Alcohol screening and brief intervention in criminal justice settings: prevalence and performance of screening tests

The SIPS study is a major UK evaluation of screening and brief intervention strategies for

alcohol users in primary care, emergency departments and criminal justice settings. Here we

present the results of a pilot study of screening tools and the main study screening results in

probation settings. In the pilot study 592 individuals in a variety of settings where approached

and 205 consented to take part in the study. The screening tools being evaluated were the

modified Single Alcohol Screening Questionnaire and the Fast Alcohol Screening Test. The

Gold standard comparison was AUDIT. The mean age in the pilot study was 31 years (SD 9)

and the majority were male. The overall prevalence of alcohol use disorders in the population

was high at 70% with almost 50% at the dependent end of the spectrum. Those scoring

positive on AUDIT had significantly poorer overall health status and were greater users of

health and criminal justice services. A ROC analysis of the instruments demonstrated high

sensitivity and specificity for both M-SASQ and FAST and ROC analysis indicated a marginal

superiority of FAST over M-SASQ (AUC 0.97 vs. 0.92). The main study is a pragmatic

factorial randomised controlled trial set in probation services in the UK. The study compares

screening tool (FAST vs. M-SASQ) and 3 brief interventions (Patient information leaflet vs.

Brief advice vs. Brief Lifestyle Counselling). A total of 976 individuals were approached and

854 were eligible and screened with 573 screening positive. The initial results indicate a high

prevalence of alcohol use disorders in this population (68%). The sensitivity of M-SASQ and

FAST was high (81% vs. 92%) but FAST appears to be more sensitive than M-SASQ at

identifying those with more severe alcohol use disorders with an odds ratio for FAST versus

M-SASQ of 2.69 (CI 1.55–4.67) for all alcohol use disorders and 1.58 (CI 1.11–2.24) for

harmful alcohol use disorders. FAST appears to be the most efficient screening mechanism in

this population but we do not yet know how the screening mechanism interacts with the

treatment intervention.