Alcohol misuse

The FAST Alcohol Screening Test, Dr Bev John

Quick facts

  • One of the shortest tools available for screening hazardous drinkers in busy clinical settings
  • Used worldwide as a brief screening measure
  • Recommended by NICE guidelines
  • Translated into many languages, including Swedish, Spanish and Portuguese


Screening for hazardous alcohol consumption can identify those who may not realise they are drinking too much, and who would benefit from changing their behaviour. It can also constitute a very brief intervention in its own right. The extent of alcohol related attendances in Primary Care settings suggests that screening patients would be very beneficial. Standard screening tools take too long to administer routinely in such settings. The FAST comprises 4 questions, and more than 50% of patients are correctly categorised by question, making it very quick to administer

Why this research is important

This research was an examination of the extent of alcohol related admissions to Accident and Emergency departments in England and Wales. It was also a feasibility study into the attitudes of medical and nursing professionals about the appropriateness of A & E settings for both screening for hazardous alcohol use, and the delivery of brief interventions. This partly reflected the changes in approach to alcohol problems during the 1990s from identifying and treating severely dependent ‘alcoholics’, to broadening the base of treatment to those who are drinking hazardously who may need help or advice. This study confirmed the high levels of alcohol related admissions, the general goodwill of professionals to being part of a positive solution through appropriate screening and treatment, but also the many barriers specific to the setting. These were focused around resources, especially staff time. It was generally considered that the current ‘gold standard’ screening instrument would take too long to be used routinely in A & E departments. This led to the next stage of the research, to develop and validate a brief alcohol screening measure that would be suitable for use in busy primary care settings.

The FAST is now being routinely used in many primary care services in the UK, and around the world

The FAST is now being routinely used in many primary care services in the UK, and around the world. It has been used in an innovative study of brief interventions by pharmacists in Glasgow, and with general practitioners in the North East of England, as its potential as a ‘minimal intervention’ as well as a screening tool is becoming clearer. It has attracted international interest, and has been validated in many languages, cultures and populations.

The FAST is recommended by the National Institute for Clinical Excellence as the screening tool of choice for general practitioners in England, to be used with all new patients over the age of 16. It is the screening tool of choice of many charities and self- help health groups both on the internet and in paper copy (e.g.; Alcohol Concern). It is also used by the Primary Care Support Service Wales, for doctors, dentist and pharmacists, and by the NHS in Scotland, to name but a few.