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.
초록
연구배경: 일차 진료에서 알코올리즘을 선별하는 도구는 흔히 사용된다. 본 연구는 알코올리즘 선별 검사들의 민감도가 환자의 병식 상태에 따라 어떻게 영향을 받는지에 대해 알아보고자 하였다. 방법: 알코올 의존으로 진단된 122명의 환자들을 대상으로 하였다. 알코올리즘 선별 검사와 함께 병식 상태를 평가하였다. 알코올리즘 선별 검사는 Alcohol Use Disorders Identiÿcation Test (AUDIT)와 CAGE 설문지를 이용하였다. AUDIT는 20점 이상, CAGE는 3점 이상을 알코올 의존 양성으로 하였다. 병식 상태는 Hanil Alcohol Insight Scale을 이용하여 부정 병식 군, 병식 부분 형성 군 그리고 병식 형성 군으로 분류하였다. 결과: 부정 병식 군(35명)의 AUDIT에 대한 민감도는 62.9%였으며 CAGE에 대한 민감도는 65.7%이었다. 병식 부분 형성 군(55명)의 AUDIT에 대한 민감도는 92.7%, CAGE의 민감도는 96.4%이었다. 병식 형성 군(32명)의 AUDIT에 대한 민감도는 96.9%이었으며, CAGE의 민감도 역시 96.9%였다. 병식 형성 군 대비 부정 병식 군의 AUDIT 설문지의 양성 비율이 유의하게 낮았다(Odd ratios [OR], 0.025, 95% conÿdence interval [CI], 0.002-0.411). CAGE 설문지의 양성 비율도 부정 병식 군에서 유의하게 낮았다(OR, 0.016; 95% CI, 0.001-0.358). 결론: 알코올 의존 환자의 병식 상태가 낮은 경우 알코올리즘 선별 검사의 위 음성이 높았다. 이러한 결과는 일차 진료 의사가 알코올리즘 선별 검사 결과를 해석함에 있어서 주의를 기울여야 함을 암시한다.
Citations
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