abuse, agitation and sleep disturbances, particularly in men; problems associated with tobacco use included agitation and non-compliance. Discussion and Conclusions. Orthopaedic patients who smoke and/or drink heavily prior to surgery may have more non-medical complications than non-smokers and light or non-drinkers. All surgery patients should thus be screened for alcohol and tobacco use and alcohol withdrawal, which may cause other symptoms such as behavioural problems, non-compliance and verbal abuse post-surgery.

Wilson CR; Harris SK; Sherritt L; Lawrence N; Glotzer D; Shaw JS et al. Parental alcohol screening in pediatric practices. Pediatrics 122(5): E1022-E1029, 2008. (38 refs.)

OBJECTIVES. Pediatricians are in an ideal position to screen parents of their patients for alcohol use. The objective of this study was to assess parents' preferences regarding screening and intervention for parental alcohol use during pediatric office visits for their children. METHODS. A descriptive multicenter study that used 3 pediatric primary care clinic sites (rural, urban, suburban) was conducted between June 2004 and December 2006. Participants were a convenience sample of consecutively recruited parents who brought children for medical care. Parents completed an anonymous questionnaire that contained demographics; 2 alcohol-screening tests (TWEAK and Alcohol Use Disorders Identification Test); and items that assessed preferences for who should perform alcohol-screening, acceptance of screening, and preferred interventions if the screening result was positive. RESULTS. A total of 929 of 1028 eligible parents agreed to participate, and 879 of 929 completed surveys that yielded sufficient data for analysis. Most participants were mothers. A total of 101 of 879 parents screened positive on either the TWEAK or the Alcohol Use Disorders Identification Test. Parents with a negative alcohol screen (alcohol-negative) were more likely than parents with a positive alcohol screen (alcohol-positive) to report that they would agree to being asked about their alcohol use. There were no significant differences in preferences within alcohol-positive and alcohol-negative groups for screening by the pediatrician or computer-based questionnaire. Most preferred interventions for the alcohol-positive group were for the pediatrician to initiate additional discussion about drinking and its effect on their child, give educational materials about alcoholism, and refer for evaluation and treatment. Alcohol-positive men were more accepting than alcohol-positive women of having no intervention. CONCLUSIONS. A majority of parents would agree to being screened for alcohol problems in the pediatric office. Regardless of their alcohol screen status, parents are accepting of being screened by the pediatrician, a computer-based questionnaire, or a paper-and-pencil survey. Parents who screen positive prefer that the pediatrician discuss the problem further with them and present options for referral.

Winters KC; Kaminer Y. Screening and assessing adolescent substance use disorders in clinical populations. Journal of the American Academy of Child and Adolescent Psychiatry 47(7): 740-744, 2008. (25 refs.)

The objectives of this column are, first, to introduce several established screening and comprehensive assessments, and, second, to make recommendations as to standards of training and professional proficiency. In a clinical setting with an adolescent suspected of or known to have a substance abuse problem, it is important to integrate the assessment process with treatment decisions. The initial phase involves efficient identification of substance use and related problems, psychiatric comorbidity, and psychosocial maladjustment. This objective can be achieved by the use of screening instruments as a brief first step for the assessment of drug use before moving, if necessary, to the second step of comprehensive assessment of problem severity once it becomes clear that the adolescent may meet criteria for a substance use disorder (SUD). The result of this assessment is a diagnostic summary that identifies the adolescent treatment needs. Finally, an integrative treatment plan is developed to target multidimensional areas of dysfunction, which includes psychiatric comorbidity, as well as potential problems in the school, family, peer, and legal domains. With 6.0% and 5.4% of youths ages 12 to 17 years classified as needing treatment for alcohol use and illicit drug use, respectively, and with substance use during adolescence appearing to lead to a much greater rate of a current SUD compared to rates if drug use occurs later in life, these are important public health issues. Reports on performance of pediatricians who customarily see youths for periodic checkups and address their medical needs have not been encouraging. Less than half of the pediatricians surveyed reported screening adolescents for use of tobacco, alcohol, and other drugs, and less than one fourth acknowledged feeling comfortable conducting a comprehensive assessment or offering or making referral for treatment. The reasons for these troubling figures have been summarized as follows: insufficient time, lack of training to manage positive screens, need to triage competing medical problems, lack of treatment resources, unfamiliarity with screening tools, and tenacious parents (who may not readily leave the room). The authors make recommendations as to standards of training and professional proficiency, for those working with adolescents.

Wolfenden L; Dalton A; Bowman J; Knight J; Burrows S; Wiggers J. Computerized assessment of surgical patients for tobacco use: Accuracy and acceptability. Journal of Public Health 29(2): 183-185, 2007. (10 refs.)

Background: Despite increased risks of postoperative complications among patients who use tobacco, a number of barriers hinder the systematic identification of surgical patients who smoke. The study investigated the accuracy and acceptability of a patient-completed touchscreen computer program, which assessed patient smoking status during attendance at a surgical pre-operative clinic. Methods One thousand and four patients participated in the study and completed a touchscreen computer smoking assessment program. Results: The sensitivity and specificity measures of the computerized assessment were 93% and 95% respectively. Patients, and clinic receptionists, nurses and anaesthetists found the touchscreen computer-based assessment acceptable. Conclusions: The findings suggest that computerized assessment of smoking status is an accurate and acceptable way to identify tobacco users in a pre-operative clinic setting.

Wu SI; Huang HC; Liu SI; Huang CR; Sun FJ; Chang TY et al. Validation and comparison of alcohol-screening instruments for identifying hazardous drinking in hospitalized patients in Taiwan. Alcohol and Alcoholism 43(5): 577-582, 2008. (48 refs.)

Aim: The aim of this study was to validate the Mandarin Chinese version of different screening instruments and compare their performances for identifying hazardous drinkers in Taiwan. Methods: We compared the performance of the Mandarin Chinese versions of AUDIT, AUDIT-C (AUDIT items 1, 2 and 3), AUDIT-4 (AUDIT items 1, 2, 3 and 10), AUDIT-3 (AUDIT item 3), TWEAK, SMAST and CAGE to detect hazardous drinking in hospitalized patients in Taiwan. The results of the test instruments were blindly compared with the reference standard Schedule for Clinical Assessments in Neuropsychiatry (SCAN). Results: Of 404 patients evaluated, 100 were identified as having a hazardous drinking pattern. All screening instruments showed acceptable sensitivities (ranging from 85 to 93%) and specificities (ranging from 72 to 92%), but AUDIT and its short forms performed consistently better than the other instruments. Conclusions: The Mandarin Chinese versions of AUDIT and its derivatives perform well in screening hospitalized Taiwanese patients for hazardous drinking.