FAST Alcohol Screening Test

How does this FAST alcohol screening test work?

This is a health tool that is used in the screening of patients, who present to the ER, for hazardous drinking.

Originally created just for emergency rooms, nowadays the test is sometimes used for the general population as well.

During the original study, over 3,000 patients were assessed. The test can either be self completed or administered and only takes a couple of minutes.

It is based on the Alcohol Use Disorders Identification Test (AUDIT), a long term effective screening method and comprises of four key questions from the AUDIT version and concerns a one year period. These are arranged in a two phase test as follows:

■ Phase 1, Q1. How often do you have EIGHT (men)/ SIX (female) or more drinks* on one occasion?

*One drink is defined as half a pint of bear, 1 glass of wine or 1 serving of spirits.

■ Phase 2, Q2. How often during the last year have you been unable to remember what happened the night before because you had been drinking?

■ Phase 2, Q3. How often during the last year have you failed to do what was normally expected of you because of your drinking?

■ Phase 2, Q4. Has a relative or friend, a doctor or other health worker been concerned about your drinking or suggested you cut down?

While the two phases should both be employed, in some specific cases, it might be enough for the user to answer just the first question and to reach the threshold thus making the second phase of the test redundant.

This is why the FAST alcohol screening test is also considered the shortest alcoholism screening test.

In terms of efficacy, compared to the AUDIT method, the FAST test detects 93% of hazardous drinking cases.

There have been two studies for reliability by testing the strength of the inter-correlations between the four items with a good score of 0.77 and by retesting after one week period with more than 0.8 reliability.

FAST scoring

The four questions total a number of 16 points but the cut off result that indicates hazardous drinking is set at 3. The following describes the number of points awarded to each answer choice:

Questions 1, 2 and 3 are scored as follows:

■ Never (0 points);

■ Less than monthly (1 points);

■ Monthly (2 points);

■ Weekly (3 points);

■ Daily or almost daily (4 points).

Question 4 is scored:

■ No (0 points);

■ Yes, but not in the last year (2 points);

■ Yes, in the last year (4 points).

This explains why, in cases where the patient answers with “Weekly” or “Daily or almost daily”, the cut off is equaled or surpassed from the beginning and continuing the test is only optional if requested by the clinician in charge with the alcoholism assessment.

This test is included in routine screenings for alcohol misuse and the first phase is said to successfully identify more than 50% of cases of hazardous or non-hazardous drinking.

Clinicians are advised to look after signs of intoxication or alcohol withdrawal. Some of the physical and psychological possible symptoms include:

■ hand tremors – "the shakes";

■ sweating;

■ visual hallucinations;

■ insomnia;

■ depression;

■ anxiety.

Long term alcohol misuse consequences include conditions such as heart disease, stroke, liver disease, malignancy and pancreatitis.

References

1) Hodgson R, Alwyn T, John B, Thom B, Smith A. (2002) The FAST Alcohol Screening Test. Alcohol Alcohol; 37(1):61-6.

2) Allen JP, Maisto SA, Connors GJ. (1995) Self-report screening tests for alcohol problems in primary care. Arch Intern Med; 155(16):1726-30.

3) Bradley KA, Bush KR, Epler AJ, Dobie DJ, Davis TM, Sporleder JL, Maynard C, Burman ML, Kivlahan DR. (2003) Two brief alcohol-screening tests From the Alcohol Use Disorders Identification Test (AUDIT): validation in a female Veterans Affairs patient population. Arch Intern Med; 163(7):821-9.

4) National Institute on Alcoholism and Alcohol Abuse. Assessing Alcohol Problems - A Guide for Clinicians and Researchers, Second Edition. 2003. Alcohol Concern. Primary Care Alcohol Information Service.