SCREENING FOR HAZARDOUS OR HARMFUL DRINKING USING ONE OR TWO QUANTITY–FREQUENCY QUESTIONS

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