While alcohol use disorders are serious public health problems estimated to affect more than 10 percent of the U.S. population, many individuals with such problems remain undetected. This is unfortunate for several reasons. First, their continued drinking holds significant potential for further alcohol-related negative consequences. Second, it is not possible to refer such drinkers for appropriate services until they are detected. Particularly noteworthy in this regard are persons experiencing mild to moderate levels of alcohol problems, who have responded well to secondary prevention interventions. Techniques to screen for alcohol use disorders need to be developed and applied. Fortunately, much work has been done in this area. This chapter focuses on a variety of issues and measures relevant to the identification of persons with alcoholrelated problems.

Definition of Screening

Definitions of screening are numerous, ranging from the narrowest to the broadest focus or coverage. For purposes of this chapter, the term screening is used to represent the skillful use of empirically based procedures for identifying individuals who have alcohol-related problems/consequences or who are at risk for such difficulties. Screening measures are not designed (if for no other reason than their brevity) to explicate the nature and extent of such problems. Instead, assessment procedures are used to explore fully the nature of a person's problems with alcohol (see Maisto and McKay, this volume). Such assessment information can be used to

determine whether the person meets the criteria for a particular diagnostic category, such as alcohol abuse or alcohol dependence, depending on the nomenclature system being applied.

The empirically based procedures used in screening include biological markers and self-report techniques. For example, elevated levels of gamma-glutamyltransferase (GGT) and mean corpuscular volume (MCV) have been used as a screen for excessive alcohol consumption (see Leigh and Skinner 1988, Rosman and Lieber 1990, and Anton et al. in this volume for more detail on such laboratory tests). This chapter focuses on self-report screening procedures.

Although some researchers and clinicians believe that information from selfreports on alcohol-related variables generally is invalid (e.g., alcohol abusers will deny they have problems), many others believe these reports can be valid and useful in screening, assessment, and treatment of alcohol abusers. This controversy over selfreports has been discussed in greater detail by Babor et al. (1987), Maisto et al. (1990), and Sobell and Sobell (1990).

The generally accepted idea among clinical researchers in the alcohol field is that the degree of confidence in self-report data increases when information is collected in multiple modes and under circumstances shown to enhance self-reports regarding alcohol use. For example, the accuracy of selfreports may decrease as a function of recent alcohol consumption, concurrent psychiatric