A Comparison of Two Single-Item Screeners for Hazardous Drinking and Alcohol Use Disorder

Background: There is increasing interest in and physician support for the use of single-item screeners for problem drinking. Methods: In a representative sample of U.S. adults (n = 43,093) and within selected subgroups, past-year frequency of drinking 5+/4+ drinks and maximum drinks consumed on any day were evaluated as screeners for past-year alcohol dependence, any alcohol use disorder (AUD), and any AUD or hazardous drinking, using standard measures of screening performance. AUDs were defined according to DSM-IV criteria. Hazardous drinking was defined as consuming > 14 drinks/wk or 5+ drinks on any day for men and >7 drinks/wk or 4+ drinks on any day for women. Results: Optimal cutpoints for both screeners varied across population subgroups, and these variations should be taken into account in order to maximize screening performance. At the optimal cutpoints for the total population, the sensitivity and specificity of maximum drinks were 89% and 82% for dependence at >= 5 drinks, 90% and 79% for any AUD at >= 4 drinks, and 90% and 96% for any AUD or hazardous drinking at >= 4 drinks. Comparable values of sensitivity and specificity for 5+/4+ frequency were 90% and 83% at >= 3 times a year, 87% and 82% at >= once a year, and 88% and 100% at >= once a year, respectively. Specificity was lower when only past-year drinkers were considered. The 5+/4+ frequency screener yielded fairly low sensitivity in predicting alcohol problems among the elderly and among Blacks. Results supported a past-year reference period for frequency of 5+/4+ drinks and substantiated gender- and age-specific thresholds for defining risk drinking. Conclusions: Both of the single-item screeners performed nearly on a par with the AUDIT-C and have potential for use in primary and emergency care settings.