FAST screening for alcohol problems

Alcohol Insight Number 5

Research and Development Grant

Background

A recently developed screening test for alcohol misuse is the Alcohol Use Disorders Identification Test (AUDIT), which was developed in a World Health Organisation collaborative project across six countries. Although AUDIT has been well validated and is turning out to be a very useful screening test, there are some situations, such as Accident and Emergency departments, where AUDIT takes too long to administer routinely.

The aim of the current study was to test three shorter screening questionnaires using the AUDIT as the gold standard. The Fast Alcohol Screening Questionnaire (FAST), the CAGE questionnaire and the Paddington Alcohol Test (PAT) were compared to the AUDIT in four A & E departments. Sixty-two nurses and 2,185 patients were involved in the study.

This collaborative project between the Health Education Authority, Middlesex University and the University of Wales College of Medicine asks the question: Could a shorter questionnaire be used instead of the AUDIT when there are pressures on time?

Findings

The FAST questionnaire turns out to have high sensitivity and specificity when the AUDIT is used as the gold standard. Sensitivity is the ability of the test to identify a high percentage of problem drinkers. Specificity is its ability to accurately identify those who are not problem drinkers.

  • The FAST questionnaire is completed in 12 seconds, on average. This compares to CAGE at 14 seconds, PAT 42 seconds and AUDIT over one minute.
  • The cost per year of routinely screening 50,000 patients, using the FAST, if the questions are asked by an E Grade nurse would be: FAST £1,669 CAGE £1,916 PAT £5,600 AUDIT £10,400
  • Of those patients identified as problem drinkers using the FAST, 77% would be happy to receive Alcohol Education material, 46% would welcome a 5-minute discussion with a nurse and 25% would accept 3 counselling sessions from a nurse.

Implications

  • The FAST questionnaire identifies those who are hazardous and problem drinkers as well as those who are severely dependent. This opens the door for targeted health promotion as well as treatment.
  • Commissioners of services can easily estimate the prevalence of alcohol misuse within a range of services using the FAST questions.
  • A screening test that takes just 12 seconds to administer enables all health care workers to be more aware of alcohol misusers within their services.
  • Research is now required to look at the feasibility of screening and very brief interventions within A&E departments, using the FAST questions.

Further Information

  • Twelve nurses who had administered all four screening instruments were interviewed to ascertain whether any of the tests were preferred, for any reason, over any of the others. Ten nurses concluded that the FAST was the most appropriate test, especially in a very busy medical setting, since it was quicker than the PAT and was less intrusive than the CAGE (e.g. CAGE asks: “Do you feel guilty about your drinking”).
  • The FAST is terminated after the first question for over 60% of patients since this one question identifies more than 6 out of 10 patients as either alcohol misusers or not.
  • FAST identifies 930 out of every thousand alcohol misusers identified by AUDIT; 716 of these would accept alcohol education materials.

Research Team

Bev John,Tina Abbasi, Rachel Hodgson, Seta Waller, Betsy Thom, Robert Newcombe & Ray Hodgson.

Downloads

This Alcohol Insight
The Final Report