Work-place screening of mine employees using the alcohol use disorders identification test (AUDIT) and alcohol breathalyzation

Although public health campaigns focusing on alcohol in the work-place are receiving increasing attention, there is little empirical evidence regarding the use of screening. In this work-place study, 152 mining personnel (67% of the work-force) completed a self report screen using the Alcohol Use Disorders Identification Test (AUDIT). One hundred and thirty-three of these (58.5% of the work-force) also consented to be breathalysed and one (0.75%) recorded a BAC just over threshold for detection. Forty-eight males (37.7% of the male work-force) recorded AUDIT scores of eight or more consistent with hazardous alcohol use and one female registered a cumulative score above the female cut-off level for hazardous alcohol use. Eighty males (67% of the work-force), recorded binge drinking at least monthly and 81 males recorded a cumulative AUDIT score of less than eight; however, on item analysis, 64 (83%) of these recorded binge drinking at least sometimes. There is substantial hazardous alcohol use in this sample work group and younger males had higher alcohol consumption, more adverse consequences and higher total AUDIT scores identifying them as particularly at risk. The Cronbach & AUDIT was 0.72, confirming adequate internal consistency.     

The use of AUDIT as a screening tool for alcohol use in the police work-place

There has been little research examining the use of the Alcohol Use Disorders Identification Test (AUDIT) as a work-place screening tool. In the current study a large scale sample ( n = 4193) of police personnel completed the 10 AUDIT questions and two readiness-to-change questions. The sample represented 67% of all members of an Australian State Police organization. Analysis of AUDIT scores showed that 65% of the sample scored in the low risk of hazardous alcohol consumption range, 32% (33% of males and 24% of females) scored in the at risk for harmful alcohol consumption range and 3% scored in the range indicating risk of alcohol dependence. Age emerged as a clear risk factor of hazardous drinking patterns. The 18-25-year age group recorded higher average alcohol consumption, higher rates of risk of abnormal drinking behaviour, higher rates of adverse consequences from drinking alcohol and higher total AUDIT scores than other age groups. This was consistent for both males and females. Of those scoring in the at-risk range, 72.5% reported that they did not have a drinking problem. Sixty percent also reported that it would be easy to stop drinking. This study exemplifies how the AUDIT can be used to provide strong evidence for the need for work-based intervention programmes. Further, it can be used to target particular groups within the organization at risk of harmful alcohol use.     

Examination of the latent factor structure of the Alcohol Use Disorders Identification Test in two independent trauma patient groups using confirmatory factor analysis

Recent research on the factor structure of the Alcohol Use Disorders Identification Test (AUDIT) provides support for two underlying factors: consumption and consequences. The current study sought to extend these findings to two independent and diverse trauma populations: traumatic injury patients and military veterans treated for posttraumatic stress disorder. The 2- and 3-factor solutions provided the best fit to the data, but there was a very high correlation between the second and third factors of the 3-factor solution. Parsimony suggests that the 2-factor solution is the preferred model. The 2-factor model has implications for alcohol screening using the AUDIT and supports the goal of screening to identify those with hazardous drinking and alcohol use disorders. An algorithm is proposed to inform alcohol screening protocols in a range of health settings for trauma-exposed patient groups.     

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.     

Beliefs about alcohol use among university students

The aim of this study was to analyze and compare standards of consumption and beliefs about alcohol among university students. There were 255 students who participated in this study. Of all the students, 61 were taking up psychology, 106 were taking up medicine, and 88 were taking up business administration. We used a sociodemographic questionnaire, the Inventory of Personal Expectations and Beliefs About Alcohol, and the Alcohol Use Disorders Identification Test (AUDIT) as study instruments. Of the total sample, 83.9% consumed alcohol. There was good correlation between the marks in the inventory and the total score in the AUDIT-R (0.519; p < .01); the more positive the beliefs about alcohol and its effects were, the higher the scores in the AUDIT were. Many beliefs are associated with risk behaviors, and identifying them can contribute to prevention strategies and health promotion. Alcohol abuse and its consequences, especially for young people, are important aspects of public health and justify studies such as this one. Action strategies must be wide-reaching and directed toward cultural change. They must serve to foster discussions and take into account the real implications that alcohol use has for public health.     

The validity of an Australian modification of the AUDIT questionnaire

The Alcohol Use Disorders Identification Test (AUDIT) has been used widely and is reported to be superior to conventional questionnaires in detection of current hazardous and harmful alcohol use. We assessed the validity of an Australian modification of the AUDIT (the AusAUDIT), which has been employed widely in Australian and New Zealand early intervention programmes. We used a cross-sectional study of 370 subjects from the follow-up phase of a randomized controlled trial of early intervention to reduce hazardous alcohol consumption. Scores on the AusAUDIT were compared against 12-month ICD-10 diagnoses of harmful alcohol use and dependence, as determined by the Composite International Diagnostic Interview, and against self-report of alcohol consumption exceeding Australian National Health and Medical Research Council (NH&MRC) recommended limits. AusAUDIT had good internal consistency and discriminated significantly between persons meeting criteria for ICD-10 alcohol use disorders, and drinkers who did not. At currently recommended cut-off scores, AusAUDIT detected more than 85% of people meeting criteria for ICD-10 alcohol use disorders, or drinking over NH&MRC recommended limits, but its specificity was limited (29% in men, and 58% in women for drinking over NH&MRC limits). No subset of questions performed as well as the full AusAUDIT in detection of drinking problems, but the alcohol consumption items provided a reasonable screen for drinking over NH&MRC limits. We conclude that AusAUDIT is effective in detecting problematic drinking, but positive cases should be confirmed by clinical assessment. The findings illustrate the need for validation of questionnaire modifications, and the difficulty in increasing test sensitivity without reducing specificity. \[Degenhardt LJ, Conigrave KM, Wutzke SE, Saunders JB. The validity of an Australian modification of the AUDIT questionnaire. Drug Alcohol Rev 2001;20:143-154]     

Screening for hazardous alcohol use and dependence in psychiatric in-patients using the AUDIT questionnaire

The Alcohol Use Disorders Identification Test (AUDIT) has been used to screen for hazardous and harmful alcohol consumption among general hospital populations but not in psychiatric patients. Using the AUDIT, we assessed alcohol use in patients with four major types of psychiatric disorder, namely mood, adjustment, anxiety and psychotic disorders. Nine hundred and ninety consecutive admissions to the psychiatric units of two hospitals during a 12-month period underwent assessment. In each diagnostic group a high proportion of patients was alcohol-dependent. Among those with mood disorders 25.4% of men were alcohol-dependent, compared with 16.3% of women, while 34.5% of men with anxiety disorder were alcohol-dependent compared with 25.0% of women. Both gender differences were statistically significant. The differences were even greater for adjustment disorder (44.4% vs. 14.5%) and psychosis (29.2% and 4.2%, respectively). More men than women with anxiety disorder were classified as hazardous (24.1%vs. 11.7%) or harmful drinkers (13.8%vs. 3.3%), but for the other diagnostic groupings the percentages in these drinking categories were more nearly similar. Thus, there is a high rate of excessive alcohol consumption in people with psychiatric disorders, especially males. Such individuals may be particularly vulnerable to complications of alcohol misuse such as suicide and exacerbation of their disorder. The potential for decreased severity of psychiatric symptoms and a reduction in the number of hospital admissions following cessation or reduction in alcohol consumption is considerable. The AUDIT is a simple screening device for investigating alcohol use and dependence, and offers a means of initiating intervention in this population. [Hulse GK, Saundes JB, Roydhouse RM, Stodwell TR, Basso MR. Screening for hazardous alcohol use and dependence in Psychiatric in-patients using the AUDIT questionnaire. Drug Alcohol Rev 2000;19:291-298]     

Web‐based screening and advice for hazardous drinkers: Use of a Spanish site

Introduction and Aims. A website for implementing screening and brief intervention on alcohol was launched in Barcelona, Spain, in October 2006. Its aim was to reach hazardous drinkers who probably would not ask for advice. This article describes use of the site, profiles users and discusses limitations concerning screening. Design and Methods. The website included screening, advice and information. Demographic and self‐screening data (typical weekly consumption and the Alcohol Use Disorders Identification Test, AUDIT) were examined. Results. In a 12 month period, 12 138 visitors entered the website, 2574 started self‐assessment, 1342 completed the table and 724 of these participants completed the AUDIT. These users had a mean age of 27.6 years, one‐third of them drank above recommended weekly limits and 84.1% of those who completed the AUDIT (n = 724) scored positive (≥5); a total of 70.3% of identified at‐risk drinkers entered the advice section. Among visitors to the site, risk factors for hazardous drinking were: being male,≥35 years of age, and drinking heavily at weekends. Discussion and conclusions. The percentage of hazardous drinkers accessing the site was high, and visitors reported that they liked the design, that it was easy to use and that it provided relevant information. Most of those who had sought advice considered it to be helpful. The website seems to be an accessible and useful tool for young people and might be used in youth centres as well as in health‐care settings, such as primary care and emergency centres, where it could contribute to health promotion and constitute an easier alternative to screening and brief intervention given by the staff.[Rodríguez‐Martos A, Castellano Y. Web‐based screening and advice for hazardous drinkers: Use of a Spanish site. Drug Alcohol Rev 2009;28:54–59]     

A peer-drinking group motivational intervention among Thai male undergraduate students

BackgroundExcessive alcohol consumption, particularly among young males, is an important global health problem, in part because of the increased risks of intentional and non-intentional injuries, uses of illicit drug, crime, and psychiatric disorders. There are no data available to evaluate the extent to which interventions are effective in reducing hazardous/harmful alcohol consumption among young males in Thailand. We examined the efficacy of alcohol harm reduction strategies administered as a peer-drinking group motivational intervention (PD-GMI) among Thai male undergraduates.MethodsWe used a quasi-experimental study design that included two student groups assessed at baseline and at two time points post-intervention. Participants were students enrolled in two public universities and who reported alcohol consumption during the current academic year. Students in one university were assigned to an assessment-only study group (n = 110); and students in the other university were assigned to a 2-h PD-GMI (n = 115). This intervention was designed to (1) increase the awareness of risks associated with hazardous/harmful alcohol consumption; (2) enhance students’ motivation to change their drinking behaviours; and (3) encourage harm reduction strategies during episodes of alcohol consumption. Alcohol consumption and adverse consequences were assessed using the Alcohol Use Disorders Identification Test (AUDIT) and the Rutgers Alcohol Problem Index (RAPI).ResultsStudents receiving the intervention had significant reductions in mean AUDIT scores; 50.4% at baseline to 1-month and 61.2% at baseline to 3-month post-intervention. Their mean RAPI scores were also reduced; 42.0% at baseline to 1-month and 42.9% at baseline to 3-month post-intervention. Reductions in alcohol consumption and the prevalence of harmful alcohol consumption patterns were statistically significant among students in the intervention group versus those in the control group. The reductions remained after adjustments for baseline differences.ConclusionsThese results suggest the efficacy of the PD-GMI intervention for reducing alcohol consumption and adverse consequences among Thai male students.     

Factor structure of the Alcohol Use Disorders Identification Test (AUDIT) in a mental health clinic sample

OBJECTIVE: To examine the factor structure of the Alcohol Use Disorders Identification Test (AUDIT) and to identify the implications of this structure for its clinical use. METHOD: The AUDIT was administered to mental health clinic outpatients (N = 197; 86% men) at high risk for alcohol-use disorders. Confirmatory and exploratory factor analyses were used to determine the underlying factor structure of the AUDIT for this high-risk population. RESULTS: Confirmatory analyses indicated that the a priori three- and one-factor solutions did not fit the observed data. The exploratory analyses supported a two-factor solution that included level of alcohol consumption and drinking problems, with both factors explaining substantial variance in AUDIT scores. These findings contrast the original three-factor design of the AUDIT and the conventional use of the AUDIT as a one-factor screening device with a single cutoff score. CONCLUSIONS: Other screening methods that incorporate this two-factor model may be important for mental health patient populations. Replication of these findings among other mental health samples is needed.     

Hazardous or harmful alcohol use in Royal Australian Navy veterans of the 1991 Gulf War: identification of high risk subgroups

Elevated alcohol use disorders have been observed in 1991 Gulf War veterans from a variety of countries. This study used a self-report instrument, the Alcohol Use Disorders Identification Test (AUDIT), to ascertain whether any subgroups of 1232 male Royal Australian Navy (RAN) Gulf War veterans were at higher risk of hazardous or harmful alcohol use. Recursive partitioning/classification and regression tree (CART) analysis, followed by logistic regression, found five subgroups among the veterans, with differing risks of AUDIT caseness. The highest risk subgroup comprised current smokers. The other two high risk groups both consisted of former or never smokers of lower rank who were (1) not married, or (2) married, with a current diagnosis of major depression. The above subgroups were over three times as likely to exhibit AUDIT caseness than those who were former or never smokers of higher rank. The findings have important implications for effective development of public health initiatives designed to encourage safe alcohol use among veterans.     

How alike are young non-drinkers,former-drinkers,low-risk drinkers,and hazardous drinkers?

The aim of this study was to examine whether – in terms of personality characteristics and beliefs – former-drinkers and people who have never consumed alcohol exist on a continuum that includes low-risk drinkers and hazardous drinkers, or are distinct groups. An online questionnaire hosted on a secure server was completed by 1418 young people (642 men and 776 women) aged 16–21 living in South-East England. Participants' scores on the Alcohol Use Disorders Identification Test (AUDIT) were used to classify them as non-drinkers, former-drinkers, low-risk drinkers or hazardous drinkers. Multinomial logistic regression identified eight significant multivariate correlates that explained 39% of the variance in men's AUDIT category membership (χ²₍₂₄₎ = 263.32, p < .01), and seven significant multivariate correlates that explained 41% of the variance in women's AUDIT category membership (χ²₍₂₁₎ = 332.91, p < .01). The results suggest that non-drinkers and former-drinkers are more similar to each other than they are to both low risk and hazardous drinkers. We should not, therefore, treat these groups of young people as representing a drinking continuum. In particular, interventions for high risk young drinkers may be more effective if distinguished from general campaigns intended for all young people.     

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.     

It Goes with the Job: officers' insights into the impact of stress and culture on alcohol consumption within the policing occupation

The current study surveyed members of an Australian state police service (N = 749), in order to assess what officers felt were the major contributing factors to alcohol consumption within the policing occupation. The study further examined which of these factors were actually predictive of risk of harmful drinking as measured by the Alcohol Use Disorders Identification Test - AUDIT (Saunders et al., 1993). Results showed that 30% of respondents were at risk of harm from excessive alcohol consumption. When asked to rate the importance of factors they felt contributed to their drinking, officers rated social factors such as celebration, and socializing with peers as the most important factors. However factors related to stress emerged as the most predictive of scores on the AUDIT. These findings highlight an often seen contradiction and have important implications for intervention strategies aimed at reducing alcohol consumption within the policing occupation. While officers appear to be drinking to reduce stress, they report drinking for social reasons, thus interventions must take into account the real impact of stress while dealing with social factors to give interventions face validity in the eyes of the officers they aim to help.     

Alcohol and risks for HIV/AIDS among sexually transmitted infection clinic patients in Cape Town, South Africa.

Alcohol use is prevalent in South Africa and alcohol use may be associated with higher risk for HIV transmission. This paper reports a study of the association between alcohol use and HIV risk-related behavior among 134 men and 92 women receiving sexually transmitted infection (STI) clinic services in Cape Town, South Africa. Participants completed anonymous surveys of demographic information, substance use, and sexual risk behaviors. Results showed that problem drinking was common among STI clinic patients; 58% of men and 28% of women scored above a cut-off of 9 on the Alcohol Use Disorders Identification Test (AUDIT) suggesting possible problem drinking and 46% of men and 19% of women scored above 12 on the AUDIT indicating probable drinking problems. For men, heavier alcohol use was associated with having multiple sex partners in the past month, less condom use, and having a history of sexually assaulting women. Among women, higher scores on the AUDIT were also related to having multiple sex partners as well as a history of exchanging sex for money or materials. The association between alcohol use and sexual risk behaviors in a population at high-risk for HIV transmission demonstrates the need for integrating alcohol risk reduction counseling with HIV prevention counseling among STI clinic patients in South Africa.     

Disinhibition and reward sensitivity in relation to alcohol consumption by university undergraduates

Deficits of prefrontal cortex functioning and associated executive cognitive impairments are well-known correlates of chronic alcoholism and may reflect cumulative effects of high alcohol exposure. However, such associations may also reflect traits predating alcohol exposure which predispose to heavy drinking. In the present investigation, 60 university undergraduates aged 18–25 years were administered the Alcohol Use Disorders Identification Test (AUDIT), Frontal Systems Behavior Scale (FrSBe), and Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ). All participants reported they were at least occasional drinkers who rarely or never used illicit drugs and had no reported history of head injury or neurological problems. All were sober at time of testing. AUDIT total scores were positively correlated with both FrSBe Disinhibition scores and SPSRQ Reward Sensitivity scores. The latter were negatively correlated with age at onset of regular alcohol use. High risk drinkers (as defined by AUDIT) had higher FrSBe Disinhibition and SPSRQ Reward Sensitivity scores compared to low risk drinkers. Findings indicate that even in a highly selected subset of young adults–undergraduates attending a prestigious private university–associations may be present between indices of prefrontal cortex dysfunction and alcohol consumption, perhaps reflecting traits that predispose to heavy drinking.     

An examination of the factor structure of the Alcohol Use Disorders Identification Test in two high-risk samples

The Alcohol Use Disorders Identification Test (AUDIT) was examined by employing confirmatory factor analytic techniques to data from two samples collected 1998-1999: college students (n = 465) and court-referred, substance use treatment outpatients (clinical sample; n = 135). Despite the fact that the AUDIT was originally designed as a three-factor measure (consumption, dependence, and consequences), previous studies have lent support to one- and two-factor models. The results of this study support a two-factor model (alcohol consumption and dependence/consequences) in both samples. As further evidence that the two-factor model is appropriate, a psychometric evaluation suggested that the AUDIT generated reliable scores in both groups when used as either a one- or two-factor measure, but not when three scores are derived in the student sample.     

Self-perceived problem with alcohol use among opioid substitution treatment clients

Background and aim

Excessive alcohol use increases mortality and morbidity among opioid substitution therapy (OST) clients. Regular attendance for OST dosing presents key opportunities for screening and treatment. However, individuals' perception of their alcohol consumption as problematic or otherwise may impact their willingness to change. This study examines patterns of alcohol consumption among OST clients, perceptions of their own use and correlates of excess consumption.

Methods

Confidential, structured interviews were conducted with 264 clients of two Sydney OST clinics. Alcohol consumption was assessed using the Alcohol Use Disorders Identification Test (AUDIT); and illicit drug dependence with the Severity of Dependence Scale.

Results

Forty-one percent of the participants scored ≥ 8 on the AUDIT (‘AUDIT-positive’), indicating excessive alcohol use. The higher a participant's AUDIT score, the more likely they were to demonstrate insight into the potential problems associated with their drinking (linear trend, p < 0.01). However, only half of AUDIT-positive participants believed they drank too much and/or had a problem with alcohol. One-third had discussed their drinking with OST staff, and a similar proportion reported a history of alcohol treatment. AUDIT-positive participants were more likely than others to be classified as dependent on an illicit drug in the last six months (AOR = 1.76, 95% CI:1.00–3.09), report a history of alcohol treatment (AOR = 5.70, 95% CI:2.83–11.48) and believe it is safe to drink 4 + standard drinks in one session (AOR = 5.30, 95% CI:2.79–10.06).

Conclusions

OST clients with AUDIT scores ≥ 8 appear to underestimate the risks associated with their alcohol consumption. Regular assessments of alcohol use and targeted brief alcohol interventions may improve health outcomes among OST clients.     

Short forms of the AUDIT in a Web‐based study of young drinkers

Introduction. The Alcohol Use Disorders Identification Test (AUDIT) is under‐studied among young drinkers, as are the contributions of individual items to total AUDIT scores, and online performance of the existing briefer versions of this instrument. Design and Methods. This study examined individual items of the AUDIT, and various combinations, including the existing briefer versions, in relation to total AUDIT scores in a Web‐based study of young drinkers. A total of 167 young people aged 16–24 years old who had consumed any alcohol within the previous 7 days were recruited by both offline and online methods. Results. Considered individually, items 3, 4, 5 and 8 were predictive of the majority of the variance in total AUDIT scores in this Web‐based study. Existing briefer versions of the AUDIT do not better predict total scores than possible alternative combinations of items, for which acceptable levels of sensitivity and specificity for screening have been demonstrated. Conclusions. Short forms of the AUDIT, particularly those based only on consumption questions, require further validation study in online applications with young people.[McCambridge J, Thomas BA. Short forms of the AUDIT in a Web‐based study of young drinkers. Drug Alcohol Rev 2009;28:18–24]     

Alcohol and Drug Use,Smoking, and Gambling Among Psychiatric Outpatients: A 1-Year Prevalence Study

ABSTRACT

Background and Aims: Studies of alcohol habits in general psychiatric populations are scarce. The objective was to investigate alcohol and drug use, smoking, and gambling in a clinical sample of psychiatric outpatients. A further aim was to study age and gender differences in the rates of these habits. Methods: Data were collected among psychiatric outpatients with mainly mood (47%) and anxiety (35%) disorders. A questionnaire package was distributed, including AUDIT (Alcohol Use Disorders Identification Test), DUDIT (Drug Use Disorders Identification Test), tobacco items, and gambling items. Two major drinking categories were formed: “Nonhazardous alcohol use” (NH) and “Alcohol use above hazardous levels” (AH). Results: In total, 2160 patients (65% females) responded to the questionnaire package. The AH rate was high among psychiatric outpatients (28.4%), particularly among young females (46.6%). Young female patients also reported a high prevalence of problematic drug use (13.8%). Problematic drug use, daily smoking, and problematic gambling were frequent. The unhealthy habits were linked to AH. Conclusions: Alcohol and drug use, smoking, and gambling are all highly prevalent among psychiatric outpatients. Young females are in particular need of attention. Interventions should be tailored for co-occurring psychiatric disorders and applied within routine psychiatric care.