Opportunistic screening for alcohol use disorders in primary care: comparative study

doi:10.1136/bmj.38743.421574.7C

BMJ 2006;332:511-517 (4 March), doi:10.1136/bmj.38743.421574.7C (published 17 February 2006)

Research

Opportunistic screening for alcohol use disorders in primary care: comparative study

Simon Coulton, senior research fellow¹, Colin Drummond, professor², Darren James, trainee clinical psychologist³, Christine Godfrey, professor¹, J Martin Bland, professor¹, Steve Parrott, research fellow⁴, Timothy Peters, professor⁵, the Stepwice Research Team

¹ Department of Health Sciences, University of York, York YO10 5DD, ² Section of Addictive Behaviour, Division of Mental Health, St George's Hospital Medical School, University of London, London SW17 0RE, ³ Department of Clinical Psychology Training, Whitchurch Hospital, Cardiff CF14 7XB, ⁴ Centre for Health Economics, Alcuin College, University of York, ⁵ Department of Biochemistry, King's College, University of London, London WC2R 2LS

Correspondence to: S Coulton sc21{at}york.ac.uk

Abstract

Objective To evaluate the efficacy and relative costs of differentscreening methods for the identification of alcohol use disordersin an opportunistic screening programme in primary care in theUnited Kingdom.

Design Comparative study.

Setting Six general practices in south Wales.

Participants 194 male primary care attendees aged 18 or overwho completed an alcohol use disorders identification test (AUDIT)questionnaire.

Main outcome measures Scores on alcohol use disorders identificationtest and measures of ${gamma}$ -glutamyltransferase, aspartate aminotransferase,per cent carbohydrate deficient transferrin, and erythrocytemean cell volume. Hazardous alcohol consumption, weekly bingeconsumption, and monthly binge consumption were ascertainedusing the time line follow back method over the previous 180days. Alcohol dependence was determined using the Diagnosticand Statistical Manual of Mental Disorders, fourth edition.Unit costs were established from published resource referencesand from actual costs of analysing the biochemical tests.

Results A significant correlation was observed be alcohol consumptionand score on the alcohol use disorders identification test (Pearson'scorrelation coefficient r = 0.74) and measures of ${gamma}$ -glutamyltransferase(r = 0.20) and per cent carbohydrate deficient transferrin (r= 0.36) but not aspartate aminotransferase (r = 0.08) or erythrocytemean cell volume (r = 0.02). The alcohol use disorders identificationtest exhibited significantly higher sensitivity, specificity,and positive predictive value than all of the biochemical markersfor hazardous consumption (69%, 98%, and 95%), weekly bingeconsumption (75%, 90%, and 71%), monthly binge consumption (66%,97%, and 91%), and alcohol dependence (84%, 83%, and 41%). Thequestionnaire was also more cost efficient, with a lower costper true positive for all consumption outcomes.

Conclusion The alcohol use disorders identification test questionnaireis an efficient and cost efficient diagnostic tool for routinescreening for alcohol use disorders in primary care.

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Rapid Responses:

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