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Two questions accurately diagnose 80 percent of patients with alcohol problems

Some patients may resent being asked, but it would only take two questions to begin a dialogue about alcohol and health dangers.
Some patients may resent being asked, but it would only take two questions to begin a dialogue about alcohol and health dangers.
Photo by Joe Raedle/Getty Images

“How often do you have six or more drinks on one occasion?” and “As a result of your drinking did anything happen in the last year that you wish didn’t happen?” A study published in the July British Journal of General Practice found these two questions alone scored an accurate diagnosis of 79.8 percent of hidden substance abuse among more than 5,000 respondents.

But combined with a CAGE questionnaire — which comprises an additional four questions — the approach achieved an overall accuracy of 90.9 per cent. (CAGE is an acronym for a century-old alcohol self-test, see related article.) The research was led by scientists from the University of Leicester, who looked at 17 previous studies relating to alcohol abuse to determine whether one or two questions could accurately predict preliminary screening.

The study could have benefits in helping doctors and nurse practitioners diagnose many illnesses in addition to the disease of alcoholism, as alcohol consumption is a primary or secondary cause of more than 60 other health problems including cancer. A January 2014 Centers for Disease Control and Prevention (CDC) report indicated that medical professionals in the U.S. don't routinely screen patients – even high-risk ones – for alcohol use disorders. Only one in six adults, and only one in four binge drinkers, say a health professional has ever discussed alcohol use with them, according to the CDC's conclusions.

“Drinking too much alcohol has many more health risks than most people realize,” said CDC Director Tom Frieden, M.D. “Alcohol screening and brief counseling can help people set realistic goals for themselves and achieve those goals.

There is much interest in ultra-short alcohol screening in primary care that may support brief alcohol interventions. Alcohol consumption is the third-leading cause of illness and death, claiming more than 88,000 Americans annually: Only one in eight of those killed are at the hands of an intoxicated driver. Additionally, as a result of illness, legal costs and lost productivity, alcohol use exacts a toll of more than $223 billion a year on the U.S. economy. Through the Affordable Care Act (or Obamacare), alcohol screening and brief counseling can be covered by most health insurance plans without co-pay and addiction-related treatment is covered to the same level as other medical/surgical procedures.