Validation of the Alcohol Use Disorders Identification Test and the Drug Use Disorders Identification Test in a Swedish sample of suspected offenders with signs of mental health problems: Results from the Mental Disorder,Substance Abuse and Crime study

Substance abuse is common among offenders. One method widely used for the detection of substance abuse is screening. This study explored the concurrent validity of the Alcohol Use Disorders Identification Test (AUDIT) and the Drug Use Disorders Identification Test (DUDIT) screening tools in relation to (a) substance abuse and dependency diagnoses and (b) three problem severity domains of the sixth version of the Addiction Severity Index in a sample of 181 suspected offenders with signs of mental health problems. The screening tools showed moderate to high accuracy for identification of dependency diagnoses. The AUDIT was associated with alcohol problem severity, whereas the DUDIT was associated with drug and legal problem severity. Administering the screening tools in the current population yields valid results. However, the suggested cutoff scores should be applied with caution due to the discrepancy between present and previous findings.     

Exploration of the (Interrater) Reliability and Latent Factor Structure of the Alcohol Use Disorders Identification Test (AUDIT) and the Drug Use Disorders Identification Test (DUDIT) in a Sample of Dutch Probationers

Background: The use of brief, reliable, valid, and practical measures of substance use is critical for conducting individual (risk and need) assessments in probation practice. In this exploratory study, the basic psychometric properties of the Alcohol Use Disorders Identification Test (AUDIT) and the Drug Use Disorders Identification Test (DUDIT) are evaluated. Methods: The instruments were administered as an oral interview instead of a self-report questionnaire. The sample comprised 383 offenders (339 men, 44 women). A subset of 56 offenders (49 men, 7 women) participated in the interrater reliability study. Data collection took place between September 2011 and November 2012. Results: Overall, both instruments have acceptable levels of interrater reliability for total scores and acceptable to good interrater reliabilities for most of the individual items. Confirmatory factor analyses (CFA) indicated that the a priori one-, two- and three-factor solutions for the AUDIT did not fit the observed data very well. Principal axis factoring (PAF) supported a two-factor solution for the AUDIT that included a level of alcohol consumption/consequences factor (Factor 1) and a dependence factor (Factor 2), with both factors explaining substantial variance in AUDIT scores. For the DUDIT, CFA and PAF suggest that a one-factor solution is the preferred model (accounting for 62.61% of total variance). Conclusions: The Dutch language versions of the AUDIT and the DUDIT are reliable screening instruments for use with probationers and both instruments can be reliably administered by probation officers in probation practice. However, future research on concurrent and predictive validity is warranted.     

Psychometric properties of the Drug Use Disorders Identification Test (DUDIT) with substance abusers in outpatient and residential treatment

The psychometric properties of the Drug Use Disorders Identification Test (DUDIT), an 11-item self-report questionnaire developed to screen individuals for drug problems, are evaluated. The measure, developed in Sweden and evaluated there with individuals with severe drug problems, has not been evaluated with less severe substance abusers or with clinical populations in the United States. Participants included 35 drug abusers in an outpatient substance abuse treatment program, 79 drug abusers in a residential substance abuse treatment program, and 39 alcohol abusers from both treatment settings who did not report a drug abuse problem. The DUDIT was found to be a psychometrically sound drug abuse screening measure with high convergent validity (r = .85) when compared with the Drug Abuse Screening Test (DAST-10), and to have a Cronbach's alpha of .94. In addition, a single component accounted for 64.91% of total variance, and the DUDIT had sensitivity and specificity scores of .90 and .85, respectively, when using the optimal cut-off score of 8. Additionally, the DUDIT showed good discriminant validity as it significantly differentiated drug from alcohol abusers. These findings support the DUDIT as a reliable and valid drug abuse screening instrument that measures a unidimensional construct. Further research is warranted with additional clinical populations.     

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.     

An examination of the utility of the AUDIT in people with schizophrenia

OBJECTIVE: To examine the reliability and validity of the Alcohol Use Disorders Identification Test (AUDIT) compared to a structured diagnostic interview, the Composite International Diagnostic Interview (CIDI; 12-month version) in psychiatric patients with a diagnosis of schizophrenia. METHOD: Patients (N = 71, 53 men) were interviewed using the CIDI (Alcohol Misuse Section; 12-month version) and then completed the AUDIT. RESULTS: The CIDI identified 32.4% of the sample as having an alcohol use disorder. Of these, 5 (7.0%) met diagnostic criteria for harmful use of alcohol, 1 (1.4%) met diagnostic criteria for alcohol abuse and 17 (23.9%) met diagnostic criteria for alcohol dependence. The AUDIT was found to have good internal reliability (coefficient = 0.85). An AUDIT cutoff of > or = 8 had a sensitivity of 87% and specificity of 90% in detecting CIDI-diagnosed alcohol disorders. All items except Item 9 contributed significantly to discriminant validity. CONCLUSIONS: The findings replicate and extend previous findings of high rates of alcohol use disorders in people with severe mental illness. The AUDIT was found to be reliable and valid in this sample and can be used with confidence as a screening instrument for alcohol use disorders in people with schizophrenia.     

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.     

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.     

High prevalence of alcohol use among hepatitis C virus antibody positive injection drug users in three US cities

Injection drug users (IDUs) acquire the majority of new hepatitis C virus (HCV) infections and frequently use alcohol. Alcohol abuse accelerates liver disease among HCV-infected persons, can reduce the effectiveness of treatment for HCV infection and may be a contraindication for HCV treatment. HCV seropositive, HIV-negative IDUs aged 18-35 years in Baltimore, New York City and Seattle who were enrolled in a behavioral risk-reduction intervention trial underwent computerized self-interviews to assess baseline alcohol use and dependence and medical history. We measured problem alcohol use using the 10-item Alcohol Use Disorders Identification Test (AUDIT) scale. Of 598 participants, 84% responded "false" to: "it is safe for a person with HCV to drink alcohol". Problem drinking, defined as score > or =8 on AUDIT, was identified in 37%. Correlates of scoring > or =8 on AUDIT included homelessness, male gender, primarily injecting speedballs, having injected with used needles, prior alcohol treatment and depression. Although most HCV seropositive IDUs in our sample appear informed about their increased risk of liver disease from alcohol, two-fifths screened positive for problem alcohol use. These findings underscore the importance of referring HCV-positive persons to effective alcohol treatment programs to reduce future liver damage and improve eligibility for and effectiveness of treatment of HCV.     

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.     

Psychometric Properties of the Turkish Versions of the Drug Use Disorders Identification Test (DUDIT) and the Drug Abuse Screening Test (DAST-10) in the Prison Setting

The aim of this study was to evaluate psychometric properties of the Drug Use Disorders Identification Test (DUDIT) and the Drug Abuse Screening Test (DAST-10) in prisoners with (n = 124) or without (n = 78) drug use disorder. Participants were evaluated with the DUDIT, the DAST-10, and the Addiction Profile Index-Short (API-S). The DUDIT and the DAST-10 were found to be psychometrically sound drug abuse screening measures with high convergent validity when compared with each other (r = 0.86), and API-S (r = 0.88 and r = 0.84, respectively), and to have a Cronbach’s α of 0.93 and 0.87, respectively. In addition, a single component accounted for 58.28% of total variance for DUDIT, whereas this was 47.10% for DAST-10. The DUDIT had sensitivity and specificity scores of 0.95 and 0.79, respectively, when using the optimal cut-off score of 10, whereas these scores were 0.88 and 0.74 for the DAST-10 when using the optimal cut-off score of 4. Additionally, both the DUDIT and the DAST-10 showed good discriminant validity as they differentiated prisoners with drug use disorder from those without. Findings support the Turkish versions of both the DUDIT and the DAST-10 as reliable and valid drug abuse screening instruments that measure unidimensional constructs.     

Validation of the Alcohol Use Identification Test in a Prison Sample Living in the Arabian Gulf Region

The purpose of this study was to assess the utility of the Arabic translation of the Alcohol Use Disorders Identification Test (AUDIT) among a sample of male Muslim prisoners (N = 107) in Dubai, United Arab Emirates (UAE). Confirmatory factor analysis indicated a two-factor model to be the best fit of the data. Good internal reliability (α =.91) and predictive validity were also observed. While the limitations of the study are observed, these promising results suggest that the Arabic version of the AUDIT is a reliable and sound measure of alcohol use disorders among prisoners in the UAE.     

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.     

The reliability and validity of the Alcohol,Smoking and Substance Involvement Screening Test (ASSIST) in first-episode psychosis

Aims

The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) is a brief, easily administered, valid and reliable screening instrument for all psychoactive substances in drug treatment and primary care settings. This study aims to determine the reliability and validity of the ASSIST for detecting substance use disorders in first-episode psychosis.

Participants

Participants were 214 first-episode psychosis patients attending the Early Psychosis Prevention and Intervention Centre (EPPIC) in Melbourne, Australia.

Measurements

Participants were administered the ASSIST, Alcohol Use Disorders Identification Test (AUDIT), the Severity of Dependence Scale (SDS) and the Brief Psychiatric Rating Scale (BPRS). Presence of DSM-IV substance abuse and dependence disorders in the previous 12 months was assessed using the Structured Clinical Interview for DSM-IV (SCID-IV).

Findings

The ASSIST total substance involvement (TSI) score and specific substance involvement (SSI) scores for cannabis, alcohol and amphetamine use demonstrated high levels of internal consistency and acceptable levels of concurrent and discriminative validity. Individuals with cutoff scores of ≥ 2, 4 and 1 on the ASSIST cannabis, alcohol and amphetamine SSI scores were 5 to 6 times more likely to meet the diagnostic criteria for these substance use disorders.

Conclusions

The ASSIST is a psychometrically sound measure of cannabis, alcohol and amphetamine use disorders in first-episode psychosis.     

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.     

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.     

Alcohol abuse and dependence in an urban primary care clinic in Nigeria.

A two-stage epidemiological survey was conducted in an urban walk-in clinic in Nigeria to detect, among other disorders, the prevalence of alcohol abuse and dependence using DMS-IIIR criteria. At the first stage, respondents were administered the 12-item General Health Questionnaire and the Alcohol Use Disorders Identification Test (AUDIT). A proportion of the respondents were selected for detailed interview at the second stage using the Composite International Diagnostic Interview (CIDI). An estimated 1.7% of this sample met the criteria for alcohol abuse or dependence. All the identified cases were males, thus giving an estimated prevalence of 5.2% in males. In this setting, the AUDIT performed poorly as a screening instrument. It has a sensitivity of 32% but a specificity of 93%. Apart from reasons relating to the low base rates of the disorders under investigation, cultural factors influencing the ways alcohol use are perceived may explain this poor performance.     

Identifying young people who drink too much: the clinical utility of the five-item Alcohol Use Disorders Identification Test (AUDIT)

The current study investigated the patterns and consequences of alcohol use among young people and their perceptions of associate health risk, and explored the clinical utility of the five-itemversion of the Alcohol Use Disorders Identification Test (AUDIT) in screening young people for hazardous drinking. A cross-sectional sample of 393 young people aged 16-19 years were accessed through two tertiary colleges in South London and self-completed an anonymous, confidential questionnaire recording the five-item AUDIT, patterns of alcohol consumption, hazardous consequences and perception of associate health risk. Over 90% of the sample reported drinking alcohol regularly, commonly excessive weekend use and related physical, psychological and social consequences. A significant minority (20.4% of males, 18.0% of females) reported consumption of alcohol in excess of UKrecommended limits, while almost a third (34.2%of males, 30.2%of females) reported scores in the 'hazardous' range of the five-item AUDIT. However, the majority had little perception of associate health risk, perceiving their use to be 'light' and unproblematic. Only one in 10 of those drinking at 'hazardous' levels recognized their alcohol use as problematic, most believing the hazardous consequences of this use were acceptable. Self-reported patterns of alcohol consumption (except age first used) and total number of psychological and social hazardous consequences were found to significantly predict AUDIT scores using linear regression analysis. Therefore the five-item AUDIT appears to have predictive validity, reflecting self-reported alcohol consumption, perception of associate health risk and hazardous consequences among young people. It is concluded that it may consequently have clinical utility as a simple screening tool (suitable for use by a variety of professionals in contact with young people) for the identification of hazardous alcohol consumption among this population. \[Miles H, Winstock A, Strang J. Identifying young people who drink too much: the clinical utility of the five-item Alcohol Use Disorders Identification Test (AUDIT). Drug Alcohol Rev 2001:20:9-18]     

Alexithymia in relation to parental alcoholism, everyday frontal lobe functioning and alcohol consumption in a non-clinical sample

Background

Recent studies have indicated that 45-67% of those in treatment for alcohol use disorders suffer from alexithymia, a multifaceted personality trait characterized by difficulties identifying and describing emotions and an externally oriented cognitive style. The high reported prevalence rates of alexithymia among those with alcohol dependence led to speculation that alexithymia is a personality dimension that may predispose to risky or problematic alcohol use.

Methods

This notion was examined in 314 adult volunteers (54% female) aged 18-45 years (M = 27.6 years), all of whom reported at least occasional alcohol consumption, who completed online surveys assessing alexithymia (Toronto Alexithymia Scale, or TAS-20), parental alcoholism (Children of Alcoholics Screening Test, or CAST), everyday signs of frontal lobe dysfunction (Frontal Systems Behavior Scale, or FrSBe) and risky alcohol use (Alcohol Use Disorders Identification Test, or AUDIT).

Results

TAS-20 scores were positively correlated with the index of parental alcoholism CAST, index of frontal lobe dysfunction FrSBe and measure of alcohol-related problems AUDIT. Chi-square test showed an association between TAS-20-defined alexithymia and being the offspring of an alcoholic parent as defined by CAST. Regression analysis showed that frontal lobe dysfunction (FrSBe) mediated the relationship between alexithymia (TAS-20 total score) and risky alcohol use (AUDIT).

Conclusions

The findings suggest that alexithymia is related to deficiencies in frontal lobe functioning that may reflect a heritable predisposition to alcohol problems.     

Population screening of risky alcohol and drug use via Internet and Interactive Voice Response (IVR): a feasibility and psychometric study in a random sample

Background

The wide accessibility of computer-based technologies like the Internet and Interactive Voice Response (IVR) systems raises the question of whether population survey data could be collected more easily and cheaply compared to using paper questionnaires. In the area of possibly stigmatized behaviors such as problematic alcohol and drug use, the question extends to whether the prevalence of such behaviors in the general population could be surveyed without compromising the quality of the data.

Aims

This study compares Internet and IVR versions of the AUDIT and DUDIT with respect to: (1) response rate, (2) problematic alcohol and drug use and (3) reliability.

Method

5000 individuals, randomly selected from the Swedish general population, were contacted via postal mail and invited to complete the AUDIT and DUDIT questionnaires via Internet or IVR. In total, 1861 (37.8%) participated in the study, 1089 via Internet and 772 via IVR.

Results

The Internet administration mode yielded a higher response rate (38.1%) compared to the IVR mode (33.9%). When respondents were given a choice between Internet and IVR, a higher response rate resulted (43.2-46.6%). Problematic alcohol and drug use occurred among 21.1% and 2.8% of the sample, respectively, with no significant differences by administration mode. Both the AUDIT and DUDIT exhibited satisfactory reliability across administration modes, Cronbach's α 0.76/0.86.

Conclusions

Data quality does not deteriorate with computerized administration methods for the AUDIT and DUDIT in population studies but paper questionnaires should also be made available to respondents in order to maximize response rates.     

Measurements,Instruments, Scales,and Tests: Use of AUDIT for Alcohol Screening among Emergency Room Patients in Thailand

This study evaluated the Alcohol Use Disorders Identification Test (AUDIT) against blood alcohol levels and medical diagnoses. The population under study included 695 current drinkers admitted to emergency rooms of four regional Thailand hospitals. The AUDIT positivity rate was 61% among 343 patients who drank prior to admission and 32% among 352 patients who did not drink alcohol before admission. Breath alcohol levels were positively associated with AUDIT scores. The sensitivity against a previous or current alcohol-related medical diagnosis was 89%. We concluded that the AUDIT is a satisfactory instrument for alcohol screening in this population.