Substance Use
Asking adults About Their Maximum Number Drinks in A single day to Screen for DSM-5 Alcohol Use Disorder – Comparison With Other Screening Strategies Rikki Fan* Rikki Fan Aaron White
Background: Screening adults for alcohol misuse is critical for closing the treatment gap for alcohol use disorder (AUD) in the United Sates. The US Preventive Services Task Force recommends using either the Alcohol Use Disorders Identification Test –Consumption (AUDIT-C) or a single screener developed by NIAAA, which asks how often an adult engaged in binge drinking (4+ for women or 5+ for men) in the past year. Additional research suggests that knowing the maximum number of drinks an adult consumed in a single day in the past year (MaxDrinks) helps identify risk of AUD, as well. Identifying optimal screening questions is important for helping clinicians connect people who need help with appropriate care. Here we compare MaxDrinks to other standard questions for identifying risk of AUD.
Methods: Using data from a large representative sample of U.S. adults (NESARC III), we conducted Receiver Operative Characteristics (ROC) analyses to compare MaxDrinks with AUDIT-C and binge frequency for discriminating AUD of different severities among current drinkers across gender and age groups.
Results. The screening performance of MaxDrinks was comparable with AUDIT-C in discriminating any DSM-5 AUD for both men and women among current drinkers. However, for discriminating moderate and severe forms of AUD, AUDIT-C appeared to perform better. The performance of frequency of binge drinking in discriminating DSM-5 AUD was inferior to MaxDrinks and AUDIT-C. Optimal cutpoints of MaxDrinks for discriminating AUD were higher for men (6 drinks) than that for women (4 drinks), and higher for discriminating more severe forms of AUD. Optimal cutpoints for MaxDrinks were more sensitive to age effects (younger drinkers had higher cutpoints than older drinkers) than AUDIT-C.
Conclusions: Findings support the value of all three simple screeners for identifying drinkers at risk of DSM-5 AUD. MaxDrinks is an ideal single-item screener that could be used in primary care settings to screen for AUD.