The Alcohol Use Disorders Identification Test (AUDIT): a review of recent research

BACKGROUND: Efficient, inexpensive screening for early stage alcohol problems is important in health care settings. The Alcohol Use Disorders Identification Test (AUDIT) has been studied extensively to establish its value in this regard. METHODS: A literature search that used EtOH as a database was conducted to identify studies published on the AUDIT through September 2001. Keywords used for the search were "Alcohol Use Disorders Identification Test" and "AUDIT." All studies reporting psychometric properties of the measure were reviewed with particular attention being given to the period 1996 and later. A small number of additional references were located by noting their citation in other studies reviewed. RESULTS: Although more research is needed on non-English versions to establish their psychometric properties, at least in its English edition, the AUDIT demonstrates sensitivities and specificities comparable, and typically superior, to those of other self-report screening measures. Test-retest reliability and internal consistency are also quite favorable. For males, the AUDIT-C, a shortened version of the AUDIT, appears approximately equal in validity to the full scale. CONCLUSIONS: Recent research continues to support use of the AUDIT as a means of screening for alcohol use disorders in health care settings in the United States.     

Screening for Problem Drinking Comparison of CAGE and AUDIT

OBJECTIVE: To compare self-administered versions of three questionnaires for detecting heavy and problem drinking: the CAGE, the Alcohol Use Disorders Identification Test (AUDIT), and an augmented version of the CAGE. DESIGN: Cross-sectional surveys. SETTING: Three Department of Veterans Affairs general medical clinics. PATIENTS: Random sample of consenting male outpatients who consumed at least 5 drinks over the past year ("drinkers"). Heavy drinkers were oversampled. MEASUREMENTS: An augmented version of the CAGE was included in a questionnaire mailed to all patients. The AUDIT was subsequently mailed to "drinkers." Comparison standards, based on the tri-level World Health Organization alcohol consumption interview and the Diagnostic Interview Schedule, included heavy drinking (>14 drinks per week typically or >/=5 drinks per day at least monthly) and active DSM-IIIR alcohol abuse or dependence (positive diagnosis and at least one alcohol-related symptom in the past year). Areas under receiver operating characteristic curves (AUROCs) were used to compare screening questionnaires. MAIN RESULTS: Of 393 eligible patients, 261 (66%) returned the AUDIT and completed interviews. For detection of active alcohol abuse or dependence, the CAGE augmented with three more questions (AUROC 0.871) performed better than either the CAGE alone or AUDIT (AUROCs 0.820 and 0.777, respectively). For identification of heavy-drinking patients, however, the AUDIT performed best (AUROC 0.870). To identify both heavy drinking and active alcohol abuse or dependence, the augmented CAGE and AUDIT both performed well, but the AUDIT was superior (AUROC 0.861). CONCLUSIONS: For identification of patients with heavy drinking or active alcohol abuse or dependence, the self-administered AUDIT was superior to the CAGE in this population.     

The Alcohol Use Disorders Identification Test (AUDIT) and carbohydrate-deficient transferrin (CDT) in a routine workplace health examination

BACKGROUND: Only a few studies on workplaces have examined the Alcohol Use Disorders Identification Test (AUDIT) or carbohydrate-deficient transferrin (CDT) as screening instruments for the early identification of elevated and risky levels of alcohol consumption. The purpose of this study was to compare the performances of AUDIT, CDT, and gamma-glutamyltransferase (GGT) in a routine health examination (alcohol screening) in the workplace. METHODS: The study, carried out over 16 months in a large workplace in the transport sector, was part of an on-going controlled study. Employees who came to the company health service for a routine health examination were offered the opportunity to undergo an alcohol screening and check their alcohol habits. RESULTS: Of the 570 subjects who participated, 105 (18.4%) screened positive according to AUDIT, CDT, or both. Only 7.6% of the persons who screened positive did so according to both instruments. If GGT had been included as a screening instrument, the proportion of positive results would have increased to 22.0%. If we had only used AUDIT in the screening process, the proportion of positives would have fallen by nearly half. CONCLUSIONS: The present findings suggest that AUDIT and CDT are complementary instruments for alcohol screening in a routine workplace health examination, and each has value for identifying a different segment of the risky drinking population.     

Validity of the alcohol use disorders identification test in college students

BACKGROUND: High-risk alcohol use among college students is associated with accidents, partner violence, unwanted sexual encounters, tobacco use, and performance issues. The identification and treatment of high-risk drinking students is a priority for many college campuses and college health centers. The goal of this study was to test the psychometric properties of the Alcohol Use Disorders Identification Test (AUDIT) in college students. METHODS: A convenience sample of students coming into a college health clinic was asked to complete the 10-question AUDIT and then participate in a research interview. The interview focused on assessing students for alcohol abuse and dependence by using the Composite International Diagnostic Interview Substance Abuse Module and timeline follow-back procedures to assess a 28-day drinking history. RESULTS: A total of 302 students met the eligibility criteria and agreed to participate in the study. The sample consisted of 185 females (61%) and 117 males (39%), with a mean age of 20.3 years. Forty students were abstinent, 88 were high-risk drinkers, and 103 met criteria for a 12-month history of dependence. Receiver operator curves demonstrated that the AUDIT had the highest area under the cure for detecting high-risk alcohol use (0.872) and the lowest for identifying persons with a lifetime history of alcohol abuse or dependence (0.775). An AUDIT cutoff score of 6 or greater demonstrated a sensitivity of 91.0% and a specificity of 60.0% in the detection of high-risk drinkers. CONCLUSIONS: The AUDIT has reasonable psychometric properties in sample of college students using student health services. This study supports the use of the AUDIT in this population.     

The TWEAK is weak for alcohol screening among female Veterans Affairs outpatients

BACKGROUND: The optimal brief questionnaire for alcohol screening among female patients has not yet been identified. This study compared the performance of the TWEAK (tolerance, worried, eye-opener, amnesia, cutdown), the Alcohol Use Disorders Identification Test (AUDIT), and the AUDIT Consumption (AUDIT-C) as self-administered screening tests for hazardous drinking and/or active alcohol abuse or dependence among female Veterans Affairs (VA) outpatients. METHODS: Women were included in the study if they received care at VA Puget Sound and completed both a self-administered survey containing the AUDIT and TWEAK screening questionnaires and subsequent in-person interviews with the Alcohol Use Disorders and Associated Disabilities Interview Schedule. Sensitivities, specificities, positive and negative likelihood ratios, and areas under Receiver Operating Characteristic curves were computed for each screening questionnaire compared with two interview-based comparison standards: (1) active DSM-IV alcohol abuse or dependence and (2) hazardous drinking and/or active DSM-IV alcohol abuse or dependence, the more appropriate target for primary care screening. RESULTS: Of 393 women who completed screening questionnaires and interviews, 39 (9.9%) met diagnostic criteria for alcohol abuse or dependence, and 89 (22.7%) met criteria for hazardous drinking or alcohol abuse or dependence. The TWEAK had relatively low sensitivities (0.62 and 0.44) but adequate specificities (0.86 and 0.89) for both interview-based comparison standards, even at its lowest cut-point (>/=1). The AUDIT and AUDIT-C were superior, with the following areas under the receiver operating characteristic curve for active alcohol abuse or dependence and hazardous drinking and/or active alcohol abuse or dependence, respectively: AUDIT, 0.90 [95% confidence interval (CI), 0.85-0.95] and 0.87 (95% CI, 0.84-0.91); AUDIT-C, 0.91 (95% CI, 0.88-0.95) and 0.91 (95% CI, 0.88-0.94); and TWEAK, 0.76 (95% CI, 0.66-0.86) and 0.67 (95% CI, 0.60-0.74). CONCLUSIONS: The TWEAK has low sensitivity as an alcohol-screening questionnaire among female VA outpatients and should be evaluated further before being used in other female primary care populations. The three-item AUDIT-C was the optimal brief alcohol-screening questionnaire in this study.     

Validity of the obsessive compulsive drinking scale in a heavy drinking population

Background:  The Obsessive Compulsive Drinking Scale [OCDS; Anton et al., Alcohol Clin Exp Res 19 (1995), 92 ] is the most widely used measure of alcohol craving. There are no studies which comprehensively investigate the construct and concurrent validity of the OCDS in a severe alcohol dependent population.
Methods:  Three hundred and seventy alcohol-dependent patients were referred to a hospital-based alcohol treatment program. All participants completed the OCDS, the Alcohol Use Disorders Identification Test [AUDIT; Saunders et al., Addiction 88 (1993), 791 ] and provided demographic and alcohol consumption data.
Results:  The sample was randomly split into 2. Exploratory factor analysis and confirmatory factor analysis were conducted on these subsamples. Both analyses identified a 4-factor solution (compulsions, interference, obsessions and resisting obsessions). All factors showed sound internal consistency. Neither the factor scores nor the total OCDS score was related to baseline alcohol problems (AUDIT) or consumption.
Conclusions:  There was some support for the construct validity of the OCDS in this clinical group. Concurrent validity of the scale was not supported by these cross-sectional data. Future research should examine the predictive utility of the OCDS over time.     

Alcohol use disorders identification test: factor structure in an adolescent emergency department sample

BACKGROUND: This study examined whether the factor structure of a modified version of the Alcohol Use Disorders Identification Test (AUDIT) represented the three intended conceptual domains of consumption, dependence symptoms, and alcohol-related consequences in an adolescent sample. Additionally, the utility of factor-specific cut scores in identifying patients with DSM-IV alcohol diagnoses was investigated. METHODS: Adolescents treated for an injury in an emergency department and who reported alcohol use in the last year (n = 173; 57% male, 72% white) constituted the study sample. A modified version of the AUDIT and the alcohol section of the Diagnostic Interview Schedule for Children were administered. The AUDIT's factor structure was determined by confirmatory factor analysis and exploratory principal components analysis. Factor-specific cut scores that identified adolescents with a DSM-IV alcohol diagnosis were determined by using receiver operating characteristic analysis. RESULTS: A two-factor model representing consumption and dependence/consequences provided the best fit to the data. A cut score of 3 on the consumption factor and a cut score of 1 on the dependence/consequences factor demonstrated optimal performance in identifying patients with alcohol diagnoses. The consumption factor had better overall performance compared with the dependence/consequences factor, and it had similar overall performance compared with the AUDIT total score. CONCLUSIONS: The AUDIT comprised two correlated factors: consumption and dependence/consequences. The better performance of the consumption factor in detecting adolescents with DSM-IV alcohol diagnoses suggests the utility of including consumption items in brief alcohol screens used with adolescents. Results also indicate the need to identify developmentally appropriate alcohol-related problems to enhance screening performance among adolescents.     

Reliability and validity of the Alcohol Use Disorders Identification Test (AUDIT) imbedded within a general health risk screening questionnaire: results of a survey in 332 primary care patients

BACKGROUND: Self-administered, general health risk screening questionnaires that are administered while patients wait in the doctor's office may be a reasonable and timesaving approach to address the requirements of preventive medicine in a typical 10-min medical visit. The psychometric characteristics of the Alcohol Use Disorders Identification Test (AUDIT) incorporated within a health questionnaire (H-AUDIT) have not been examined. METHODS: The reliability and validity of the self-administered AUDIT were compared between the H-AUDIT and the AUDIT used as a single scale (S-AUDIT) in 332 primary care patients. RESULTS: No major demographic or alcohol use characteristics were found between the 166 subjects who completed the H-AUDIT and the 166 individuals who completed the S-AUDIT. The test-retest reliability of the 166 subjects who completed the H-AUDIT [estimated by Spearman correlation coefficient at a 6-week interval (0.88), internal consistency (total correlation coefficients for all items ranged from 0.38 to 0.69; Cronbach alpha index 0.85), and the sensitivity and specificity of the H-AUDIT were used to identify at-risk drinkers' areas under receiver operating characteristic (0.77) and alcohol-dependent subjects' areas under receiver operating characteristic (0.89)] was similar to the same measurements obtained with the 166 individuals who completed the S-AUDIT. CONCLUSIONS: The AUDIT incorporated in a health risk screening questionnaire is a reliable and valid self-administered instrument to identify at-risk drinkers and alcohol-dependent individuals in primary care settings.     

A Review of Research on the Alcohol Use Disorders Identification Test (AUDIT)

Research on the core version of the Alcohol Use Disorders Identification Test (AUDIT) is reviewed. Sensitivities and specificities of the AUDIT for criteria of current hazardous use and, to a slightly lesser extent, lifetime alcohol dependence are high. In general, AUDIT scores are at least moderately related to other self-report alcohol screening tests. Several studies also show them as correlated with biochemical measures of drinking. Results of the AUDIT have also been associated with more distal indicators of problematic drinking. Indices of internal consistency, including Cronbach's α and item-total correlations, are generally in the 0.80's. Future directions for research on the AUDIT are suggested.     

Alcohol Use Disorders Identification Test (AUDIT): establishment of cut-off scores in a hospitalized Chinese population

BACKGROUND: Alcohol use has become a problem for Taiwanese society. Developing a brief, rapid, and flexible tool to screen an individual's alcohol consumption is important. Many countries use the Alcohol Use Disorders Identification Test (AUDIT) to screen for harmful and dangerous alcohol consumption. The psychometric characteristics of the AUDIT have not been examined in a Chinese population. METHODS: Determination of the cutoff points for the AUDIT Chinese version included three stages: translating the questionnaire, expert review and formal testing on subjects. Participants (N = 112) were recruited from a medical research center of four gastroenterology wards in northern Taiwan. RESULTS: The cutoff point for participants diagnosed as "harmful users" was an AUDIT score of 8. The sensitivity was 0.96, specificity was 0.85, positive predictive value (PPV) was 0.85, negative predictive value (NPV) was 0.96, and area under the receiver-operating characteristic curve (AUROC) was 0.93. The cutoff point for participants diagnosed as "alcohol dependent" was an AUDIT score of 11. The sensitivity was 0.94, specificity was 0.63, PPV was 0.31, NPV was 0.98, and AUROC was 0.84. Furthermore, males had significantly higher AUDIT and AUDIT-C scores. Males were also significantly more likely than females to be diagnosed as harmful users or alcohol dependents. CONCLUSIONS: The Chinese version of the AUDIT gave the same cutoff point for harmful alcohol use by Taiwanese individuals as that set by the World Health Organization. This finding shows that this cutoff point is generally appropriate in screening for problem alcohol consumption. Moreover, the cutoff AUDIT score of 11 for alcohol dependence provides a reference for screening in Taiwanese clinics.     

Brief Intervention for Problem Drinkers in a Chinese Population: A Randomized Controlled Trial in a Hospital Setting

Background:  Alcohol is a legal and accessible substance in Taiwan. As excessive alcohol has been linked to health and social problems, it is necessary to develop a brief, rapid, and low-cost tool to help health care providers deal with persons in Taiwan whose alcohol consumption has become hazardous or harmful to their health.
Methods:  A randomized controlled clinical trial with 6- and 12-month follow-ups was designed. Eighteen medical/surgical units at a medical center in northern Taiwan were randomly assigned to 2 groups: experimental ( n  = 9) and control ( n  = 9). Inpatients on the units were enrolled if they met the following criteria: were older than 18 years, had no severe psychiatric illness, and were not pregnant. The experimental group ( n  = 138) received the intervention, a 15-minute counseling visit in which nurses screened participants using the Alcohol Use Disorders Identification Test (AUDIT), provided a health promotion booklet for adults, and individually discussed the booklet contents with patients based on their drinking level (AUDIT score). The control group ( n  = 137) received no treatment. Patterns of alcohol consumption were determined by AUDIT scores at baseline, 6, and 12 months later.
Results:  Alcohol use disorders identification test scores decreased significantly in both groups at 6 months after the intervention, but did not differ significantly between the 2 groups. However, 12 months after the brief alcohol intervention, experimental subjects' AUDIT scores were significantly better than those of the control group.
Conclusions:  Our brief alcohol intervention provided a 12-month benefit for problem drinkers in Taiwan.     

The alcohol use disorders identification test: an update of research findings

BACKGROUND: The Alcohol Use Disorders Identification Test (AUDIT) has been extensively researched to determine its capability to accurately and practically screen for alcohol problems. METHODS: During the 5 years since our previous review of the literature, a large number of additional studies have been published on the AUDIT, abbreviated versions of it, its psychometric properties, and the applicability of the AUDIT for a diverse array of populations. The current article summarizes new findings and integrates them with results of previous research. It also suggests some issues that we believe are particularly in need of further study. RESULTS: A growing body of research evidence supports the criterion validity of English version of the AUDIT as a screen for alcohol dependence as well as for less severe alcohol problems. Nevertheless, the cut-points for effective detection of hazardous drinking as well as identification of alcohol dependence or harmful use in women need to be lowered from the originally recommended value of 8 points. The AUDIT-C, the most popular short version of the AUDIT consisting solely of its 3 consumption items, is approximately equal in accuracy to the full AUDIT. Psychometric properties of the AUDIT, such as test-retest reliability and internal consistency, are quite favorable. Continued research is urged to establish the psychometric properties of non-English versions of the AUDIT, use of the AUDIT with adolescents and with older adults, and selective inclusion of alcohol biomarkers with the AUDIT in some instances. CONCLUSIONS: Research continues to support use of the AUDIT as a means of screening for the spectrum of alcohol use disorders in various settings and with diverse populations.     

Insight into Alcohol-Related Problems and Its Associations with Severity of Alcohol Consumption,Mental Health Status,Race, and Level of Acculturation in Southern Taiwanese Indigenous People with Alcoholism

Objective: While not well known in the West, Taiwan has a substantial indigenous population, and this population has rapidly developed alcohol problems. This study examined the level of insight into alcohol-related problems and its associations with the severity of alcohol consumption, mental health status, race, and the level of acculturation among indigenous populations with alcohol problems in southern Taiwan. Methods: A total of 332 indigenes, whose total Alcohol Use Disorders Identification Test (AUDIT) score was equal to 8 or higher, were interviewed. The associations between the level of insight into alcohol-related problems and the severity of alcohol drinking on the AUDIT, mental health status on the Chinese Health Questionnaire-12 (≥ 4 vs. < 4), race (Bunun vs. non-Bunun), and the level of acculturation on the Taiwan Aboriginal Acculturation Scale were examined using logistic regression models. Results: The results of this study found that 72.6% of the participants had poor insight into alcohol-related problems and no participant had good insight. Participants who had more severe alcohol drinking or poor mental health were more likely to have a higher level of insight into alcohol-related problems. Participants who were non-Bunun were also more likely to have a higher level of insight into alcohol-related problems, but the level of acculturation was not associated with the level of insight into alcohol-related problems. Conclusions: These findings suggest that most alcoholic indigenes in southern Taiwan have poor insight into their own alcohol-related problems. Cultural specific interventions targeting and improving the indigenes' insight into alcohol-related problems are needed.     

Prevalence of alcohol use disorders and associated factors: a population-based study using AUDIT in southern Brazil

Aims   To assess the prevalence of potential alcohol use disorders and associated factors using the Alcohol Use Disorders Identification Test (AUDIT).
Design   Cross-sectional study.
Setting   A town in southern Brazil.
Participants   A representative sample of 1260 people aged 15 and over.
Measurements   Demographic, socioeconomic, smoking habit and mental health data were collected. Logistic regression was used in the multivariate analysis, and odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.
Findings   Overall prevalence of alcohol use disorder was 7.9%, with 14.5% prevalence among men and 2.4% among women. The risk of alcohol misuse increased across social class ( P linear trend = 0.03) and compared with the highest classes (A and B), groups C through E had ORs of 1.48, 1.51 and 2.36, respectively. Males had an OR of 6.89 (CI 3.61–13.16) compared with women. A linear trend was found ( P  = 0.001) between smoking categories, and smokers (OR 3.27; CI 1.91–5.58) and ex-smokers (OR 1.30; CI 0.56–2.98) were at higher risk than non-smokers. Those with minor psychiatric disorders had a 2.48 OR (CI 1.35–4.56) of presenting a positive test.
Conclusions   The AUDIT detected a high prevalence of potential alcohol use disorders in the population sampled. Those identified are potential targets for preventive measures implemented through health policies.     

Predictive capacity of the AUDIT questionnaire for alcohol-related harm

The Alcohol Use Disorders Identification Test (AUDIT) is a 10-item questionnaire designed to screen for hazardous and harmful alcohol consumption. We examined its ability to predict alcohol-related illness and social problems, hospital admission and mortality over a 2–3-year period. At initial interview, 330 ambulatory care patients were assessed using a detailed interview including the AUDIT questions and laboratory tests. After 2–3 years, 250 (76%) subjects were reassessed and their experience of alcohol-related harm determined. Of those who scored eight or more on A UDIT at initial interview, 61 % experienced alcohol-related social problems compared with 10% of those with lower scores (p < 0.0001); they also had a significantly greater experience of alcohol-related medical disorders and hospitalization. A UDIT score was a better predictor of social problems and of hypertension than laboratory markers. Its ability to predict other alcohol-related illnesses was similar to the laboratory tests. However, gamma glutamyltransferase was the only significant predictor of mortality. We conclude that A UDIT should prove a valuable tool in screening for hazardous and harmful alcohol consumption so that intervention can be provided to those at particular risk of adverse consequences.     

The AUDIT Alcohol Consumption Questions: Reliability, Validity, and Responsiveness to Change in Older Male Primary Care Patients

Objectives : To determine the reliability, validity, and responsiveness to change of AUDIT (Alcohol Use Disorders Identification Test) questions 1 to 3 about alcohol consumption in a primary care setting. Patients : Randomly selected, male general medical patients ( n = 441) from three VA Medical Centers, who had 5 or more drinks containing alcohol in the past year and were willing to be interviewed about their health habits. Measures : Three self-administered AUDIT consumption questions were compared with a telephone-administered version of the trilevel World Health Organization interview about alcohol consumption. Results : Of 393 eligible patients, 264 (67%) completed interviews. Test-retest reliability —Correlations between baseline and repeat measures 3 months later for four dimensions of consumption according to the AUDIT, ranged from 0.65 to 0.85, among patients who indicated they had not changed their drinking (Kendall's Tau-b). Criterion validity —Correlations between AUDIT and interview for four dimensions of alcohol consumption ranged from 0.47 to 0.66 (Kendall's Tau-b). Discriminative validity —The AUDIT questions were specific (90 to 93%), but only moderately sensitive (54 to 79%), for corresponding criteria for heavy drinking. Responsiveness to change —The AUDIT consumption questions had a Guyatt responsiveness statistic of 1.04 for detecting a change of 7 drinks/week, suggesting excellent responsiveness to change. Conclusions : AUDIT questions 1 to 3 demonstrate moderate to good validity, but excellent reliability and responsiveness to change. Although they often underestimate heavy alcohol consumption according to interview, they performed adequately to be used as a proxy measure of consumption in a clinical trial of heavy drinkers in this population.     

Alcohol use disorders among emergency department-treated older adolescents: a new brief screen (RUFT-Cut) using the AUDIT, CAGE, CRAFFT, and RAPS-QF

BACKGROUND: Early identification of alcohol use disorders (AUD) among emergency department (ED)-treated patients is important for facilitating intervention and further evaluation outside EDs. A number of brief screening instruments have been developed for identifying patients with AUD, but it is not clear whether they are practical and perform well with older adolescents in an ED setting. This study contrasted four brief screening instruments for detecting DSM-IV-defined AUD and tested a newly developed brief screen for use among ED-treated older adolescents. METHODS: The Alcohol Use Disorders Identification Test (AUDIT), the CAGE, the CRAFFT, and a modified RAPS-QF were given to 93 alcohol-using older adolescents (55% men; aged 18-20 years) in an ED. Receiver operator characteristic analyses were used to evaluate the performance of brief screens against the criterion of a lifetime DSM-IV alcohol abuse or dependence diagnosis. RESULTS: Of existing instruments, the AUDIT had the best overall performance in identifying AUD (sensitivity, 82%; specificity, 78%). A new, shorter screening instrument composed of two AUDIT items, two CRAFFT items, and one CAGE item (RUFT-Cut) performed as well as the AUDIT (sensitivity, 82%; specificity, 78%). CONCLUSIONS: Among existing alcohol screening instruments, the AUDIT performed best for identifying ED-treated older adolescents with alcohol use disorders. The RUFT-Cut is a brief screening instrument for AUD that shows promise for identifying ED-treated older adolescents who are in need of intervention or further evaluation. Future research should focus on use of the RUFT-Cut in other settings with larger, more diverse samples of adolescents.     

The Alcohol Use Disorders Identification Test (AUDIT) as a screen for at-risk drinking in primary care patients of different racial/ethnic backgrounds

This study examined the operating characteristics of the Alcohol Use Disorders Identification Test (AUDIT) as a screen for "at-risk" drinking in a multi-ethnic sample of primary care patients, from a family practice center located in the southwestern United States. A probability sample of 1333 family medicine patients, stratified by gender and racial/ethnic background (white, African-American and Mexican-American) completed the AUDIT, followed by the Alcohol Use Disorders and Associated Disabilities Interview Schedule (AUDADIS) to determine ICD-10 diagnoses. Indicators of hazardous alcohol use and alcohol-related problems were included as measures of "at-risk" drinking. Despite differences in the spectrum of alcohol problems across patient subgroups, there was no evidence of gender or racial/ethnic bias in the AUDIT as indicated by Receiver Operating Characteristic Curve analysis. Excluding abstainers from the analysis had little impact on screening efficacy. In this patient population, the AUDIT appears to be an unbiased measure of "at-risk" drinking.     

Screening with the alcohol use disorders identification test (AUDIT) in an inner-city population

Objectives: 1) To determine the operating characteristics of the Alcohol Use Disorders Identification Test (AUDIT) in an inner-city population and 2) to compare AUDIT performance with physician recognition of alcohol-related problems. Design: New patients were administered a health habits questionnaire, which included the AUDIT and the alcohol portion of the Structured Clinical Interview for DSM-III-R (used as the “gold standard” for alcohol abuse or dependence). The findings were compared with physician recognition based on chart review. Setting: Inner-city general medicine clinic staffed by resident physicians with faculty supervision. Patients/participants: Consecutive new patients over a ten-week period. Of 166 consecutive new patients, 23 were not contacted, 17 refused to participate, two were excluded for gross cognitive deficits, and 124 completed the study. Results: Of the 124 patients, 41 (33%) met criteria for past or present alcohol abuse or dependence. The AUDIT correctly identified 26/27 (sensitivity of 96%) of patients with current problems and 0/14 of patients with past problems only. Physician rates of recognition of current and past alcohol-related problems based on chart review were 12/27 (sensitivity of 44%) and 1/14 (7%), respectively. The specificities of both the AUDIT and physician recognition were high, 96% and 99%, respectively. Conclusions: 1) Alcohol-related problems were common in this setting. 2) The AUDIT had a high sensitivity and a high specificity for detection of current alcohol problems in this setting, but it failed to detect patients with only past histories of alcohol problems. 3) The AUDIT performed significantly better than did the physicians in detecting alcohol problems. 4) The addition of an assessment of past alcohol use to supplement information from the AUDIT would appear to represent a promising screening strategy worthy of further investigation. Presented in part at the annual meeting of the Society of General Internal Medicine, April 30, 1993, Arlington, Virginia. Supported in part by the Alumni Association of Wayne State University Medical School.     

Using alcohol screening results and treatment history to assess the severity of at-risk drinking in Veterans Affairs primary care patients

Abstract : Background: Primary care providers need practical methods for managing patients who screen positive for at‐risk drinking. We evaluated whether scores on brief alcohol screening questionnaires and patient reports of prior alcohol treatment reflect the severity of recent problems due to drinking. Methods: Veterans Affairs general medicine outpatients who screened positive for at‐risk drinking were mailed questionnaires that included the Alcohol Use Disorders Identification Test (AUDIT) and a question about prior alcohol treatment or participation in Alcoholics Anonymous (“previously treated”). AUDIT questions 4 through 10 were used to measure past‐year problems due to drinking (PYPD). Cross‐sectional analyses compared the prevalence of PYPD and mean Past‐Year AUDIT Symptom Scores (0–28 points) among at‐risk drinkers with varying scores on the CAGE (0–4) and AUDIT‐C (0–12) and varying treatment histories. Results: Of 7861 male at‐risk drinkers who completed questionnaires, 33.9% reported PYPD. AUDIT‐C scores were more strongly associated with Past‐Year AUDIT Symptom Scores than the CAGE (p < 0.0005). The prevalence of PYPD increased from 33% to 46% over the range of positive CAGE scores but from 29% to 77% over the range of positive AUDIT‐C scores. Among subgroups of at‐risk drinkers with the same screening scores, patients who reported prior treatment were more likely than never‐treated at‐risk drinkers to report PYPD and had higher mean Past‐Year AUDIT Symptom Scores (p < 0.0005). We propose a simple method of risk‐stratifying patients using AUDIT‐C scores and alcohol treatment histories. Conclusions: AUDIT‐C scores combined with one question about prior alcohol treatment can help estimate the severity of PYPD among male Veterans Affairs outpatients.