CORK Bibliography: T-ACE (Screening Test)

18 citations. 1997 to present

Prepared: March 2011

Burns E; Gray R; Smith LA. Brief screening questionnaires to identify problem drinking during pregnancy: A systematic review. (review). Addiction 105(4): 601-614, 2010. (80 refs.)

Aims: Although prenatal screening for problem drinking during pregnancy has been recommended, guidance on screening instruments is lacking. We investigated the sensitivity, specificity and predictive value of brief alcohol screening questionnaires to identify problem drinking in pregnant women. Methods: Electronic databases from their inception to June 2008 were searched, as well as reference lists of eligible papers and related review papers. We sought cohort or cross-sectional studies that compared one or more brief alcohol screening questionnaire(s) with reference criteria obtained using structured interviews to detect 'at-risk' drinking, alcohol abuse or dependency in pregnant women receiving prenatal care. Results: Five studies (6724 participants) were included. In total, seven instruments were evaluated: TWEAK (Tolerance, Worried, Eye-opener, Amnesia, Kut down), T-ACE [Take (number of drinks), Annoyed, Cut down, Eye-opener], CAGE (Cut down, Annoyed, Guilt, Eye-opener], NET (Normal drinker, Eye-opener, Tolerance), AUDIT (Alcohol Use Disorder Identification Test), AUDIT-C (AUDIT-consumption) and SMAST (Short Michigan Alcohol Screening Test). Study quality was generally good, but lack of blinding was a common weakness. For risk drinking sensitivity was highest for T-ACE (69-88%), TWEAK (71-91%) and AUDIT-C (95%), with high specificity (71-89%, 73-83% and 85%, respectively). CAGE and SMAST performed poorly. Sensitivity of AUDIT-C at score >= 3 was high for past year alcohol dependence (100%) or alcohol use disorder (96%) with moderate specificity (71% each). For life-time alcohol dependency the AUDIT at score >= 8 performed poorly. Conclusion: T-ACE, TWEAK and AUDIT-C show promise for screening for risk drinking, and AUDIT-C may also be useful for identifying alcohol dependency or abuse. However, their performance as stand-alone tools is uncertain, and further evaluation of questionnaires for prenatal alcohol use is warranted.

Bradley KA; Boyd-Wickizer J; Powell SH; Burman ML. Alcohol screening questionnaires in women: A critical review. (review). Journal of the American Medical Association 280(2): 166-171, 1998. (54 refs.)

Objective.-To describe the performance of alcohol screening questionnaires in female patients. Data Sources.-We searched MEDLINE from 1966 to July 1997 for alcoholism or alcohol-drinking and for CAGE, AUDIT, BMAST, TWEAK, T- ACE, MAST, SMAST, or SAAST; Citations Indexes for newer screening questionnaires and those without acronyms; and MEDLINE from 1996 to July 1997 for alcoholism or alcohol-drinking and screening. Study Selection and Data Extraction.-Reviewed studies presented data for women comparing brief alcohol screening questionnaires with valid criterion standards for heavy drinking (greater than or equal to 2 drinks per day) or alcohol abuse or dependence in US general clinical populations. Sensitivities, specificities, and areas under receiver operating characteristic curves (AUROCs) were extracted. Data Synthesis.-Thirteen articles (9 studies) were reviewed. The CAGE questionnaire had AUROCs of 0.84 to 0.92 for alcohol abuse and dependence in predominantly black populations of women, but using the traditional cut point of 2 or more resulted in low sensitivities (38%- 50%) in predominantly white female populations. The TWEAK and Alcohol Use Disorders Identification Test (AUDIT) questionnaires had high AUROCs (0.87-0.93) for past-year alcohol abuse or dependence in black or white women, but had sensitivities less than 80% at traditional cut points. For detecting heavy drinking, the AUDIT questionnaire had AUROCs of at least 0.87 in female primary care patients. The TWEAK and T-ACE questionnaires had higher AUROCs (0.84-0.87) than the CAGE questionnaire (0.76-0.78) for detecting heavy drinking before pregnancy was recognized in black obstetric patients. Conclusions.-The CAGE questionnaire was relatively insensitive in predominantly white female populations. The TWEAK and AUDIT questionnaires have performed adequately in black or white women, using lower cut points than usual.

Burns E; Gray R; Smith LA. Brief screening questionnaires to identify problem drinking during pregnancy: A systematic review. (review). Addiction 105(4): 601-614, 2010. (80 refs.)

Canadian Paediatric Society. Fetal alcohol syndrome. Paediatrics and Child Health 7(3): 161-174, 2002. (62 refs.)

This position statement from the Canadian Paediatric Society addresses fetal alcohol syndrome (FAS) prevention, diagnosis, early identification and management for health care professionals. Prevention of FAS must occur at two levels. Primary prevention involves eliminating FAS through classroom or community education, and encouraging women to avoid consuming alcohol before conception and throughout pregnancy. Secondary prevention involves identifying women who are drinking while pregnant and reducing their consumption. This statement describes a variety of screening strategies including Tolerance-Annoyance (T-ACE), Cut Down, and Eye Opener. Medical practitioners should recommend abstinence starting with the first prenatal visit. Prompt referral for alcohol treatment is recommended for pregnant individuals who are unable to stop drinking alcohol. This statement describes the diagnosis of FAS, partial or atypical FAS, alcohol-related birth defects and alcohol-related neurodevelopment disorder. With a history of in-uteri alcohol exposure, a diagnosis of FAS should be considered with a current or previous growth deficiency, select facial abnormalities involving the upper lip and eyes, and neurodevelopment abnormalities. These features are best quantified with the use of a four-digit diagnostic method. Strategies for early identification of possible alcohol-related abnormalities are outlined. Intervention focuses on optimizing development, managing behavioral difficulties and providing appropriate school programming. Of prime importance is earliest possible childhood intervention to prevent secondary disabilities that may result from delay while awaiting a definitive diagnosis of FAS. There are a number of charts, and check lists.

Chang G. Screening and brief intervention in prenatal care settings. Alcohol Research & Health 28(2): 80-84, 2004. (24 refs.)

Pregnant women continue to drink despite evidence that prenatal alcohol consumption can negatively affect fetal growth and development. Because no universally safe level of prenatal alcohol use has been established, it is beneficial to identify and modify a woman's prenatal alcohol use early in her pregnancy, particularly as her past drinking habits can predict her drinking levels during pregnancy. Some women may voluntarily disclose the extent of their prenatal alcohol consumption. if not, the T-ACE, a four-item screening questionnaire based on the CAGE assessment tool, has been demonstrated to be a valuable and efficient method for identifying a range of alcohol use. Studies have shown that combined with brief interventions, early identification of a woman's prenatal alcohol use could avert its more severe adverse consequences and may be the logical first-line approach.

Public Domain

Chang G; Goetz MA; Wilkins-Haug L; Berman S. Identifying prenatal alcohol use: Screening instruments versus clinical predictors. American Journal on Addictions 8(2): 87-93, 1999. (19 refs.)

The purpose of this study, is to compare the accuracy of screening instruments with clinical predictors in the identification of prenatal alcohol use. 350 women initiating prenatal care at the Brigham and Women 's Hospital (Boston, MA) completed the T-ACE, AUDIT: and SMAST. The predictive accuracy of each was compared using Receiver Operating Characteristic (ROC) curve analysis. The T-ACE, AUDIT, and clinical predictors alone correctly identified 65 to 70% of current drinkers, whereas the SMAST alone performed only slightly better than chance. The predictive ability of the T-ACE was further improved with the addition of clinical predictors.

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

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

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

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

Chang G; Wilkins-Haug L; Berman S; Goetz MA; Behr H; Hiley A. Alcohol use and pregnancy: Improving identification. Obstetrics & Gynecology 91(6): 892-898, 1998. (19 refs.)

Objective: To test the effectiveness of a four-item prenatal-alcohol-use, self-administered screening questionnaire that asks about tolerance to alcohol, being annoyed by other's comments about drinking, attempts to cut down, and having a drink first thing in the morning ("eye-opener") (T-ACE) in an ethnically and socioeconomically diverse sample. Methods: Two hundred fifty T-ACE-positive and 100 T-ACE-negative women completed a comprehensive assessment of their alcohol use after initiating prenatal care at the Brigham and Women's Hospital in Boston, Massachusetts. This comprehensive assessment, which included the Alcohol Use Disorders Identification Test and the Short Michigan Alcoholism Screening Test as comparisons to the T-ACE, generated three criterion standards: Diagnostic and Statistical Manual of Mental Disorders, Third, Ed., Revised (DSM-III-R), lifetime alcohol diagnoses, risk drinking (regularly having more than one fluid ounce of alcohol per drinking day before pregnancy), and current drinking. Results: T-ACE-positive pregnant women were more likely than T-ACE-negative women to satisfy DSM-III-R criteria for lifetime alcohol diagnoses (40% versus 14%, P < .001) and risk drinking (39% versus 8%, P < .001) and to have current alcohol consumption (43% versus 13%, P < .001). In contrast, obstetric staff members documented only 33 (9%) women as using alcohol at any time, even though nearly all subjects (96%) were asked about drinking upon initiation of prenatal care. Conclusion: The T-ACE was the most sensitive screen for lifetime alcohol diagnoses, risk drinking, and current alcohol consumption. It outperformed obstetric staff assessment of any alcohol use by pregnant women enrolled in the study.

Chiodo LM; Sokol RJ; Delaney-Black V; Janisse J; Hannigan JH. Validity of the T-ACE in pregnancy in predicting child outcome and risk drinking. Alcohol 44(7/8, special issue): 595-603, 2010. (73 refs.)

Preventing fetal alcohol spectrum disorders (FASDs) requires detection of in-pregnancy maternal risk drinking. The widely used T-ACE screen has been applied in various ways, although the impact of those different uses on effectiveness is uncertain. We examined relations among different T-ACE scoring criteria, maternal drinking, and child outcome. Self-reported across-pregnancy maternal drinking was assessed in 75 African-American women. The different T-ACE criteria used varied the level of drinking that defined tolerance (two or three drinks) and the total T-ACE score cut-points (two or three). Receiver operator curves and regression analysis assessed the significance of relations. Increasing the total T-ACE score cut-point to 3 almost doubled specificity in detecting risk drinking whereas maintaining adequate sensitivity, equivalent to that in the original report, and identified substantially more neurobehavioral deficits in children. Redefining tolerance at three drinks did not improve T-ACE effectiveness in predicting outcomes. This study is among the first to show the ability of an in-pregnancy T-ACE assessment to predict child neurodevelopmental outcome. In addition, increasing the total T-ACE score criterion (from 2 to 3) improved identification of non-drinking mothers and unaffected children with little loss in detection of drinkers and affected children. Efficient in-pregnancy screens for risk drinking afford greater opportunities for intervention that could prevent/limit FASDs.

Chiodo LM; Sokol RJ; Delaney-Black V; Janisse J; Hannigan JH. Validity of the T-ACE in pregnancy in predicting child outcome and risk drinking. Alcohol 44(7/8, special issue): 595-603, 2010. (73 refs.)

Gupman AE; Svikis D; McCaul ME; Anderson J; Santora PB. Detection of alcohol and drug problems in an urban gynecology clinic. Journal of Reproductive Medicine 47(5): 404-410, 2002. (19 refs.)

OBJECTIVE: To compare screening instruments for their utility to detect substance use problems in women seeking gynecologic care, to assess the likelihood that alcohol/drug problems mill be detected by physicians during a routine office visit and to examine the relationship between regular alcohol and/or drug use and the patient's presenting gynecologic complaints. STUDY DESIGN: Women (N = 360) attending a hospital-based gynecology clinic were screened prior to physician visit using the Michigan Alcoholism Screening Test, CAGE and T-ACE. After the visit, information on presenting complaint and physician's documentation of the patient's tobacco, alcohol and other drug use was abstracted from the medical record. RESULTS: The rates of alcohol and illicit drug use varied across assessment instruments; physician documentation, however, yielded the lowest prevalence estimates. Regular alcohol and drug users were more likely to present with chronic and acute medical problems than patients who were not regular users of these substances. CONCLUSION: The gynecology clinic offers an opportunity for early identification of women with substance problems, and alternative strategies are needed to encourage gynecologists to routinely screen for such problems at each medical visit.

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.

McQuade WH; Levy SM; Yanek LR; Davis SW; Liepman MR. Detecting symptoms of alcohol abuse in primary care settings. Archives of Family Medicine 9(9): 814-821, 2000. (30 refs.)

Background: Studies on alcohol abuse are frequently based on patients who meet minimum diagnostic criteria, thus ignoring patients with individual symptoms of harmful or hazardous use. Consequently, we are unable to characterize alcohol-abusing patients with sufficient clarity to effectively focus screening for primary prevention. Objective: To determine the prevalence of harmful and hazardous use of alcohol, assess screening instruments for detecting alcohol abuse or dependence, and assess the impact of alcohol use on other diagnoses treated in outpatient settings. Design: Survey (cross-sectional study). Setting: Hospital-based outpatient clinic. Participants: Three hundred randomly selected adults (aged 18 years and older). Main Outcome Measure: Diagnosis of alcohol abuse or dependence based on the Diagnostic Interview Schedule (DIS). Results: About 18% met DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) criteria of abuse or dependence while almost 50% had at least one symptom of harmful or hazardous use. The T-ACE questionnaire, a modified version of the CAGE questionnaire, was the most effective screening instrument for both men and women. Selected diagnoses, personal characteristics such as family history of alcohol abuse, and self-reported patterns of alcohol use could identify patients likely to meet diagnostic criteria. Conclusions: Many symptoms of substance use disorders are not adequately addressed in outpatient practice. Little is known about how alcohol use in varying quantities affects health care utilization and treatment of conditions commonly seen in outpatient medicine. Consequently, we lack a full appreciation of the burden of disease borne by alcohol use and have yet to achieve a universally accepted method of approaching primary and secondary prevention of alcohol-related problems.

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

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

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

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

Russell M; Martier SS; Sokol RJ; Mudar P; Jacobson S; Jacobson J. Detecting risk drinking during pregnancy: A comparison of four screening questionnaires. American Journal of Public Health 86(10): 1435-1439, 1996. (21 refs.)

OBJECTIVES. This study investigated the efficacy of screening for risk drinking during pregnancy with two brief questionnaires, TWEAK and T-ACE. Both include an assessment of tolerance based on the number of drinks women report they can hold. METHODS. Subjects were disadvantaged African-American obstetric patients in Detroit, Mich. Traditional alcoholism screens (Michigan Alcohol Screening Test [MAST], CAGE) and the tolerance question were administered (n = 2717); TWEAK and T-ACE were constructed from tolerance and embedded MAST and CAGE items. In a separate sample (n = 1420), only the T-ACE was administered, Periconceptional risk drinking was the gold standard. Screen evaluations were based on receiver-operating characteristic analyses. RESULTS. At the cutpoint of 2, sensitivity/specificity for embedded screens were 91/77 for TWEAK and 88/79 for T-ACE; comparable values for T-ACE alone were 67/86, TWEAK and T-ACE Screened more effectively than CAGE or MAST. CONCLUSIONS. Embedded versions of TWEAK and T-ACE were both highly sensitive to periconceptional risk drinking in this population. Administering T-ACE alone reduced its sensitivity; this suggests that MAST and CAGE administration improves its performance.

Stevenson JS; Masters JA. Predictors of alcohol misuse and abuse in older women. Journal of Nursing Scholarship 37(4): 329-335, 2005. (42 refs.)

Purpose: To determine the predictive ability of self-report questions, physical measures, and biomarkers to detect alcohol misuse and abuse among older women. Design and Methods: Healthy women volunteers age 60 and older who fit selection criteria were enrolled. The 135 participants were divided into nondrinkers (ND; n = 63) and drinkers (D; n = 72) based on self-reports of quantity and frequency of standard drinks consumed per month. The mean ages for the groups were 69.2 (ND) and 69.6 (D). Findings: The best predictor was a score > 0 on the T-ACE, a four-item instrument to detect alcohol abuse. Other significant predictors were: (a) behaviors: smoking, mixing over-the-counter (OTC) drugs with alcohol, heavy coffee drinking, using alcohol to sleep, and less sleep latency; and (b) biomarkers: higher mean corpuscular volume (MCV), hemoglobin (Hgb), hematocrit (Hct), and high-density lipoprotein cholesterol (HDL). The heaviest drinker subgroup had more physical stigmata, including broken blood vessels in nose and larger liver spans. Conclusions: The "best predictor model" showed that older women who were at risk for alcohol misuse or abuse had T-ACE scores of 1 or higher, used two or more OTC drugs regularly, drank large amounts of coffee, used alcohol to fall asleep, and had less sleep latency. Because positive T-ACE scores have high sensitivity and specificity for alcohol abuse, scores of 1 or greater should be addressed in clinical settings, e.g., referrals for more definitive diagnoses and relevant treatment.

Taylor P; Zaichkin J; Bailey D, eds. Substance Abuse during Pregnancy: Guidelines for Screening. revised edition. Olympia WA: Washington State Department of Health, 2002. (40 refs.)

This document sets forth guidelines for screening for substance abuse during pregnancy. It is intended for all health care providers working with pregnant women. It is organized into five sections Ask, Advise, Assess, Assist, Arrange. It describes the scope of the problem, describes the benefits of universal screening, identifies screening tools and the role of laboratory testing. The guidelines provide concrete suggestions for dealing with clinical concerns, such as handling cases where a women denies use. There is also a separate chapter on harm reduction as an intervention. Pregnancy management issues are identified from prenatally to post partum. The section on screening tools for alcohol use recommends that all women be screened for alcohol use during pregnancy since no safe limit of alcohol consumption during pregnancy has been established. Accordingly, pregnant women who drink any alcohol should be encouraged to abstain, and those who are problem drinkers should be supported in changing their behavior through harm reduction, support groups, and treatment. Screening instruments presented for identifying problem drinking and binge drinking include the Alcohol Use Disorders Identification Test (AUDIT), the T-ACE questionnaire, the TWEAK questionnaire, and the CAGE questionnaire.

Public Domain

Vanable PA; King AC; de Wit H. Psychometric screening instruments. IN: Zernig G; Saria A; Kurz M; O'Malley SS, eds. Handbook of Alcoholism. Boca Raton: CRC Press Inc., 2000. pp. 39-46. (37 refs.)

This chapter focuses on the use of brief, validated assessment instruments to aid in the screening, diagnosis, and treatment of patients with alcohol-related disorders. Alcohol disorders often go undetected in a variety of patient care settings. The routine use of screening tests can dramatically increase the likelihood of identifying patients in need of treatment services. This chapter proves an overview of approaches to screening for alcohol-related problems. Issues pertaining to the selection of appropriate screening questionnaires are described, along with a discussion of the relative strengths and weaknesses of the most widely use test instruments. The tests described include the CAGE, AUDIT, Michigan Alcoholism Screening Test (MAST), Munich Alcoholism Test (MALT), TWEAK and T-ACE.