The key to determining whether an individual has an alcohol abuse problem is asking the right questions, according to Daniel C. Vinson, MD. For example, if a person is queried about his or her average alcohol consumption during the course of a week, someone who typically has two beers each night and two six-packs on the weekend might answer “two beers.” Instead, advises Dr. Vinson, clinicians should rephrase their question to ask about the maximum quantity consumed during a specific time period.

“We wanted to help doctors identify people who have hazardous drinking habits or engage in alcohol abuse,” said Dr. Vinson, who is a Professor of Family and Community Medicine at the University of Missouri–Columbia. “Previous research has shown that one question is not sufficient to root out any problems. However, with the average doctor visit lasting about 15 minutes, there usually is not enough time to ask enough questions to identify abuse. In our study, we found that with the right phrase, doctors needed to ask only one question to get a relatively accurate answer. That question is, When was the last time you had more than five drinks (or four drinks for a female) in one day?” The study was published in the May/June online edition of Alcohol and Alcoholism.

ASK AN INTELLIGENT QUESTION . . .

Dr. Vinson said that more commonly asked questions such as, How often do you drink? and How much do you drink on average? were helpful if the limit was set low enough. He posed these questions to more than 2,500 patients and found that if the cutoff quantity was set at an average consumption of two or more drinks, these questions were useful in soliciting helpful information. “Of course, anyone answering yes to this single question—drinking on average two or more drinks per occasion—does not mean that he or she has an alcohol problem,” Dr. Vinson noted. “Additional questions would determine the extent of the problem if one existed.”

SCREENING FOR HARMFUL DRINKING

Three groups of participants were interviewed—patients presenting to emergency departments for care of an acute injury (1,537) or a medical illness (1,151) and community controls interviewed by telephone (1,112). 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 = five for men and four for women, and one drink = 14 g ethanol) with any time in the past three months considered a positive screen. The subsequent alcohol questions were a calendar-based review of recent drinking and the alcohol questions from the diagnostic interview schedule, which included questions about usual frequency and average quantity.

Hazardous drinking was defined as having more than four drinks in one day or more than 14 drinks in one week for men (three and seven for women, respectively). Current alcohol use disorders were defined using DSM-I criteria. The areas under the receiver operating characteristic curves in identifying hazardous drinking or current alcohol use disorder were then compared. Dr. Vinson and colleagues found that the quantity-frequency product and the question about average quantity were consistent across the three groups.

“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,” the researchers reported.

SOFTWARE PROGRAM TO HELP ALCOHOL ABUSERS

Dr. Vinson is developing a computer program to help alcohol abusers understand their problem and identify possible solutions. Not only would this computer program help people determine if they had a problem but it would also allow the physician and patient to continue to use most of their time together to address other issues that are important to both of them. He plans on testing the computer program in rural and metropolitan doctors’ offices this summer.

“Once a patient answers the first question in such a manner that the doctor might believe there could be a problem, the patient might be asked to answer some questions on the computer,” Dr. Vinson said. “While the patient is answering this 12-minute survey, the doctor could check with other patients. At the same time, the computer could determine if there was a serious problem with the patient, and when the doctor returned, the doctor and patient could discuss the problem further and any potential steps that should be taken.”

Suggested Reading
Canagasaby A, Vinson DC. Screening for hazardous or harmful drinking using one or two quantity-frequency questions. Alcohol Alcohol. 2005;40:208-213.
Vinson DC, Galliber JM, Reidinger C, Kappus JA. Comfortably engaging: which approach to alcohol screening should we use? Ann Fam Med. 2004;2:398-404.

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