Screening and Assessment
Graphic of 4 step screening and assessment process
Step 1: Ask: quantity and frequency, binge, CAGE, and AUDIT
Step 2: Assess: Academic, Social, Behavioral, and Medical
Step 3: Advise Appropriate Action: Iterative process of Brief Intervention, Motivational Interview, and Referral
Step 3: Follow-Up Supportive Care: Iterative process of Brief Intervention, Motivational Interview, and Referral
Screening - What We know...
- Quantity, frequency, and binge drinking questions seem to have the best psychometric properties to detect high-risk college drinking.
- Asking about alcohol use in the context of other behaviors such as smoking, exercise, nutrition, and sexual activities results in more accurate alcohol use information.
- Just asking the question may change alcohol use and norms.
- Context! Method of administration! Skills of the provider! All are critical factors!
- No current biological or laboratory markers are sufficiently sensitive for routine screening in college students.
- Denial is much less common than previously thought! From a public health perspective, it is unimportant; part of the noise.
Clinical Opportunities: Screening...
- Health maintenance visits
- School and sports physicals
- Foreign travel consultation
- Possible alcohol-related symptoms
- Acute care visits for trauma
- Be sincere
- Be respectful
- Emphasize confidentiality
- Establish trust
Alcohol Screening: Consumption Questions To Detect At-Risk and Problem Drinkers
Frequency: “On average, how many days per week do you drink alcohol?”
Quantity: “On a typical day when you drink, how many drinks do you have?”
Binge drinking: “How many times did you have more than four drinks on a single occasion in the last 30 days?”
Alcohol Screening: To Detect At-Risk or Problem Drinkers
Single questions developed by Cherpital, Vinson, Brown and others.
- “Do you have five or more drinks one or more times per week?”
- “Have you felt the need to cut down on your alcohol use?”
- “How many drinks does it take to get high?”
- “How many six packs did you drink last weekend?”
Alcohol Screening: To Detect Dependent Drinkers - CAGE
- “Have you ever felt that you should Cut down on your drinking?”
- “Have people Annoyed you by criticizing your drinking?"
- “Have you ever felt bad or Guilty about your drinking?"
- “Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?” (Eye opener)
Additional Screening Questions: RAFFT (Cherpital)
- Relax - Use to relax?
- Alone - Use alone?
- Family - Use with family?
- Friends - Use with friends?
- Trouble - Had any problems related to alcohol use?
Additional Screening Questions Used to Predict Risk
- Has anyone in your family, such as as your parents or siblings, had any problems with alcohol?
- Do you think they drink too much?
- Did their drinking affect you when you were growing up?
Additional Screening Questions Used to Predict Risk
- Age at first drink?
- Age first time you became drunk?
- How many times did you drink in high school?
- How many times a week did you drink alcohol in high school?
Self Administered Pencil and Paper Questionnaire
Alcohol Use Disorder Inventory Test (AUDIT) (10 questions)
- 3 quantity/frequency questions
- 3 CAGE questions
- 4 consequence (blackouts, injuries, DUI, physician advice)
Alcohol use Disorders Identification Test (AUDIT)
**A score of 8 or more is suggestive of at-risk drinking. Patients who score
positive on the AUDIT should be assessed for potential alcohol-related problems.
AUDIT Reference: Babor TF, de la Fuente JR, Saunders J, Grant M. AUDIT: The
Alcohol use Disorders Identification Tests: Guidelines for use in Primary health
Care. Geneva, Switzerland: World Health Organization, 1992.
- Blood Alcohol Level/Breathalyzer
- MCV (Mean Corpuscular Volume)
- GGT (Gamma-Glutamyl Transferase)
- CDT (Carbohydrate-Deficient Transferrin)
- Urine Toxicology Screens
A “Standard Drink”
- A mug of ordinary beer, ale, or malt liquor 12 oz.
- A single shot of spirits -- whisky, gin, vodka, etc. 1.5 oz.
- A glass of wine 5 oz.
- A wine cooler 12 oz.
- A small glass of sherry, liqueur, or aperitif 4 oz.
Blood Alcohol Level (BAL) 0.015 mg% = 1 drink (14 grams in US)
- a standard drink is metabolized in 60-90 minutes in an average person
- 3-4 standard drinks over 1-2 hours to get to 0.08 mg% (women)
- 5-6 standard drinks to get to 0.08 mg% (men)
- Assess for alcohol-related medical concerns
- Assess for alcohol dependence
- Assess for mental health conditions
- Assess for alcohol-related behavioral problems
- Assess for readiness to change
Assess for Alcohol-Related Medical Concerns
- Driving Under Influence
- Suicide ideation
- GI tract
- High blood pressure
Assess for Alcohol Dependence
- Loss of control
- Preoccupation with use
- Repeated alcohol-related problems
- Tolerance or morning withdrawal
- Making rules to control drinking
- Compulsive use
Assess for Mental Health Conditions
- Panic attacks
- Physical or sexual abuse
- Bipolar disorders
- Axis II disorder (DSM – IV)
Assess for Alcohol-Related Behavioral Problems
- Academic performance below ability
- Receives incompletes for failing to turn in course assignments
- Dropping courses
- Getting into fights with roommates and friends
- Involvement with campus police
Readiness to Change Paradigm
Is the student considering reducing or stopping alcohol use?
Line progression first stage-Not considering change, second stage-Thinking about change, third stage-Ready to change, fourth stage-Taking action, fifth stage-Maintaining change
The student shows resistance between the first and second stage and ambivalence between the second and third stage
How to Implement Routine Screening and Assessment in a College Population
- Administer alcohol use questions on AUDIT as part of new patient process.
- Have nurse ask alcohol question on every visit as part of vital signs check and document in record.
- Have all freshman complete a health history questionnaire that contains the AUDIT as part of routine admissions process.
How to Implement (continued)
Urgent Care and Emergency Departments
- Routine screening by nurse
- Routine BAL on all patients seen for trauma
- Availability of counselor to conduct brief intervention in Emergency Department
Last reviewed: 9/23/2005