1. Skinner HA, Holt S. The Alcohol Clinical Index: Strategies for Identifying Patients With Alcohol Problems. Toronto: Addiction Research Foundation, 1987.
Purpose:
This is the ACI manual.
Sample:
Not-applicable
Methods:
Not-applicable
Implications:
Not-applicable
2. Skinner HA, Holt S, Sheu WJ, Israel Y. Clinical versus laboratory detection of alcohol abuse: the alcohol clinical index. Br Med J (Clin Res Ed). 1986 Jun 28;292(6537):1703-8. [PMID: 3089362]
Purpose:
To determine reliable indicators of alcohol abuse.
Sample:
131 outpatients with alcohol problems, 131 social drinkers and 52 patients from a family practice. Participants had a mean age of 38 years (SD 11) and were approximately two-thirds male.
Methods:
Information was collected on 108 clinical and laboratory tests from a review of the literature. These tests were used to evaluate 314 subjects who made up the three groups. The outpatients with alcohol problems were matched on age and sex with the social drinkers, and compared. The group of family practice patients was included to make the results applicable to general practice. Each patient had a physical exam, received self-administered medical history and alcohol intake questionnaires, completed blood samples and were administered the Michigan Alcoholism Screening Test (MAST.
Implications:
Results from clinical examination were more accurate than lab tests for detecting abuse. Analyses showed that 17 clinical signs and 13 medical history items formed a diagnostic instrument (the ACI).
3. Alterman AI, Gelfand LA, Sweeney KK.. The Alcohol Clinical Index in lower socioeconomic alcohol-dependent men. Alcohol Clin Exp Res. 1992 Oct;16(5):960-3. [PMID: 1443435]
Purpose:
To validate the ACI among a group of 40 alcoholic men (veterans) undergoing treatment at VAMC and 17 nonalcoholic men treated at a VAMC Outpatient Clinic.
Sample:
40 alcoholic and 17 nonalcoholic men. In the alcoholic group, none were over 65 years old (mean=45.3), were 77.5% black, had 11.8 years of education, reported drinking three or more times per week for 16.9 years, and average age of drinking onset was 21.6 years old. In the nonalcoholic group, none were over 65 years old (mean=41.1), had 13.0 years of education, were 70.6% black, and reported drinking 0.75 ounces per day.
Methods:
The ACI was administered to a group of outpatient alcoholic men and a group of outpatient nonalcoholic men. A diagnosis was initially made by an unstructured psychiatric interview using DSM-III-R criteria. In addition, alcoholic subjects were given the Addiction Severity Index and a physical examination, while nonalcoholic patients were given a brief interview on demographics and alcohol consumption.
Implications:
The Clinical signs subscale showed high sensitivity but poor specificity, while the Medical history subscale showed more moderate sensitivity and 100% specificity at a cut-score of >=2.The Medical History questionnaire could be used to distinguish between alcoholic and nonalcoholic groups.
4. Escobar F, Espi F, Canteras M. Diagnostic tests for alcoholism in primary health care: compared efficacy of different instruments. Drug Alcohol Depend. 1995 Dec;40(2):151-8. [PMID: 8745137]
Purpose:
To To validate tests used in diagnosing alcoholism in primary care in Spain and compare diagnostic efficacy.
Sample:
219 randomly selected Spanish patients (over15 years old) who completed the CAGE questionnaire at an urban health center. The majority were male, married, had finished high school and were actively employed.
Methods:
Patients were given the CAGE questionnaire. Those answering CAGE-positive were asked to participate further, and for each CAGE-positive subject a CAGE-negative subject also participated. Each patient was given the ACI and a study protocol questionnaire, and interviewed using DSM-III criteria in order to diagnosis them with abuse or dependence. They were then referred for blood sample tests.
Implications:
In this Spanish sample, the ACI showed similar diagnostic efficacy to the laboratory tests, however, it had a lower specificity and higher sensitivity than previous findings. In this study, the CAGE questionnaire was most efficacious.
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