FAST Alcohol Screening Test

The assessment explained

The FAST hazardous drinking assessment is used in a wide variety of clinical settings and consists of a 4 item, self-administrable questionnaire. It is based on the Alcohol Use Disorders Identification Test (AUDIT), a long term effective screening method.

The four questions are arranged in two phases:

■ Phase 1 is equivalent to question 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.

It was found that in 50% of cases, the answer to this question is consistent with the final outcome from the assessment.

■ Phase 2 consists of the other three questions:

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

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

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

The FAST alcohol screening test is considered the most rapid alcoholism screening test. In terms of efficacy, this method detects 93% of hazardous drinking cases (when compared with the results from the AUDIT assessment).

The strength of the inter-correlations between the four items achieved 0.77 with up to 0.8 reliability when retesting after one week period.

FAST scoring method

The questions in the FAST assessment are scored as follows:

The overall score ranges from 0 to 16 but the hazardous drinking cut-off point is set at 3 points.

This means that when the patient answers with “Weekly” or “Daily or almost daily”, to at least one question, the cut-off point is immediately touched.

When this happens, the clinician can opt to stop the assessment because the patient is automatically eligible to be referred for hazardous drinking.

The FAST assessment is included in routine screenings for alcohol misuse. Straight from phase 1 (question 1), there is a successful identification of the final outcome, in about 50% of assessed cases.

Here are some of the signs of intoxication or alcohol withdrawal that clinicians should look for during the assessment:

■ Hand tremors – "the shakes";

■ Profuse sweating;

■ Reports of depression, insomnia, anxiety;

■ Visual hallucinations.

About the original study

The Fast Alcohol Screening Test was developed based on the results obtained using the AUDIT questionnaire on a cohort of 666 patients in two accident & emergency (A&E) departments in London, United Kingdom.

By using four of the AUDIT items (after analysis involving sensitivity and specificity indices) a two-stage screening test was developed.

The FAST questionnaire was deemed to be a highly specific and quick to administer assessment of hazardous drinking, in or outside emergency settings.

Original reference

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

Other references

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

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