Screening For Alcohol Abuse and Alcohol-Related Problems 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. The National Institute on alcohol Abuse and Alcoholism (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.

Approximately 39 to 44 percent of college students reported binge drinking at least once in the 2 weeks prior to taking a survey. 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.

What’s Meant By "Screening"?

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 have a 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. 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 place them at risk for increased problems, can be helped through screening and brief intervention.

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.

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.

A Range of Screening Tests

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. 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. 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. 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 using high-risk drinking as the criterion suggests that a cutoff score of 8 results in levels of sensitivity and specificity comparable to those of earlier studies. (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.)
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 assessment and interventions, and trained staff typically are available to respond to these policy violators.

Researchers 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.

How Much is Too Much?

Men may be at risk for alcohol-related problems if their alcohol consumption exceeds 14 standard drinks* 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.

*A standard drink is defined as one 12-ounce bottle of beer, one 5-ounce glass of wine, or 1.5 ounces of distilled spirits.

Source: National Institute on Alcohol Abuse and Alcoholism

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