Use of the screening suggested by the National Institute on Alcohol Abuse and Alcoholism and of a newly derived tool for the detection of unhealthy alcohol drinkers among surgical patients

Abstract

Objective: The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has developed a two-question tool for the detection of unhealthy drinking (NIAAA-2Q) that investigates excessive alcohol consumption per single occasion. NIAAA-2Q can be commuted into a four-question tool (NIAAA-4Q) by the addition of two questions aimed at investigating excessive weekly alcohol intake. NIAAA-2Q and NIAAA-4Q may prove useful in busy settings such as an anesthesiological environment. However, to date, no study has evaluated their efficacy in a surgical setting. The purpose of this study was to evaluate the accuracy of NIAAA-2Q and NIAAA-4Q in detecting unhealthy drinking among surgical patients using the more complex Alcohol Use Disorders Identification Test (AUDIT) comprising 10 questions as the criterion method.

Method: NIAAA-4Q and AUDIT were administered to 200 surgical patients by three anesthetists.

Results: A total of 23.5%, 12.5%, and 28.5% surgical patients were unhealthy drinkers according to AUDIT, NIAAA-2Q, and NIAAA-4Q, respectively. NIAAA-2Q negative and positive predictive values were 0.78 and 0.36, respectively, and positive and negative likelihood ratios were 1.80 and 0.90, respectively. NIAAA-4Q negative and positive predictive values were 0.93 and 0.65, respectively, and positive and negative likelihood ratios were 6.00 and 0.24, respectively.

Conclusions: NIAAA-4Q demonstrated a better satisfactory agreement than NIAAA-2Q with AUDIT in detecting unhealthy alcohol drinking among surgical patients. These results suggest that the detection of unhealthy alcohol drinking may be increased by the administration of questions aimed at assessing the weekly average of alcohol intake. The modest time required for NIAAA-4Q administration is a major advantage in clinical practice with respect to AUDIT. Further research will compare NIAAA-2Q and NIAAA-4Q with other brief alcohol screening tests.