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Universal screening effective in identifying ‘at-risk’ drinkers

Reducing alcohol-related morbidity and mortality is a public health priority
At-risk drinkers

Reducing alcohol-related morbidity and mortality is a public health priority.

It is estimated that around 23% of UK adults are at-risk drinkers and screening with brief interventions in primary care has been shown to have benefits.

Screening is rarely undertaken for a number of reasons, including questions as to the relative value of universal or targeted screening approaches.

This cluster (by general practices) randomised evaluation investigated the relative efficiency and effectiveness of targeted versus universal screening for at-risk alcohol use.

The study was undertaken in 29 general practices in England and used the FAST tool a four-item alcohol screening test. In the targeted arm it was offered to new patients and those presenting with conditions associated with excessive alcohol consumption: mental health, gastrointestinal, hypertension, minor injuries. In

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Reducing alcohol-related morbidity and mortality is a public health priority.


An estimated 23% of adults in the UK are classified as ‘at-risk’ drinkers. Picture: iStock

It is estimated that around 23% of UK adults are at-risk drinkers and screening with brief interventions in primary care has been shown to have benefits.

Screening is rarely undertaken for a number of reasons, including questions as to the relative value of universal or targeted screening approaches.

This cluster (by general practices) randomised evaluation investigated the relative efficiency and effectiveness of targeted versus universal screening for at-risk alcohol use.

The study was undertaken in 29 general practices in England and used the FAST tool – a four-item alcohol screening test. In the targeted arm it was offered to new patients and those presenting with conditions associated with excessive alcohol consumption: mental health, gastrointestinal, hypertension, minor injuries. In the universal arm it was offered to all patients.

Of 3562 patients offered the screening, 3021 (85%) consented to be screened and 908 (30%) scored positive for at-risk alcohol consumption. The prevalence of at-risk alcohol consumption was significantly higher in the targeted group (36.2%) than the universal group (25.6%).

However, 81% of those screening positive in the universal group would have been missed through the targeted approach.

Further analysis showed that patients attending aged 18–35 years and males aged over 35 were significantly more likely to be at-risk alcohol users.

Using this targeted approach rather than clinical condition still would have missed 25% of those with at risk drinking.

The authors conclude that universal screening is likely to be the most effective method of identifying those with at-risk drinking habits.  


Coulton S, Dale V, Deluca P et al (2017) Screening for At-Risk Alcohol Consumption in Primary Care: A Randomized Evaluation of Screening Approaches. Alcohol Alcohol. doi: 10.1093/alcalc/agx017

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