Addictive Behavior Among Young People in Ukraine: A Pilot Study

The AUDIT-like tests system was created for complex assessment and evaluation of the addictive status of adolescents in a Ukrainian population. The AUDIT-like tests system has been created from the Alcohol Use Disorders Identification Test (AUDIT) developed by the World Health Organization. The AUDIT-like tests were minimally modified from the original AUDIT. Attention was brought to similarities between stages of different addictions (TV, computer games, the Internet, etc.) and alcohol addiction. Seventeen AUDIT-like tests were created to detect the different types of chemical and non-chemical addictions.     

Fast screening for alcohol misuse

The Fast Alcohol Screening Test (FAST) has been developed from the AUDIT questionnaire. AUDIT: The Alcohol Use Disorders Identification Test: guidelines for use in primary health care. Geneva, Switzerland: World Health Organization for use in very busy medical settings. One feature of the FAST is its ease and speed of administration, especially since one question identifies over 50% of patients as either alcohol misusers or not. This study further explores the sensitivity and specificity of the FAST across ages, gender, and locations using the AUDIT as the gold standard. Two other quick tests are also compared with the AUDIT and the FAST, namely the Paddington Alcohol Test and the CAGE. All tests were quicker to administer than the AUDIT with the FAST taking just 12 s on average. All tests identified drinkers who would accept a health education booklet (over 70% of those identified) or 5 min of advice (over 40%). The FAST was consistently reliable when sensitivity and specificity were tested against AUDIT as the gold standard.     

Evaluating Shortened Versions of the AUDIT as Screeners for Alcohol Use Problems in a General Population Study

Background: Efficient alcohol screening measures are important to prevent or treat alcohol use disorders (AUDs). Objectives: We studied different versions of the Alcohol Use Disorders Identification Test (AUDIT) comparing their performance to the full AUDIT and an AUD measure as screeners for alcohol use problems in Goa, India. Methods: Data from a general population study on 743 male drinkers aged 18–49 years are reported. Drinkers completed the AUDIT and an AUD measure. We created shorter versions of the AUDIT by (a) collapsing AUDIT item responses into three and two categories and (b) deleting two items with the lowest factor loadings. Each version was evaluated using factor, reliability and validity, and differential item functioning (DIF) analysis by age, education, standard of living index (SLI), and area of residence. Results: A single factor solution was found for each version with lower factor loadings for items on guilt and concern. There were no significant differences among the different AUDIT versions in predicting AUD. No significant DIF was found by education, SLI or area of residence. DIF was observed for the alcohol frequency item by age. Conclusions/Importance: The AUDIT may be used with dichotomized response options without loss of predictive validity. A shortened eight-item dichotomized scale can adequately screen for AUDs in Goa when brevity is of paramount importance, although with lower predictive validity. Although the frequency item was endorsed more by older men, there is no evidence that the AUDIT items perform differently in other groups of male drinkers in Goa.     

Internet-based assessment and self-monitoring of problematic alcohol and drug use

A Swedish web-based service (www.escreen.se) offers self-assessment and self-monitoring of alcohol and drug use via on-line screening with the Alcohol Use Disorders Identification Test (AUDIT) and the Drug Use Disorders Identification Test (DUDIT) as well as in-depth risk assessment using extended versions of both tests (Alcohol-E and DUDIT-E). Users receive individualized feedback concerning their alcohol and drug consumption and can follow their alcohol and drug use over time in personal diagrams and by writing in an electronic diary. This study describes user characteristics, service utilization patterns, and psychometric test properties for 2361 individuals who created a valid account over 20 months starting in February 2007. Problematic alcohol use according to AUDIT criteria was indicated for 67.4%, while 46.0% met DUDIT criteria for problematic drug use. Men and women accessed the service equally, with a mean age of 23 years. Internal consistency reliability figures were 0.90 for 1846 first-time AUDIT users and 0.97 for 1211 first-time DUDIT users; among 213 second-time AUDIT users reliability was 0.93, and 0.96 for 97 second-time DUDIT users. Internet-based alcohol and drug monitoring could function as a self-help tool or as a complement to substance abuse treatment.     

Brief alcohol screening in a clinical psychiatric population: special attention needed

Introduction and Aims. Abbreviated versions of the Alcohol Use Disorders Identification Test (AUDIT) and single‐item screeners show promising results but have not previously been investigated in a clinical psychiatric setting. The aim of the present study was to investigate the capacity of three brief screening methods to detect hazardous drinking in a psychiatric treatment‐seeking population. Design and Methods. Data were collected from consecutive patients (n = 1811) visiting a general psychiatric clinic. The screening capacity of the heavy episodic drinking (HED) screener, AUDIT item # 3 (AUDIT‐3) and the three consumption items of AUDIT (AUDIT‐C) was compared to the result of the full 10‐item AUDIT with cut‐off points 6 for women and 8 for men. Results. The HED screener and AUDIT‐3 with recommended cut‐offs captured low rates of hazardous drinkers when compared to the full AUDIT. Lowering the cut‐offs created rates far above those of the full AUDIT. AUDIT‐C with recommended cut‐off limits categorised nearly the same rates of men as the full AUDIT but much higher rates of women. Raising the cut‐off for women approached the detection rate of AUDIT‐C closely to that of the full AUDIT. Discussion and Conclusions. The findings of this study suggest that the HED screener is not sensitive enough in the clinical psychiatric setting. When designing alcohol screening measures to be used all over health‐care organisations, special attention should be paid to psychiatric patients. If a somewhat more extensive screening tool is used, the full AUDIT is recommended.[Nehlin C, Fredriksson A, Jansson L. Brief alcohol screening in a clinical psychiatric population: Special attention needed. Drug Alcohol Rev 2012;31:538–543]     

Effects of item sequence on the performance of the AUDIT in general practices

BACKGROUND: One important task in identifying subjects with alcohol use disorders (AUDs) in the general medical practice setting is the development of effective screening instruments. Sensitivity of screening questionnaires might differ according to the introductory items. This study compares two versions of the alcohol use disorders identification test (AUDIT) with varied item sequence randomly applied to patients derived from a sample of general practitioners (GP) patients. METHODS: Participants were recruited from general practices in two northern German cities; they received two different versions of the AUDIT, one group receiving the original version starting with three items addressing frequency and quantity of alcohol use (AUDIT1), and a second group receiving a version in which these items were put at the end of the questionnaire (AUDIT2). In total, 10.803 screenings were conducted (refusal rate: 5%). Alcohol use disorders were diagnosed using the Munich-Composite International Diagnostic Interview (M-CIDI). RESULTS: Logistic regression analysis revealed that AUDIT1 subjects had higher scores in the consumption items of the AUDIT, whereas AUDIT2 subjects scored higher on items focussing on symptoms of alcohol dependence or abuse. CONCLUSION: The sequence upon which items of the AUDIT are presented influences the report of drinking patterns and symptoms of alcohol use disorders in GP patients.     

Is frequency of drinking an indicator of problem drinking? A psychometric analysis of a modified version of the alcohol use disorders identification test in Switzerland.

BACKGROUND: To study the psychometric properties of a modified Alcohol Use Disorders Identification Test in the multilingual context of Switzerland. METHODS: Data were obtained from the most extensive health survey to date in Switzerland, with a response rate of 69%. Seven core items of AUDIT were used. The first two items of AUDIT (frequency of drinking, quantity of drinking) were not used in their original form, but reconstructed from a quantity-frequency instrument (QF) measuring alcohol consumption, and categorized according to the AUDIT. The third AUDIT item (frequency of binge drinking) was similarly not used in its original form, but 8+ drinks instead of 6+ drinks was used. All 10 items of the modified AUDIT were completed by 10321 subjects - 6677 in the German-speaking region and 3644 in the Latin-language (French, Italian) regions. The dimensionality of the modified AUDIT was modelled by confirmatory factor analysis. The contribution of each item to the total modified AUDIT score was investigated by the prevalence of positively screened subjects when items were deleted, and factor loadings of the unidimensional model. RESULTS: In Switzerland the modified AUDIT fitted neither a unidimensional nor the hypothesized tri-dimensional model. Consumption items, especially frequency of drinking, showed almost no correlation with items measuring alcohol-related problems, but the latent constructs 'harmful drinking' and 'alcohol dependence' were highly correlated, indicating a shared underlying factor. Frequency of drinking was the item that most influenced whether an individual screened positively or not. Except for the correlation of frequency and binge drinking, results were almost identical for both linguistic regions. CONCLUSIONS: The current form of the modified AUDIT may have to be changed for screening in Switzerland, as the study raised questions about the suitability of the frequency-of-drinking item as an indicator of a screening device for alcohol-related problems in this country.     

Validation of the Alcohol Use Disorders Identification Test (AUDIT) in urban community outreach and de-addiction center samples in north India

OBJECTIVE: The Alcohol Use Disorders Identification Test (AUDIT) developed by the World Health Organization for screening disorders related to alcohol use has been shown to have robust psychometric properties. This study compared the performance of AUDIT with that of the Short Michigan Alcoholism Screening Test (SMAST) in a region of North India. METHOD: A total of 297 consecutive subjects who had used alcohol in the past year were recruited from a de-addiction center (DAC) (n = 97) and a community outreach setting (n = 200) in West Delhi. Using International Classification of Diseases, Tenth Edition (ICD-10) criteria, the relative effectiveness of the AUDIT and the SMAST in identifying alcohol-use-related disorders was assessed and compared. Internal consistency and interscale correlations were evaluated, along with sensitivity, specificity and ROC curve analyses. RESULTS: The AUDIT had very high internal reliability (alpha 0.92) in this Indian sample. There was, in general, good correlation between the total and factor scores of the AUDIT and SMAST (ranging from 0.28 to 0.97), which were higher in the community than in the DAC sample. The AUDIT (area under the curve [AUC] = 0.883) and SMAST (AUC = 0.870) were similar in detecting harmful use of alcohol. The AUDIT optimal cutoff score was 16 (sensitivity 85.3, specificity 89.4) for ICD-10 harmful use and 24 (sensitivity 69.4, specificity 87.5) for ICD-10 alcohol dependence. CONCLUSIONS: The AUDIT and SMAST seem to be comparable in their ability to screen subjects with alcohol use disorders. The AUDIT score for screening harmful use in the sample appears to be higher than previously reported. The utility of such high cutoff for screening subjects for intervention is obvious, but it is quite likely that some positive cases might be missed.     

AUDIT-C, AUDIT-3 and AUDIT-QF in screening risky drinking among Finnish occupational health-care patients

Introduction and Aims. Primary care physicians need a brief screening instrument to detect risky drinkers. In previous studies, the three first questions of the Alcohol Use Disorders Identification Test‐C (AUDIT‐C) and the third question on heavy episodic drinking alone (AUDIT‐3) have been shown to be almost as effective as the whole AUDIT. Also, AUDIT‐QF (the first two questions of AUDIT) can be a potential screening instrument. However, the validity of these short questionnaires has not been studied among the occupational health‐care patients. Design and Methods. Patients visiting their doctor in six occupational health clinics were asked to fill in a health questionnaire containing AUDIT. All together 759 patients participated in the study. Risky drinking was defined as having scored of≥10 for men or≥8 or more for women in the AUDIT questionnaire. Validity of AUDIT‐C, AUDIT‐3 and AUDIT‐QF were compared against the whole AUDIT. Results. Based on the whole AUDIT, 92 (24%) of the men and 33 (9%) of the women were risky drinkers. For men and women, area under the curve was relatively high for all tested questionnaires. For AUDIT‐C, the best combination of sensitivity and specificity was yielded at cut‐off point of 6 for men and 4 for women. Discussion and Conclusion. Short questionnaires perform almost as well as the whole AUDIT screening risky drinking among men and women. This is why they can be recommended for clinical use in busy settings. The cut‐off points, however, have to be tailored for gender and culture.[Kaarne T, Aalto M, Kuokkanen M, Seppä K. AUDIT‐C, AUDIT‐3 and AUDIT‐QF in screening risky drinking among Finnish occupational health‐care patients. Drug Alcohol Rev 2010]     

Automated telephone screening for problem drinking

OBJECTIVE: This study assessed test-retest reliability and criterion validity for an automated version of the Alcohol Use Disorders Identification Test (AUDIT), a screening tool for alcohol-related problems. Participants' willingness to use such a system to learn about and change their drinking behavior was also assessed. METHOD: Participants were 202 callers recruited through newspaper ads and flyers asking for volunteers concerned about their drinking and willing to help test a new method of screening and referral for alcohol problems. Participants were divided into two groups. The first group of subjects recruited received the Telephone-Linked Communications (TLC)-AUDIT twice, administered a week apart. The second group received the TLC-AUDIT once and a human-administered AUDIT once, also a week apart. RESULTS: Test-retest reliability was assessed in 102 participants; the intraclass correlation of AUDIT scores between both administrations was .87; kappa for nonproblem versus problem drinking (AUDIT score of 8 or above) was .89. The validity study compared the TLC-AUDIT scores of the next 100 participants to AUDIT questions administered by a human interviewer. The intraclass correlation was .94; kappa was .75. Seventy-five percent of all participants who screened positive for problem drinking agreed they would "talk to a computer again to learn more about your drinking pattern and how to deal with it". CONCLUSIONS: Automated telephone technology can be used to administer the AUDIT instrument with high levels of reliability and validity. This technology could be used to deliver behavioral change interventions.     

Does the Alcohol Use Disorders Identification Test–Consumption identify the same patient population as the full 10-item Alcohol Use Disorders Identification Test?

The aim of this study was to evaluate whether a computer-based 3-item version (Alcohol Use Disorders Identification Test-Consumption [AUDIT-C]) of the Alcohol Use Disorders Identification Test (AUDIT) identifies alcohol use disorder (AUD) in the same patients as the full 10-item version in 809 women and 747 men in an anesthesiology preoperative assessment clinic. According to cutoffs used (AUDIT: 5-8 points, AUDIT-C: 4-6 points), rate of disagreement (AUDIT-positive and AUDIT-C-negative or vice versa) ranged between 4% and 31% (men) and between 4% and 19% (women). In male patients, 15% were positive for both the AUDIT (≥8 points) and the AUDIT-C (≥6 points), 7% were positive for AUDIT-C only, and 4% were positive for AUDIT only. In female patients, using cutoffs of 5 more points (AUDIT) and 4 or more points (AUDIT-C), 16% were positive for both versions, 9% were positive for AUDIT-C only, and 2% were positive for AUDIT only. The AUDIT and AUDIT-C seem to identify AUD in differing patients.     

Construct validity of the MAST and AUDIT with multiple offender drunk drivers

The construct validity of the Michigan Alcoholism Screening Test (MAST) and the Alcohol Use Disorders Identification Test (AUDIT) in screening for current DSM-IV alcohol dependence disorders with persons convicted of multiple offenses of Driving Under the Influence (DUI) is evaluated. These tests were administered to 126 DUI offenders presenting for court-ordered inpatient treatment at an agency. DSM-IV alcohol disorders are evaluated for a representative subset of clients in this program using National Longitudinal Alcohol Epidemiologic Surveys' DSM-IV Alcohol Dependence Diagnostic Criteria and Associated Questionnaire Items. Both instruments exhibit acceptable internal consistency. The MAST and The AUDIT correlate moderately well with each other (r=0.617). The MAST correlates more highly (r=0.602) than the AUDIT (r=0.432) with DSM-IV. Future research should examine if the results reported here apply to other multiple offender DUI programs. It is recommended that such programs employing test instruments evaluate their construct validity in a similar method.     

Measuring women's alcohol consumption in an Australian inner-urban community using the AUDIT

The alcohol consumption of a systematically sampled population of women from an Australian inner-urban community was measured using the AUDIT (Alcohol Use Disorders Identification Test) in three different ways to produce varying estimations of hazardous and harmful drinking. The study was located in an area in which there is a high density of licensed premises and its female population contains large numbers of women who are young, students and professionals and thus considered to be potentially risky drinkers. Five hundred and twenty-five women returned completed questionnaires giving a response rate of 74%. Using an AUDIT score of eight as the cut-off point, 21% of women were classified as being at risk of having problems associated with their alcohol consumption. These women were more likely than women who scored less than eight to be beer drinkers, to drink at licensed premises and drink with male and female friends. An association between higher AUDIT scores and being unmarried was found. This paper argues that investigating the social and contextual factors associated with women's potentially problematic drinking can promote more effective community-based interventions.     

Severity of alcohol problems and readiness to change alcohol use in primary care

Screening measures for hazardous alcohol use that are efficient and can provide clinically relevant information are essential for primary care providers (PCPs). This study examined the clinical utility of the Alcohol Use Disorders Identification Test (AUDIT) and the AUDIT-Consumption (AUDIT-C) as predictors of readiness to change alcohol use in a primary care setting. In total, 114 veterans completed the AUDIT, readiness to change ruler, and an alcohol use disorders diagnostic interview. Two AUDIT-C scores were obtained; one administered during a primary care visit and one derived from the AUDIT. The AUDIT, both AUDIT-C scores, and number of dependence symptoms significantly predicted readiness to change independent of demographic variables. The AUDIT accounted for the greatest percentage of variance in readiness to change (19%). The AUDIT provides information about alcohol severity and readiness to change, which could be clinically useful for providers identifying patients for brief alcohol interventions.     

Heritabilities of Alcohol Use Disorders Identification Test (AUDIT) scores and alcohol biomarkers in Koreans: The KoGES (Korean Genome Epi Study) and Healthy Twin Study

BackgroundBoth the Alcohol Use Disorders Identification Test (AUDIT) and alcohol biomarkers are used to screen for alcohol problems. The purpose of this study was to examine the genetic and environmental contributions to the AUDIT score and alcohol biomarkers in Koreans.MethodsThe study included 1678 current alcohol drinkers: 818 Korean twins and 860 their families. The Korean version of AUDIT and alcohol biomarkers, i.e., gamma glutamyltransferase (GGT), alanine aminotransferase (ALT), mean corpuscular volume (MCV), and triglycerides (TG), were studied. The analyses were conducted using variance components method to estimate heritability and common environmental effects, and bivariate analyses for genetic and environmental correlations between the AUDIT score and the biomarkers after adjustment for age, gender, interaction of age and gender, smoking status, the amount of consumed alcohol, body mass index, and education.ResultsHeritabilities for the AUDIT score were 0.35 and 0.40–0.71 for biomarkers (P < 0.001). The risk of alcohol problems using AUDIT score was positively associated with the levels of biomarkers (GGT, MCV, and TG) in men, while the relationship was significant only for MCV in women. Genetic or environmental correlations between the AUDIT score and some of the biomarkers (GGT and MCV) were significant in men, but not significant in women.ConclusionsWe found a significant genetic contribution to the AUDIT score and the alcohol biomarkers.As there were significant genetic and environmental relationships between the AUDIT score and the alcohol biomarkers in men, future studies are warranted to identify common genes and environmental effects affecting the relationships.     

The distribution and role of causal beliefs,inferences of responsibility,and moral emotions on willingness to help addicts among Norwegian adults

The purpose of this study was to explore the distribution and role of causal beliefs, inferences of responsibility, and moral emotions on deservingness of help to addicts among Norwegian adults using the social motivational model of Weiner. The data derives from a web panel survey of Norwegian adults aged 20 to 69 years (N?=?1062, response rate 67%) in 2011. They responded to a questionnaire tapping into the above measures for nine different addictions in terms of a hypothetical person: “Think of a person addicted to–.” The respondents mainly located the cause of the addictions inside the person and attributed the responsibility for the problem to the individual. In general, addicted persons did not receive a high mean level of sympathy, whereas a high mean level of willingness to provide help and assistance was reported. However, there were substantial variations among the nine addictions as to mean rating levels, with snus and sedatives as the two extreme counterparts. Separate SEM analyses for the nine addictions showed support for Weiner's mediation model with inferences of responsibility and sympathy (moral emotion) as effective mediators for deservingness of help. This pattern was stable across the nine addictions. Implications for interventions and possible limitations are discussed.     

Personality profiles of substance and behavioral addictions

Substance-related and behavioral addictions are extremely prevalent and represent a major public health concern. In the ongoing attempt to understand the addictive personality, contradictory results have arisen from studies that have explored personality traits in different addiction populations. The diversity across addiction types suggests that some of these inconsistencies stem from distinct personalities underlying each addiction. The present study compares the personality profiles of several addictions, representing both substance (drugs and alcohol) and behavioral (gambling and sex) subtypes. 216 addicted individuals and 78 controls completed personality and sociodemographic questionnaires. Notable personality distinctions were found among different types of addiction. Whereas impulsivity and neuroticism were higher across all addiction populations, as compared to controls, people with alcohol use disorders also scored significantly lower on the traits of extraversion, agreeableness, and openness to experience. People with drug use disorders and those with compulsive sexual behavior were surprisingly similar, scoring lowest on the traits of agreeableness and conscientiousness. Finally, people with gambling disorder demonstrated a personality profile similar to that of the control group. Of note, personality profiles were also related to several demographic characteristics, including socioeconomic status and religiosity. Our findings support a potential role for personality in distinguishing among different types of addiction. This study suggests that different addictions may, to some extent, stem from distinct processes that are involved in personality development. These findings may provide a useful framework for understanding why different people develop different addictions.     

Binge drinking and its detection among middle-aged men using AUDIT, AUDIT-C and AUDIT-3

Binge (heavy episodic) drinking is common, but there is little knowledge on how this drinking pattern could be detected. This study compares three structured questionnaires among binge drinking middle-aged men. All 45-year-old men in the city of Tampere, Finland, were asked to fill in the Alcohol Use Disorders Identification Test (AUDIT). Based on the interview on their drinking the men were divided into non-binging moderate drinkers (n = 352), binging moderate drinkers (n = 130), non-binging heavy drinkers (n = 10) and binging heavy drinkers (n = 63). The complete AUDIT, AUDIT-C (first three AUDIT questions inquiring quantity-frequency) and AUDIT-3 (the third binging-frequency question of AUDIT) in detecting binge drinking were compared. The complete AUDIT was effective in detecting binge drinkers by a cut-off score of >or=8 or >or=7. The optimal cut-off score for AUDIT-C was >or= 6 and that for AUDIT-3 >or=2. The area under the curve (AUC) among all risky drinkers (binging moderate and binging heavy and non-binging heavy drinkers) for AUDIT was 0.824 (95% CI 0.789 - 0.859), for AUDIT-C 0.829 (95% CI 0.795 - 0.864) and for AUDIT-3 0.779 (0.739 - 0.818). The complete AUDIT and its short versions are applicable in populations where binging is the dominant drinking pattern, but the cut-off scores should be tailored to individual cultures.     

Long‐term impact of addictions training for medical residents

The present survey was conducted to determine the long‐term impact of addictions training on the practice patterns of physicians who completed a specialized addictions residency training program. Medical residents and medical research fellows who participated in a residency training program in addictions from 1981 through 1991 at the Addiction Research Foundation in Toronto were mailed a brief questionnaire about their training experience. Of the 27 physicians who responded to the questionnaire (73% response rate), 52% were currently working in the addictions field. Of the 13 who were not working in the field, 77% reported using their addictions training in their current practice. Thus, 89% of the physicians who participated in the specialized addictions residency training program and responded to the survey reported continued utilization of their training several years after the experience.     

Attitudes towards nicotine,alcohol and drug dependence among physicians in Israel

Prevalence of substance use and substance use disorders in Israel is similar to those in other developed countries. The aim of this study was to examine attitudes of physicians in Israel towards nicotine, alcohol and drug use and dependence. A national sample of physicians from different fields of medical specialty (n = 208, response rate 26%) responded to a 50-item questionnaire. Questions included general questions regarding substance use and addictions, as well as specific questions focusing on nicotine, alcohol, cannabis and heroin use. The poor response rate in this survey dictates caution in interpretation the results. However, they suggest that among medical specialties, psychiatrists had higher levels of self-reported competency in treating addictions and lower rates of moralism towards addictions. Across substances, the highest rates of moralism and lowest ratings of treatment efficacy were directed towards individuals with alcohol dependence. Physicians generally reported experiencing lower levels of satisfaction and higher levels of aggression when treating individuals with alcohol or drug dependence compared with other patients. Physicians' attitudes towards addictions have a significant role in the care that clients with addictions receive. Medical education programs in Israel should devote provisions towards educating physicians about addictions.