Effects of Insight Level on the Sensitivity of Alcoholism Screening Tests in Alcohol Dependent Patients

Cho, Kyu Chol; Kim, Jong Sung; Jung, Jin Gyu; Kim, Sung Soo; Lee, Jeong Gil; Choi, Dong Hyun

Abstract

BACKGROUND
Alcoholism screening tests are commonly used in primary medical care. This study examined how much the level of insight of alcohol-dependent patients would impact on the sensitivity of alcoholism screening tests.
METHODS
The sample consisted of 122 subjects who had been diagnosed with alcohol dependence and who completed Alcohol Use Disorders Identification Test (AUDIT), and CAGE questionnaire. AUDIT positive was defined as a score of 20 points or above and CAGE positive, 3 points or above. Insight level was classified as poor, fair, and good using the Hanil Alcohol Insight Scale (HAIS). Positive rates on the AUDIT and CAGE were analyzed according to the level of insight.
RESULTS
In good insight group, the sensitivity of AUDIT and CAGE identified 96.9% and 96.9% of the participants as alcohol dependence, respectively. In fair insight group, those were 92.7% and 96.4%, respectively. However, in poor insight group, these decreased substantially to 62.9% and 65.7%, respectively. After adjusting for general characteristics on the basis of good insight group, we found that the possibility of positive on the AUDIT was significantly lower in poor insight group (Odd ratios [OR], 0.025; 95% confidence interval [CI], 0.002 to 0.411). Also, the possibility of positive on the CAGE was significantly lower in poor insight group (OR, 0.016; 95% CI, 0.001 to 0.358).
CONCLUSION
Alcohol-dependent patients with poor insight showed a high rate of false negatives in alcoholism screening tests. These suggest that primary care physicians should be careful in interpreting the results of alcoholism screening tests.