U.S. Department of Health

& Human Services 

National Institutes of Health 

National Institute on Alcohol Abuse 

and Alcoholism 

Number 65 April 2005 

SCREENING FOR 

ALCOHOL USE AND 

ALCOHOL-RELATED 

PROBLEMS 

Screening for disease has become a mainstay of today’s 

preventive health care, with roots in medical practice 

that extend back to the 1930s and 1940s (1). As screening’s 

effectiveness continues to be demonstrated, the demand 

for these assessments also has increased. The result is 

double-edged. Increased screening enables clinicians to 

step in early to prevent and treat a wide range of public 

health problems before they become too serious. But 

the time available for conducting those screens has 

steadily declined. Deciding whether a particular screen 

is warranted, choosing the best one for an individual 

patient, and administering it in a cost-effective way are 

key issues for clinicians to address. 

Routine screening for problems with alcohol is a relatively 

recent practice, but has a solid base of support. In 1990, 

the Institute of Medicine’s landmark report (2) on 

broadening the base of alcohol and other drug abuse 

treatment recommended that patients in all medical 

settings be screened for the full spectrum of problems 

that can accompany alcohol use and, when necessary, be 

offered brief intervention or referral to treatment services. 

This Alcohol Alert focuses on the use of routine alcohol 

screening in a variety of medical settings. The next issue 

of the Alcohol Alert will examine the role of brief interventions in these same settings. 

What Is Screening? 

Doctors routinely screen patients for an increasing 

number of conditions. The term “screening” refers to 

the testing of members of a certain population (such 

as all the patients in a physician’s practice) to estimate 

the likelihood that they have a specific disorder, such 

as alcohol abuse or dependence (3). 

Screening is not the same as diagnostic testing, which 

establishes a definite diagnosis of a disorder. Instead, 

screening is used to identify people who are likely to 

havea disorder, as determined by their responses to 

certain key questions. People with positive screening 

results may be advised to undergo more detailed diagnostic 

testing to definitively confirm or rule out the disorder. 

A clinician might initiate further assessment, provide a 

brief intervention, and/or arrange for clinical followup 

when a screening test indicates that a patient may have 

a problem with alcohol (4). There is good evidence 

that even patients who do not meet the criteria for 

alcohol dependence 

or abuse, but who are 

drinking at levels that 

“Screening enables clinicians to step in early place them at risk for 

increased problems, to prevent and treat a wide range of public
 can be helped through 

screening and brief health problems.”
 intervention (5). 
An Update—New Clinician’s Guide 

In 2005, NIAAA released Helping Patients Who 

Drink Too Much: A Clinician’s Guide, featuring new 

guidelines on screening and brief intervention 

for primary care and mental health practitioners. 

It offers a simple screening method—a single 

question about heavy drinking days—and includes 

the AUDIT screening tool, both in English and Spanish, 

as a self-report option.To order, see page 8. 

Screening in Different Settings 

In Primary Care—Screening for alcohol disorders in 

primary care can vary from one simple question to an 

extensive assessment using a standardized questionnaire. 

The level of screening used by a clinician typically depends 

on the patient’s characteristics, whether he or she has 

other medical or psychiatric problems, the physician’s 

skills and interest, and the amount of time available. 

Clinicians under strict time constraints may have time 

to ask a patient only one screening question about his 

or her alcohol consumption. One study (6) has shown 

that a positive response to the question “On any single 

occasion during the past 3 months, have you had more 

than 5 drinks containing alcohol?” accurately identifies 

patients who meet either NIAAA’s criteria for at-risk 

drinking or the criteria for alcohol abuse or dependence specified in the Diagnostic and Statistical Manual 

of Mental Disorders, Fourth Edition (DSM–IV) (7). 

Whenever possible, questions about alcohol use should 

be asked of all patients on an annual basis or in response 

to problems that may be alcohol related (8). The questions can be included in a pre-exam interview and 

conducted as part of the patient’s check-in process. 

If the patient appears to be at risk for alcohol-related 

medical problems, or if the clinician suspects that the 

patient is minimizing his or her alcohol use, more 

qualitative questions should be asked to better determine the nature and extent of the problem. 

The CAGE questionnaire (9) is popular for screening 

in the primary care setting because it is short, simple, 

easy to remember, and because it has been proven 

effective for detecting a range of alcohol problems 

(see box, this page) (10). 

Longer tests, such as the 25-question Michigan Alcoholism 

Screening Test (MAST) (11) or the 10-question Alcohol 

Use Disorders Identification Test (AUDIT) (12), may 

be used to obtain more qualitative information about 

a patient’s alcohol consumption. 

The MAST includes questions about drinking behavior 

and alcohol-related problems; it is particularly useful for 

identifying alcohol dependence (13). The AUDIT includes 

questions about the quantity and frequency of alcohol 

use, as well as binge drinking, dependence symptoms, 

and alcohol-related problems (see box, page 4). Its strength 

lies in its ability to identify people who have problems 

with alcohol but who may not be dependent (10). 

Research shows that the AUDIT may be especially 

useful when screening women and minorities (14). 

This screening tool also has shown promising results 

when tested in adolescents and young adults; it is less 

accurate in older patients, though further research is 

needed with these populations (14,15). 

Computerized versions of the AUDIT and other screening instruments now are available and can be used in 

conjunction with other health assessment questionnaires. 

Screening in the Emergency Department—Many of 

the estimated 110 million emergency department (ED) 

visits in the United States each year are related to alcohol use. Up to 31 percent of patients treated in EDs 

and 50 percent of severely injured trauma patients 

(i.e., those requiring hospital admission, usually to an 

intensive care unit) screen positive for alcohol problems 

(16). Patients treated in EDs also are 1.5 to 3 times 

more likely than those treated in primary care clinics 

to report heavy drinking, to experience the adverse 

effects of drinking (e.g., alcohol-related injuries, illnesses, and legal or social problems), and to have been 

treated previously for an alcohol problem (17). 

Degutis (18) demonstrated that screening using such 

tools as quantity/frequency questions and the fouritem CAGE questionnaire is feasible in a real-world 

CAGE 

C 	Have you ever felt you should 

cut down on your drinking? 

A 	Have people annoyed you by 

criticizing your drinking? 

G 	 Have you ever felt bad or guilty 

about your drinking? 

E	 Eye opener: Have you ever had a 

drink first thing in the morning to 

steady your nerves or to get rid of 

a hangover? 

The CAGE can identify alcohol problems over 

the lifetime.Two positive responses are considered 

a positive test and indicate further assessment is 

warranted. 

2

ED setting. Likewise, Hungerford and colleagues (19) 

screened a sample of young adults ages 18 to 39 while 

they were waiting for treatment in the ED. Most of 

these patients (87 percent) consented to the screening. 

Of these, a large portion (43 percent) screened positive 

for alcohol problems on the AUDIT,1 and of those with 

positive screens, 94 percent received counseling. The high 

prevalence of alcohol problems and the broad acceptance 

of screening and brief intervention in this sample show 

that screening is indeed feasible in an ED setting (20). 

Yet barriers to screening in an ED setting are clear. 

This environment typically is chaotic and time is precious. Emergency practitioners and trauma physicians 

may believe that interventions for alcoholism are ineffective, or they may lack confidence in their ability or 

the ability of their staffs to screen patients effectively. 

And resources may not be available for conducting 

screening and brief interventions in the ED (20). 

In some cases, ethical and insurance issues also present 

obstacles to screening. For example, because of existing 

laws, third-party payers (i.e., insurers) may deny reimbursement for medical services if a patient has a positive 

blood alcohol level at the time of the ED visit. This can 

place a large financial burden on the patient or on the 

treating hospital (if it does not receive payment from 

the patient or the insurance company). 

Another legal issue related to screening for alcohol 

use in the ED is the possible denial of benefits because 

the patient was injured while committing a crime. In 

many States, driving while impaired (DWI) is a felony, 

T-ACE 

T	 Tolerance: How many drinks does 

it take to make you feel high? 

A 	Have people annoyed you by 

criticizing your drinking? 

C 	Have you ever felt you ought to 

cut down on your drinking? 

E	 Eye opener: Have you ever had a 

drink first thing in the morning 

to steady your nerves or get rid 

of a hangover? 

The T-ACE, which is based on the CAGE, is 

valuable for identifying a range of use, including 

lifetime use and prenatal use, based on the 

DSM–III–R criteria. A score of 2 or more is considered positive. Affirmative answers to questions A, 

C, or E = 1 point each. Reporting tolerance to 

more than two drinks (the T question) = 2 points. 

especially if a crash is severe enough to result in the 

need for medical attention.2 Many insurance policies 

will not pay benefits for injuries sustained during the 

commission of a felony (but will provide for injuries 

sustained in the commission of a lesser crime). Other 

policies, however, exclude benefits for injuries sustained 

in the commission of any criminal act; in these cases, 

lesser offenses such as public intoxication or illegal 

consumption of an alcoholic beverage could be used 

as justification to deny benefits (21). 

An increase in screening has occurred in trauma centers 

in recent years, but the practice still is not routine (22). 

To make screening, intervention, and referral as easy as 

possible and thereby to promote their use, the American 

College of Emergency Physicians (23) developed the 

Alcohol Screening and Brief Intervention Resource Kit for 

their members. The kit is available via the Internet and 

contains an explanation of brief interventions, samples 

of patient handouts, and information on developing 

resource lists for individual communities. 

Screening in Prenatal Care Settings—Women who 

drink during pregnancy come from all walks of life 

(24). Anywhere from 14 to 22.5 percent of women 

report drinking some alcohol while pregnant (25). 

The U.S. Surgeon General recently issued an advisory 

warning pregnant women and women who might 

become pregnant to abstain from any alcohol use to 

eliminate the chance of giving birth to a baby with 

Fetal Alcohol Spectrum Disorders (FASD)—a range 

of preventable birth defects caused by prenatal alcohol 

exposure (26). This current advisory is an update of 

the 1981 Surgeon General’s Advisory. 

Identifying women who are drinking during pregnancy 

clearly is important (27). Yet determining a woman’s 

prenatal alcohol consumption can be difficult (28). 

Many women alter their drinking once they learn they 

are pregnant (29). But a woman may have been drinking harmful levels of alcohol prior to learning about 

her pregnancy, and some injury already could have 

been done to the fetus. The standard questions about 

a woman’s current quantity and frequency of alcohol 

use may not show her true risk for problems. Asking 

her about her drinking patterns before she became 

pregnant would solicit more accurate measures of her 

first-trimester consumption (28). 

1

In this study, a score of ≥6 points was considered a positive screen. 

2

The classification of DWI offenses depends entirely on the law of each State. 

Many States classify them as misdemeanors. A number of States, however, 

classify DWI offenses as felonies under the following circumstances: when 

they are repeat offenses, when they cause death or serious bodily injury, or 

when they involve a blood alcohol concentration over 0.15 percent, or when 

there is a combination of previous traffic offenses. 

3

4

Alcohol Use Disorders Identification Test (AUDIT)

The Alcohol Use Disorders Identification Test (AUDIT) can detect alcohol problems experienced in the last

year. A score of 8+ on the AUDIT generally indicates harmful or hazardous drinking. Questions 1–8 = 0, 1,

2, 3, or 4 points. Questions 9 and 10 are scored 0, 2, or 4 only.
A woman also may not report her alcohol consumption accurately because she is embarrassed or afraid to 

admit to drinking while pregnant (30). And popular 

screening instruments, such as the CAGE, although 

effective in other populations, may not identify harmful drinking by pregnant women (31). 

The T-ACE, a four-item questionnaire based on the 

CAGE, is a simple screening instrument that can identify 

women’s prenatal consumption (see box, page 3). 

T-ACE has been tested in a wide variety of obstetric 

practices (32,33) and has proven to be a valuable and 

efficient tool for identifying a range of alcohol use, 

including any current prenatal alcohol consumption, 

prepregnancy risk drinking (defined as more than two 

drinks per drinking day), and lifetime alcohol diagnoses based on the Diagnostic and Statistical Manual of 

Mental Disorders, Third Edition, Revised (33). 

Women who screen positive using the T-ACE or another 

screening questionnaire, such as the AUDIT, should 

receive further assessment and brief intervention to help 

reduce the risk to the developing fetus and to maximize 

pregnancy outcome. 

Screening in the Criminal Justice System—By the end 

of 2003, about 1.47 million people were incarcerated 

in U.S. Federal and State prisons, and an additional 

4.85 million were on probation or parole (34,35). 

Approximately 18 percent of Federal prison inmates 

and about 25 percent of State prison inmates reported 

having experienced problems consistent with a history 

of alcohol abuse or dependence (36). Alcohol misuse 

plays a particularly large role in domestic violence and 

DWI3 offenses—29 percent of Federal and 40 percent 

of State prisoners reported a previous domestic violence 

dispute involving alcohol (36), and almost two-thirds 

of convicted DWI offenders are alcohol dependent 

(37). Routine alcohol screening of all offenders in the 

criminal justice system would help to identify people 

at greatest risk for problems with alcohol (38). 

Most States mandate screening and assessment of 

DWI offenders to evaluate the extent of their problem 

with alcohol and their need for treatment (39). Current 

sentencing guidelines also recommend that all DWI 

offenders be screened for alcohol use problems and 

recidivism risk (40), but the existing screening programs 

for DWI offenders differ in how they evaluate clients. 

Some programs conduct a simple screening—typically, 

a brief questionnaire—to determine whether the client 

should be transferred either to an education program 

“DWI” is used generically as a reference to the impaired driving offense and 

includes impairment by alcohol and/or other drugs. 

or to treatment. Other programs combine screening 

with assessment and provide referral guidelines and 

specific treatment recommendations. 

Screening for alcohol disorders in the criminal justice 

setting poses specific challenges. One factor that may 

limit the effectiveness of current screening procedures 

is that most instruments, such as the commonly used 

MAST, were developed in populations other than 

DWI offenders or other criminal justice populations 

and were not designed specifically for use in courtmandated screening (39). These instruments rely on 

the offenders’ reports of their own alcohol use (that is, 

self-reports), without considering other information 

drinks* 

NIH 

Pub No. 05–3769. Bethesda, MD: the Institute, 2005. 

*

one 5-ounce glass of wine, or 1.5 ounces of distilled spirits. 

▲ 

How Much Is Too Much 

Men may be at risk for alcohol-related problems 

if their alcohol consumption exceeds 14 standard 

per week or 4 drinks per day, and women 

may be at risk if they have more than 7 standard 

drinks per week or 3 drinks per day. 

SOURCE: National Institute on Alcohol Abuse and Alcoholism. 

Helping Patients Who Drink Too Much: A Clinician’s Guide. 

A standard drink is defined as one 12-ounce bottle of beer, 

(such as court records for previous alcohol-related 

offenses, statements from the offender’s family or others, 

or data obtained from biochemical tests to detect alcohol 

consumption), making it more difficult to truly gauge 

alcohol consumption. 

Offenders also may feel coerced into screening and treatment, fearing that they may be penalized if they admit 

to alcohol use, perhaps losing custody of their children 

or receiving unfavorable probation conditions (36). 

Issues of confidentiality also may come into play (41). 

These factors can make it difficult to assess the true 

nature and severity of an offender’s alcohol problems 

(42) and underscore the need for adequately trained 

personnel to conduct screening in criminal justice 

populations so that any under-reporting of problems 

can be avoided. Many programs, however, cannot afford 

specially trained staff to conduct these evaluations (36). 

Financial constraints are an issue in community and 

State criminal justice systems. Yet the costs to society 

of failing to properly identify and treat alcohol abusers 

in the criminal justice system also are substantial. 

Appropriately delivered treatment can be effective in 

changing behavior and reducing re-arrests—the result 

is a cost that’s much less than incarceration (41). 

5


3 
Screening in College Populations—Alcohol use 

among college students is a serious cause for concern. 

Many students are under the legal drinking age. 

Moreover, many engage in heavy episodic, or binge, 

drinking. NIAAA defines binge drinking as consuming 

enough alcohol to result in a blood alcohol content 

(BAC) of .08, which, for most adults, would be five 

drinks for men or four for women over a 2-hour period (43). 

Approximately 39 to 44 percent of college students 

reported binge drinking at least once in the 2 weeks 

prior to taking a survey (44,45). Additionally, according 

to one study, nearly one-third of college students met 

DSM–IV criteria for alcohol abuse, and 6 percent met 

DSM–IV criteria for alcohol dependence (36). 

Identifying those students at greatest risk for alcohol 

problems is the first step in prevention. Screening 

instruments must be selected that will accurately 

detect the problem within the population of interest, 

and be feasible to implement. 

A number of screening tests have been evaluated. The 

CAGE has been used in college student populations 

but has been criticized for its inability to detect the 

full range of drinking problems experienced by people 

in this age group (46). Another test, the MAST, includes 

9 to 25 questions; the longest version takes less than 

10 minutes to complete. The MAST is particularly 

useful in detecting more advanced problems with alcohol 

(such as dependence), but this may limit its usefulness 

within a college population (47). The Young Adult Alcohol 

Problems Screening Test (YAAPST), which consists of 

27 items, takes less than 10 minutes to complete and has 

demonstrated good sensitivity (see textbox “Screening 

Watchwords”). Other screening tools—the College Alcohol 

Problems Scale–revised (CAPS-r), the Rutgers Alcohol 

Problem Index (RAPI), and the AUDIT—can be used 

to detect alcohol problems experienced in the past year, 

making them good candidates for use with students. 

With the AUDIT, the proper cutoff score to use for 

screening college students has been disputed, however. 

A recent study (48) using high-risk drinking as the criterion4 suggests that a cutoff score of 8 results in levels 

of sensitivity and specificity comparable to those of 

earlier studies. 

Screening may occur in the campus health center, 

counseling center, or local hospital emergency department 

(for example, students may answer questions as part of 

normal intake procedures). Incorporating screening into 

campus judicial systems has several advantages. Many 

campuses already have policies in place that mandate 

students cited for alcohol policy violations to complete 

Sensitivity 

Specificity 

▲ ▲ 

Screening Watchwords 

The term “sensitivity” refers to the ability of a 

test to correctly identify those people in a population who actually have the disorder. A highly 

sensitive test is desirable when the cost of missing 

people who do have the condition (i.e., who have 

a false negative screening result) is high. For example, 

failure of a screening test to correctly identify a 

commercial airline pilot who exhibits “harmful 

drinking” could have potentially catastrophic results. 

Specificity is a test’s ability to identify people in 

a group who do not have the disorder under 

investigation. A highly specific screening test is 

desirable when the cost of false positive misclassification is high (e.g., when a person could be 

unjustly denied life insurance or other benefits 

because of having a false positive screening result 

for current alcohol dependence). 

assessment and interventions (49), and trained staff 

typically are available to respond to these policy violators. 

Larimer and colleagues (50) suggest that administrators also consider retaining an on-campus specialist— 

that is, a health care or counseling professional responsible for direct access to services—to reduce the need 

for off-campus providers. This specialist could coordinate 

the full range of alcohol-screening services, including 

those in the health or counseling center and mandated 

or campus judicial settings, as well as any universal 

screening efforts, thus solving some of the confidentiality issues raised by the involvement of academic 

affairs offices in screening. 

Summary 

Screening tests are a first-line defense in the prevention 

of disease. Screening for alcohol problems can take place 

in a wide variety of populations and settings. Research 

shows that a number of good screening instruments are 

available that can be tailored to specific audiences and 

needs. Detecting alcohol abuse and dependence early in 

the course of disease enables clinicians to get people the 

help they need, either by initiating a brief intervention 

or by referring the patient to treatment. Even patients 

who do not have an alcohol disorder, but who are 

drinking in ways that are harmful, can benefit from 

screening and brief intervention (5). 

4 High-risk drinking was defined, for men, as consuming 5 or more consecutive 

drinks on 4 or more occasions, or 57 or more drinks total during the preceding 

28-day period; and for women, consuming 4 or more consecutive drinks on 4 or 

more occasions, or 29 or more drinks total during the preceding 28-day period. 

6

References


(1) Berg, A.O., and Allan, J.D. Introducing the third U.S. Preventive 

Services Task Force. American Journal of Preventive Medicine 20:3–4, 

2001. (2) Institute of Medicine. Broadening the Base of Treatment for 

Alcohol Problems. Report of a Study by a Committee of the Institute of 

Medicine, Division of Mental Health and Behavioral Medicine. 

Washington, DC: National Academy Press, 1990. (3) Stewart, S.H., 

and Connors, G.J. Screening for alcohol problems: What makes a test 

effective? Alcohol Research & Health 28(1):5–16, 2004/2005. (4) 

Babor, T.F., and Higgins-Biddle, J.C. Brief Intervention for Hazardous 

and Harmful Drinking: A Manual for Use in Primary Care. Geneva: 

World Health Organization, 2001. (5) U.S. Preventive Services Task 

Force (USPSTF). Screening and Behavioral Counseling Interventions in 

Primary Care to Reduce Alcohol Misuse: Recommendation Statement. 

Rockville, MD: Agency for Healthcare Research and Quality, 2004. 

Available at http://www.ahrq.gov/clinic/3rduspstf/alcohol/alcomisrs.htm. 

(6) Taj, N.; Devera-Sales, A.; and Vinson, D.C. Screening for problem 

drinking: Does a single question work? Journal of Family Practice 

46(4):328–335, 1998. (7) American Psychiatric Association (APA). 

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. 

Washington, DC: APA, 1994. (8) Fleming, M. Screening and brief 

intervention in primary care settings. Alcohol Research & Health 

28(2):57–62, 2004/2005. (9) Ewing, J.A. Detecting alcoholism: The 

CAGE questionnaire. JAMA: Journal of the American Medical 

Association 252(14):1905–1907, 1984. (10) Fiellin, D.A.; Reid, M.C.; 

and O’Connor, P.G. Screening for alcohol problems in primary care: A 

systematic review. Archives of Internal Medicine 160(13):1977–1989, 

2000. (11) Selzer, M. The Michigan Alcoholism Screening Test: The 

quest for a new diagnostic instrument. American Journal of Psychiatry 

127:1653–1658, 1971. (12) Saunders, J.B.; Aasland, O.G.; Babor, 

T.F.; et al. Development of the Alcohol Use Disorders Identification 

Test (AUDIT): WHO Collaborative Project on Early Detection of 

Persons with Harmful Alcohol Consumption–II. Addiction 

88:791–804, 1993. (13) Reid, M.C.; Fiellin, D.A.; and O’Connor, 

P.G. Hazardous and harmful alcohol consumption in primary care. 

Archives of Internal Medicine 159(15):1681–1689, 1999. (14) Reinert, 

D.F., and Allen, J.P. Alcohol Use Disorders Identification Test 

(AUDIT): A review of recent research. Alcoholism: Clinical and 

Experimental Research 26(2):272–279, 2002. (15) Chung, T.; Colby, 

S.M.; Barnett, N.P.; et al. Screening adolescents for problem drinking: 

Performance of brief screens against DSM–IV alcohol diagnoses. 

Journal of Studies on Alcohol 61(4):579–587, 2000. (16) D’Onofrio, 

G., and Degutis, L.C. Preventive care in the emergency department: 

Screening and brief intervention for alcohol problems in the emergency 

department: A systematic review. Academic Emergency Medicine 

9:627–638, 2002. (17) Cherpitel, C.J. Drinking patterns and problems: A comparison of primary care with the emergency room. 

Substance Abuse 20:85–95, 1999. (18) Degutis, L.C. Screening for 

alcohol problems in emergency department patients with minor injury: 

Results and recommendations for practice and policy. Contemporary 

Drug Problems 25:463–475, 1998. (19) Hungerford, D.; Williams, J.; 

Furbee, P.; et al. Feasibility of screening and intervention for alcohol 

problems among young adults in the ED. American Journal of 

Emergency Medicine 21:14–22, 2003. (20) D’Onofrio, G., and Degutis, 

L. Screening and brief intervention in the emergency department. 

Alcohol Research & Health 28(2):63–72, 2004/2005. (21) Chezem, L. 

Legal barriers to alcohol screening in emergency departments and trauma centers. Alcohol Research & Health 28(2):73–77, 2004/2005. (22) 

Shermer, C.R.; Gentilello, L.; Hoyt, D.B.; et al. National survey of 

trauma surgeons’ use of alcohol screening and brief intervention. Journal 

of Trauma: Injury, Infection, and Critical Care 55:849–856, 2003. (23) 

American College of Emergency Physicians. Alcohol Screening and 

Brief Intervention Resource Kit. ACEP Product No. 409036. Available at 

http://www.acep.org (follow link to Practice Resources). Accessed 2004. 

(24) Centers for Disease Control and Prevention (CDC), National 

Center for Injury Prevention and Control. 10 Leading Causes of Death. 

Available at http://www.cdc.gov/ ncipc/osp/charts.htm. Accessed 2004. 

(25) Bearer, C.F. Markers to detect drinking during pregnancy. 

Alcohol Research & Health 25(3):210–218, 2001. (26) Office of the 

Surgeon General. Press Release: “U.S. Surgeon General Releases 

Advisory on Alcohol Use in Pregnancy, February 21, 2005.” Available at 

www.hhs.gov/ surgeongeneral/pressreleases/sg02222005.html. (27) 

Russell, M.; Martier, S.S.; Sokol, R.J.; et al. Screening for pregnancy 

risk-drinking. Alcoholism: Clinical and Experimental Research 

18(5):1156–1161, 1994. (28) Chang, G. Screening and brief intervention in prenatal care settings. Alcohol Research & Health 28(2):80–84, 

2004/2005. (29) Smith, I.E.; Lancaster, J.S.; and Moss-Wells, S. 

Identifying high-risk pregnant drinkers: Biological and behavioral correlates of continuous heavy drinking during pregnancy. Journal of 

Studies on Alcohol 48(4):304–309, 1987. (30) Jacobson, S.W.; Chiodo, 

L.M.; Sokol, R.J.; et al. Validity of maternal report of prenatal alcohol, 

cocaine, and smoking in relation to neurobehavioral outcome. 

Pediatrics 109:815– 825, 2002. (31) Bradley, K.A.; Boyd-Wickizer, J.; 

Powell, S.H.; et al. Alcohol screening questionnaires in women: A critical 

review. JAMA: Journal of the American Medical Association 

280(2):166–171, 1998. (32) Sokol, R.J.; Martier, S.S.; and Ager, J.W. 

The T-ACE questions: Practical prenatal detection of risk-drinking. 

American Journal of Obstetrics and Gynecology 160:863–871, 1989. (33) 

Chang, G.; Wilkins-Haug, L.; Berman, S.; et al. Alcohol use in pregnancy: Improving identification. Obstetrics and Gynecology 

91:892–898, 1998. (34) Bureau of Justice Statistics. Prisoners in 2003. 

NJC Pub. No. 205335. Washington, DC: U.S. Department of Justice, 

Bureau of Justice Statistics, 2004. (35) Bureau of Justice Statistics. 

Probation and Parole in the United States, 2003. NJC Pub. No. 205336. 

Washington, DC: U.S. Department of Justice, Bureau of Justice 

Statistics, 2004. (36) Knight, K.; Simpson, D.D.; and Hiller, M.L. 

Screening and referral for substance-abuse treatment in the criminal 

justice system. In: Leukefeld, C.G.; Tims, F.; and Farabee, D.; eds. 

Treatment of Drug Offenders: Policies and Issues. New York: Springer, 

2002. pp. 259–272. (37) Lapham, S.C.; Smith, E.; C’de Baca, J.; et al. 

Prevalence of psychiatric disorders among persons convicted of driving 

while impaired. Archives of General Psychiatry 58:943–949, 2001. (38) 

Lapham, S. Screening and brief intervention in criminal justice settings. Alcohol Research & Health 28(2):85–93, 2004/2005. (39) Chang, 

I.; Gregory, C.; and Lapham, S.C. Review of Screening Instruments and 

Procedures for Evaluating DWI (Driving While Intoxicated/Impaired) 

Offenders. Washington, DC: AAA Foundation for Traffic Safety, 2002. 

Available at www.aaafoundation.org/pdf/ DWI/Screeningreport.pdf. 

(40) National Highway Traffic Safety Administration (NHTSA) and 

National Institute on Alcohol Abuse and Alcoholism (NIAAA). A 

Guide to Sentencing DUI Offenders. DOT HS–808–365. Washington, 

DC: U.S. Department of Transportation, NHTSA, 1996. (41) Vigdal, 

G.L. Planning for Alcohol and Other Drug Abuse Treatment for Adults in 

the Criminal Justice System. Rockville, MD: U.S. Dept. of Health and 

Human Services, CSAT, SAMHSA, 1995. (42) Chang, I.; Lapham, 

S.C.; and Wanberg, K.W. Alcohol Use Inventory: Screening and assessment of first-time driving-while-impaired (DWI) offenders, I. 

Reliability and profiles. Alcohol & Alcoholism 36:112–121, 2001. (43) 

National Institute on Alcohol Abuse and Alcoholism (NIAAA). 

NIAAA Council approves definition of binge drinking. NIAAA 

Newsletter (3), Winter 2004. (44) Johnston, L.D.; O’Malley, P.M.; 

Bachman, J.G.; and Schulenberg, J.E. Monitoring the Future, National 

Survey Results on Drug Use, 1975–2003. Volume II: College Students and 

Adults Ages 19–45. NIH Pub. No. 04–5508. Bethesda, MD: National 

Institute on Drug Abuse, 2004. (45) Wechsler, H.; Lee, J.E.; Kuo, M.; 

et al. Trends in college binge drinking during a period of increased prevention efforts. Findings from 4 Harvard School of Public Health College 

Alcohol Study surveys: 1993–2001. Journal of American College Health 

50:203–217, 2002. (46) Larimer, M.E., and Cronce, J.M. Identification, 

prevention, and treatment: A review of individual-focused strategies to 

reduce problematic alcohol consumption by college students. Journal 

of Studies on Alcohol (Suppl. 14):148–163, 2002. (47) Svanum, S., and 

McGrew, J. Prospective screening of substance dependence: The advantages 

of directness. Addictive Behaviors 20:205–213, 1995. (48) Kokotailo, P.K.; 

Egan, J.; Gangnon, R.; et al. Validity of the Alcohol Use Disorders 

Identification Test in college students. Alcoholism: Clinical and 

Experimental Research 28(6):914–920, 2004. (49) Anderson, D.S., and 

Gadaleto, A. Results of the 2000 College Alcohol Survey: Comparison with 

1997 Results and Baseline Year. Fairfax, VA: Center for the Advancement 

of Public Health, George Mason University, 2001. (50) Larimer, M.E.; 

Cronce, J.M.; Lee, C.M.; and Kilmer, J.R. Brief interventions in college settings. Alcohol Research & Health 28(2):94–104, 2004/2005. 

7

Alcohol Research & Health ▲ ▲ ▲ 

R e s o u r c e s 

Source material for this Alcohol Alert originally appeared in 

,Volume 28, Numbers 1 and 2, 2004/2005. 

For more information on screening patients for alcohol abuse 

and alcoholism, see also: 

Assessing Alcohol Problems: A Guide for Clinicians and 

Researchers. Second Edition, Revised 2003, NIH Publication 

No. 03–3745. Describes a range of screening instruments, 

including their target audiences, reliability, clinical 

utility, and research applications. 

Helping Patients Who Drink Too Much: A Clinician’s 

Guide. 2005 Edition. NIH Publication No. 05–3769. 

Provides useful materials for screening, assessing, 

and administering brief interventions. Includes 

medication information and handy pocket guide. 

For these and other resources, visit 

NIAAA’s Web site, www.niaaa.nih.gov 

Full text of this publication is available on NIAAA’s World Wide Web site at http://www.niaaa.nih.gov 

All material contained in the Alcohol Alert is in the public domain and may be used or reproduced 

without permission from NIAAA. Citation of the source is appreciated.


Copies of the Alcohol Alert are available free of charge from the National Institute on Alcohol Abuse and Alcoholism


Publications Distribution Center, P.O. Box 10686, Rockville, MD 20849–0686.


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