: Background: Primary care providers need practical methods for managing patients who screen positive for at‐risk drinking. We evaluated whether scores on brief alcohol screening questionnaires and ...patient reports of prior alcohol treatment reflect the severity of recent problems due to drinking.
Methods: Veterans Affairs general medicine outpatients who screened positive for at‐risk drinking were mailed questionnaires that included the Alcohol Use Disorders Identification Test (AUDIT) and a question about prior alcohol treatment or participation in Alcoholics Anonymous (“previously treated”). AUDIT questions 4 through 10 were used to measure past‐year problems due to drinking (PYPD). Cross‐sectional analyses compared the prevalence of PYPD and mean Past‐Year AUDIT Symptom Scores (0–28 points) among at‐risk drinkers with varying scores on the CAGE (0–4) and AUDIT‐C (0–12) and varying treatment histories.
Results: Of 7861 male at‐risk drinkers who completed questionnaires, 33.9% reported PYPD. AUDIT‐C scores were more strongly associated with Past‐Year AUDIT Symptom Scores than the CAGE (p < 0.0005). The prevalence of PYPD increased from 33% to 46% over the range of positive CAGE scores but from 29% to 77% over the range of positive AUDIT‐C scores. Among subgroups of at‐risk drinkers with the same screening scores, patients who reported prior treatment were more likely than never‐treated at‐risk drinkers to report PYPD and had higher mean Past‐Year AUDIT Symptom Scores (p < 0.0005). We propose a simple method of risk‐stratifying patients using AUDIT‐C scores and alcohol treatment histories.
Conclusions: AUDIT‐C scores combined with one question about prior alcohol treatment can help estimate the severity of PYPD among male Veterans Affairs outpatients.
OBJECTIVE: This study describes primary care discussions with patients who screened positive for at‐risk drinking. In addition, discussions about alcohol use from 2 clinic firms, one with a ...provider‐prompting intervention, are compared.
DESIGN: Cross‐sectional analyses of audiotaped appointments collected over 6 months.
PARTICIPANTS AND SETTING: Male patients in a VA general medicine clinic were eligible if they screened positive for at‐risk drinking and had a general medicine appointment with a consenting provider during the study period. Participating patients (N = 47) and providers (N = 17) were enrolled in 1 of 2 firms in the clinic (Intervention or Control) and were blinded to the study focus.
INTERVENTION: Intervention providers received patient‐specific results of positive alcohol‐screening tests at each visit.
MEASURES AND MAIN RESULTS: Of 68 visits taped, 39 (57.4%) included any mention of alcohol. Patient and provider utterances during discussions about alcohol use were coded using Motivational Interviewing Skills Codes. Providers contributed 58% of utterances during alcohol‐related discussions with most coded as questions (24%), information giving (23%), or facilitation (34%). Advice, reflective listening, and supportive or affirming statements occurred infrequently (5%, 3%, and 5%, of provider utterances respectively). Providers offered alcohol‐related advice during 21% of visits. Sixteen percent of patient utterances reflected “resistance” to change and 12% reflected readiness to change. On average, Intervention providers were more likely to discuss alcohol use than Control providers (82.4% vs 39.6% of visits; P = .026).
CONCLUSIONS: During discussions about alcohol, general medicine providers asked questions and offered information, but usually did not give explicit alcohol‐related advice. Discussions about alcohol occurred more often when providers were prompted.
Although college women are known to be at high risk for eating-related problems, relatively little is known about how various aspects of concerns related to eating, weight, and shape are patterned ...syndromally in this population. Moreover, the extent to which various patterns represent stable conditions or transitory states during this dynamic period of development is unclear. The present study used latent class and latent transition analysis (LCA/LTA) to derive syndromes of concerns related to eating, weight, and shape and movement across these syndromes in a sample of 1,498 women ascertained as first-time freshmen and studied over 4 years. LCA identified 5 classes characterized by (a) no obvious pathological eating-related concerns (prevalence: 28%-34%); (b) a high likelihood of limiting attempts (prevalence: 29%-34%); (c) a high likelihood of overeating and binge eating (prevalence: 14%-18%); (d) a high likelihood of limiting attempts and overeating or binge eating (prevalence: 14%-17%); and (e) pervasive bulimiclike concerns (prevalence: 6%-7%). Membership in each latent class tended to be stable over time. When movement occurred, it tended to be to a less severe class. These findings indicate that there are distinct, prevalent, and relatively stable forms of eating-related concerns in college women.
Bipolar spectrum disorders have traditionally been thought to be chronic in course. However, recent epidemiologic research suggests that there may be developmentally limited forms of bipolar ...disorder. Two large, nationally representative studies reveal a strikingly high prevalence of bipolar disorders in emerging adulthood (5.5%-6.2% among 18-24-year-olds) that appear to resolve substantially during the latter half of the 3rd decade of life (3.1%-3.4% among 25-29-year-olds). Although ascertainment bias due to early mortality, institutionalization, incarceration, and homelessness may account for some of this reduction, the prevalence distribution suggests a high incidence in late adolescence and emerging adulthood that appears to resolve spontaneously in most cases. There were very few differences across age groups in symptom endorsement and comorbid diagnoses, suggesting that 18-24-year-olds that meet criteria for bipolar diagnoses experience clinically significant impairment and associated consequences of the disorder. More fine-grained longitudinal research is needed to determine whether developmentally limited forms of bipolar disorder exist and, if so, what markers might distinguish these forms of the disorder from more chronic courses.
Brief primary care interventions for alcohol use should be tailored to patients' readiness to change; however, validated measures of readiness to change are too lengthy to be practical in most ...primary care settings. We compared a readiness to change drinking algorithm (RTC Algorithm) based on three standardized questions to a validated 12-item readiness to change questionnaire (Rollnick RTCQ) in 85 hazardous drinking female Veterans Affairs (VA) patients. Results from comparisons of mean Rollnick RTCQ scale scores across RTC Algorithm categories suggest good concurrent validity. Regular assessment using the RTC Algorithm questions may help primary care providers tailor alcohol-related discussions with hazardous drinking patients.
This study describes primary care discussions with patients who screened positive for at-risk drinking. In addition, discussions about alcohol use from 2 clinic firms, one with a provider-prompting ...intervention, are compared.
Cross-sectional analyses of audiotaped appointments collected over 6 months.
Male patients in a VA general medicine clinic were eligible if they screened positive for at-risk drinking and had a general medicine appointment with a consenting provider during the study period. Participating patients ( N = 47) and providers ( N = 17) were enrolled in 1 of 2 firms in the clinic (Intervention or Control) and were blinded to the study focus.
Intervention providers received patient-specific results of positive alcohol-screening tests at each visit.
Of 68 visits taped, 39 (57.4%) included any mention of alcohol. Patient and provider utterances during discussions about alcohol use were coded using Motivational Interviewing Skills Codes. Providers contributed 58% of utterances during alcohol-related discussions with most coded as questions (24%), information giving (23%), or facilitation (34%). Advice, reflective listening, and supportive or affirming statements occurred infrequently (5%, 3%, and 5%, of provider utterances respectively). Providers offered alcohol-related advice during 21% of visits. Sixteen percent of patient utterances reflected "resistance" to change and 12% reflected readiness to change. On average, Intervention providers were more likely to discuss alcohol use than Control providers (82.4% vs 39.6% of visits; P =.026).
During discussions about alcohol, general medicine providers asked questions and offered information, but usually did not give explicit alcohol-related advice. Discussions about alcohol occurred more often when providers were prompted.
Hangover may be related to propensity to develop alcohol use disorders (AUDs). However, the etiological role, if any, played by hangover in AUD is unclear. From a motivational perspective, hangover ...can be construed as either a deterrent to future alcohol consumption or a setting event for negative reinforcement that could promote deviant drinking practices (e.g., "hair-of-the-dog" drinking). Hangover could be related to AUD risk even if it does not play a direct role in promoting or inhibiting near-term drinking. For example, measures of hangover might serve as symptoms of AUD or as markers of individual differences that more directly account for AUD risk. Empirical evidence (though usually indirect) exists to support contentions that hangover is related to both risk for and protection from AUD. In this article, we briefly address variation in assessment strategies in existing hangover research because measures of hangover frequency and hangover susceptibility may prove to have different correlates. Next, we review the existing, limited evidence on relations between hangover and AUD risk. Finally, we sketch a variety of theoretically-informed hypotheses that might help delineate productive lines of inquiry for this emerging field.
Background: The optimal brief questionnaire for alcohol screening among female patients has not yet been identified. This study compared the performance of the TWEAK (tolerance, worried, eye‐opener, ...amnesia, cutdown), the Alcohol Use Disorders Identification Test (AUDIT), and the AUDIT Consumption (AUDIT‐C) as self‐administered screening tests for hazardous drinking and/or active alcohol abuse or dependence among female Veterans Affairs (VA) outpatients.
Methods: Women were included in the study if they received care at VA Puget Sound and completed both a self‐administered survey containing the AUDIT and TWEAK screening questionnaires and subsequent in‐person interviews with the Alcohol Use Disorders and Associated Disabilities Interview Schedule. Sensitivities, specificities, positive and negative likelihood ratios, and areas under Receiver Operating Characteristic curves were computed for each screening questionnaire compared with two interview‐based comparison standards: (1) active DSM‐IV alcohol abuse or dependence and (2) hazardous drinking and/or active DSM‐IV alcohol abuse or dependence, the more appropriate target for primary care screening.
Results: Of 393 women who completed screening questionnaires and interviews, 39 (9.9%) met diagnostic criteria for alcohol abuse or dependence, and 89 (22.7%) met criteria for hazardous drinking or alcohol abuse or dependence. The TWEAK had relatively low sensitivities (0.62 and 0.44) but adequate specificities (0.86 and 0.89) for both interview‐based comparison standards, even at its lowest cut‐point (≥1). The AUDIT and AUDIT‐C were superior, with the following areas under the receiver operating characteristic curve for active alcohol abuse or dependence and hazardous drinking and/or active alcohol abuse or dependence, respectively: AUDIT, 0.90 95% confidence interval (CI), 0.85–0.95 and 0.87 (95% CI, 0.84–0.91); AUDIT‐C, 0.91 (95% CI, 0.88–0.95) and 0.91 (95% CI, 0.88–0.94); and TWEAK, 0.76 (95% CI, 0.66–0.86) and 0.67 (95% CI, 0.60–0.74).
Conclusions: The TWEAK has low sensitivity as an alcohol‐screening questionnaire among female VA outpatients and should be evaluated further before being used in other female primary care populations. The three‐item AUDIT‐C was the optimal brief alcohol‐screening questionnaire in this study.
Primary care physicians need a brief alcohol questionnaire that identifies hazardous drinking and alcohol use disorders. The Alcohol Use Disorders Identification Test (AUDIT) questions 1 through 3 ...(AUDIT-C), and AUDIT question 3 alone are effective alcohol-screening tests in male Veterans Affairs (VA) patients, but have not been validated in women.
Female VA patients (n = 393) completed self-administered questionnaires, including the 10-item AUDIT and a previously proposed modification to AUDIT question 3 with a sex-specific threshold for binge drinking (>/=4 drinks/occasion), and in-person interviews with the Alcohol Use Disorder and Associated Disabilities Interview Schedule. The AUDIT-C, AUDIT question 3 alone, and the 10-item AUDIT were each evaluated with and without the sex-specific binge question and compared with past-year hazardous drinking (>7 drinks/week or >/=4 drinks/occasion) and/or active Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition alcohol abuse or dependence, based on interviews.
Eighty-nine women (22.6%) met interview criteria for past-year hazardous drinking and/or active alcohol abuse or dependence. Standard and sex-specific AUDIT-Cs were sensitive (0.81 and 0.84, respectively) and specific (0.86 and 0.85, respectively). Their areas under the receiver operating characteristic curves were equivalent (0.91, and 0.92, respectively) and slightly higher than for the standard 10-item AUDIT (0.87). A single, sex-specific question about binge drinking (modified AUDIT question 3) had a sensitivity of 0.69 and specificity of 0.94, whereas the standard AUDIT question 3 was specific (0.96) but relatively insensitive (0.45).
The standard and sex-specific AUDIT-Cs are effective screening tests for past-year hazardous drinking and/or active alcohol abuse or dependence in female patients in a VA study.
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