Comparing screening instruments for alcohol dependence and abuse

  • The usefulness of many screening instruments for alcohol-use disorders may be limited to certain populations.
  • New research compares the performance of a two short screening instruments, RAPS4 and CAGE, against established criteria for alcohol dependence and abuse.
  • RAPS4 outperformed CAGE among the population examined.
  • When quantity-frequency (QF) questions were added, the RAPS4-QF performed even better for alcohol abuse.

Despite the challenges of living in an excessively busy world, clinicians do not have the luxury of "cutting corners" where their patients are concerned. If they do, their patients' health may be compromised. An overt illness may be treated while underlying alcohol problems avoid diagnosis. The distinctions between alcohol abuse and alcohol dependence may be overlooked. Without intervention, problem drinking may develop into dependence. In an effort to identify for clinicians an effective and short screening instrument for alcohol-use disorders, a study in the November issue of Alcoholism: Clinical & Experimental Research (ACER) compares the performance of two short screening instruments.

The Rapid Alcohol Problems Screen (RAPS) is a five-item instrument, derived from other screens, that is designed to maximize sensitivity while maintaining good specificity. The RAPS4, a further refinement of the RAPS, asks if an individual felt guilt after their drinking (Remorse), could not remember things said or did after drinking (Amnesia), failed to do what was normally expected after drinking (Perform), or had a morning drink (Starter). The CAGE questionnaire is a short screening instrument commonly used in the clinical setting that asks if an individual has thought about Cutting down on their drinking, become Annoyed by criticism of their drinking, felt Guilty about their drinking, or had a morning drink as an 'Eye opener.' The ACER study compares performance of the RAPS4 and CAGE against the W


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