Adolescent alcohol use disorder and comorbid stressors: examining the effectiveness of safer drinking messages

Identifying and Reducing Bias in Genome-Wide Association Studies of Alcohol-Related Traits.

To examine the rates of young adult alcohol and drug use and alcohol problems, adolescent predictors of young adult alcohol problems and correlations with young adult social, work and recreational environments. Adolescents were followed longitudinally into young adulthood. Predictors were measured in grade 9 (average age 15), and environmental correlates and outcomes in young adulthood (average age 21). Students recruited in Victoria, Australia in 2002, were resurveyed in 2010/11. Analytical n=2309, 80% retention. Adolescent self-report predictors included past-month alcohol use. Young adults completed the Alcohol Use Disorders Identification Test (AUDIT) together with reports of environmental influences. Comparisons to United States national school graduate samples revealed higher rates of alcohol, tobacco and illicit drug use (other than cannabis) in Victoria. For example, rates of past month use at age 21-22 were: alcohol 69.3% US versus 84.9%, 95% confidence interval (CI) 81.3-88.6% Victoria; illicit drugs (other than cannabis) 8.8 versus 12.7%, CI 9.7-15.7%. AUDIT alcohol problems (scored 8+) were identified for 41.2%, CI 38.8-43.6% of young adults in Victoria. The likelihood of young adult alcohol problems was higher for frequent adolescent alcohol users and those exposed to environments characterized by high alcohol use and problems in young adulthood. High rates of alcohol problems are evident in more than two in five Australian young adults, and these problems appear to be influenced both by earlier patterns of adolescent alcohol use and by young adult social, work and recreational environments.

Associations of parental and peer cross-substance use with 12–17-year-old adolescents’ problematic alcohol use: A parent-child dyadic gender analysis

Introduction: Regular serves of alcohol and repeated episodes of intoxication in adolescence are linked with increased risk of alcohol dependence and other social and health inequalities in adulthood. The Australian Guidelines to Reduce Health Risks from Drinking Alcohol (National Health and Medical Research Council (NHMRC), 2009) suggest that abstinence from alcohol is the safest option for young people under the age of 18 years, and that for those aged 15-17 years, it is preferable to delay initiation. For under-age Australian adolescents, parents are the most common source of supply of alcohol. However, there is a dearth of research on parents‟ beliefs and practices in relation to the supply of alcohol to young people. Aim: The aim of this study was to determine the extent to which parent and adolescent characteristics may influence Australian parents‟ beliefs and practices in relation to the supply of full serves of alcohol (i.e., not simply sips) to their adolescent aged 14-16 years and their adolescents‟ attendance at parties where alcohol is available. Method: A cross-sectional sample of 388 Victorian parents of 14-16 year olds, registered with a market research company, completed an online survey about parental supply of alcohol to their adolescent and adolescents‟ party attendance. Parametric and non-parametric equivalent inferential statistics were used to measure associations between parental supply of alcohol and parental beliefs, behaviours and parent/adolescent socio-demographic characteristics. Linear and logistic regression was used to measure the association between parental supply of alcohol, adolescent attendance at parties, the supply of alcohol in such settings, and multiple independent variables. Results: Seventy percent of parents reported that that their adolescent may/does currently drink. Of these, 37% reported supplying their under-age adolescent with more than a sip of alcohol in the last three months. Alcohol supply was significantly positively associated with parents‟ perceptions that their adolescent drinks and higher levels of parental monitoring but was not significantly associated with parent/adolescent socio-demographic characteristics or parents‟ self-reported drinking patterns. Parents‟ plans to supply alcohol to their adolescent in the next six months were significantly positively associated with their reports of supplying alcohol in the last three months, perceptions that their adolescent drinks, parents‟ reports of not practising religion, and parents‟ alcohol consumption scores as measured by the Alcohol Use Disorder Identification Test (AUDIT) (Saunders, Aasland, Babor, De la Fuente, & Grant, 1993). Forty-one percent of parents reported that their adolescent had attended a party in the last three months. Of these, 34% reported that their adolescent had been supplied with alcohol. Adolescents‟ friends were reported as the most common source of supply followed by parents. While 70% of parents reported that they were likely to contact the parents hosting a party, only 32% said they actually did so. Party attendance was significantly positively associated with parents‟ perceptions that their adolescent drinks, parents‟ beliefs about adolescents‟ access to alcohol and parents‟ AUDIT scores. Supply of alcohol at a party was significantly positively associated with parents‟ perceptions that their adolescent drinks, that their adolescents‟ friends drink and parenting a „middle‟ child. Discussion and conclusion: Consistent with reports from Australian students, parents are a major source of supply of alcohol to under-age adolescents. Parents‟ perceptions of their adolescent‟s drinking are a significant predictor of parental alcohol supply and adolescent alcohol use at a party. Parents report higher levels of monitoring when supplying their adolescent with alcohol. This may be a reflection of alcohol supply in the family home where many parents sanction the use of alcohol in the belief that this will teach their adolescent to “drink responsibly.” Parties represent “high-risk” alcohol use environments but few parents could be expected to be aware of recent neurobiological research that links changes in the brain at adolescence to increased sensation-seeking behaviour, particularly when in the company of peers. Parents‟ beliefs about adolescents‟ attendance at parties and the supply of alcohol to adolescents may be mediated by broader social and environmental factors (e.g., price and ease of availability) that contribute to the normalisation of alcohol use by adolescents. While there are legislative and policy guidelines regarding the use of alcohol by underage adolescents, there is arguably a need for policy change and national guidelines for parents, embedded in the broader social context and consistent with the Australian Alcohol Guidelines (NHMRC, 2009), to support parents in implementing strategies to reduce their adolescent‟s exposure to alcohol-related harm.

Background: Comorbidities such as mental illness and alcohol use disorders (AUD) worsen the prognosis of both conditions. There is a need to identify early alcohol use disorders in psychiatric patients to prevent the development of dual diagnosis diseases, which are more difficult to treat. The Alcohol Use Disorders Identification Test (AUDIT) was developed by the World Health Organisation to promote early identification of alcohol use disorders and has been validated mainly in primary care settings. No study has validated the AUDIT in a French-speaking psychiatric setting. There is also a need to identify the risk factors of heavy drinking with psychiatric disorders. Purpose: This study aims at (1) validating the French version of the Alcohol Use Disorders Identification Test (AUDIT) for psychiatric inpatients and (2) determining the frequency of alcohol use disorders in four major psychiatric ICD-10 diagnostic categories: neurotic and depressive disorders (F3 and F4), personality disorders (F6), psychotic disorders (F2) and other disorders (n = 10). Subjects and methods: Of 383 consecutive psychiatric admissions, 219 completed the AUDIT. A subset was also interviewed with the CIDI (gold standard) and was retested with the AUDIT. Psychiatric diagnoses were recorded from hospital medical records. Results: Validation of the AUDIT showed a very good sensitivity (94.1%) and specificity (91.7%) in this psychiatric inpatient population. Frequency of alcohol use disorders was 35.1%. Personality disorders had the highest rate of AUDIT scores ≥8 (50.7%). Gender was the only statistically significant outcome in a multivariate model. Discussion: Male sex as an outcome associated with the presence of alcohol use disorders, is consistent with the other AUDIT studies in psychiatry. The uniqueness of the present study is the evaluation of personality disorders among the psychiatric diagnostic categories. Conclusion: This study strengthens the evidence that the AUDIT is reliable and valid with psychiatric patients and confirms the high frequency of alcohol use disorders in this population. Drinking habits of patients with emotionally labile personality disorders should be screened.

There is a wide discrepancy in the epidemiology of alcohol use disorders (AUDs) due to diverse scales and survey approaches. We estimated the prevalence of AUDs by comparing the pooled prevalence based on the alcohol use disorders identification test (AUDIT) Vs. non-AUDIT (all scales other than AUDIT). This review searched the community-based prevalence of AUDs in PubMed, Web of Science, PsycINFO, Scopus, Ovid, and Google Scholar. Articles published during the years from 2000 to 2020 were included. The methodological quality of each study was scored, and data were extracted from the published reports. Pooled prevalence was estimated, and the publication bias was evaluated. Twenty-one studies conducted in different states of India included 73997 community-based respondents, which estimated the overall prevalence of AUDs as 12.5% (95% CI: 9 to 17.3%). The pooled prevalence based on AUDIT was 12.4% (AUDIT ≥8; 95% CI: 8.8 to 17.1%) in which the magnitude of hazardous and harmful alcohol use (8.6%; 95% CI: 5.7 to 12.8%; AUDIT 8-19) was significantly higher than dependent alcohol use (2.3%; 95% CI: 1.1 to 4.8%; AUDIT ≥ 20). The pooled prevalence using the non-AUDIT tool was 14.2(95%; CI: 6-30%). Our findings further reveal that about one in twelve of the population of India have AUDs, and there is a gross variation in the patterns of alcohol use across the country. The high prevalence of AUDs suggests developing a national policy to benefit alcohol use, justifying regional variations. Supplemental data for this article is available online at https://doi.org/10.1080/15332640.2022.2056105 .

65: How Does Hazardous and Heavy Episodic Alcohol Drinking Relate to HIV Sexual Risk among Emergency Department Patients?

Aims: The Alcohol Use Disorders Identification Test (AUDIT) is a well-established and widely used screening instrument. It has been shown that AUDIT has good criterion validity in relation to alcohol abuse and dependence according to DSM-IV, but it has not yet been validated following the introduction of the DSM-5 diagnostic system. The aim of this study was to evaluate concurrent validity for the AUDIT in relation to self-reported DSM-5 severity levels for Alcohol Use Disorder (AUD) in a Swedish general population sample.Methods: A postal questionnaire, containing the AUDIT and the 13-item brief DSM-5 AUD diagnostic assessment screener, was sent to a random sample of 1,500 persons drawn from the Swedish population, aged between 17 and 80 years and having a public residence address in Sweden. To evaluate the concurrent validity of AUDIT in relation to DSM-5 severity criteria for AUD, a Receiver Operating Characteristics (ROC) curve analysis was conducted.Results: Area under the curve (AUROC) showed excellent differentiation between AUD or not, mild (.93), moderate (.92) and severe (.99). Higher individual AUDIT scores were associated with more severe levels of AUD according to the DSM-5 screener. The optimal cutoff scores approximate earlier research on the DSM-IV and were identified as 5, 7 and 13 points, respectively, for mild, moderate and severe AUD.Conclusions: Our findings indicate that AUDIT is a valid screener for detecting concurrent AUD at three severity levels in the Swedish general population.

BackgroundThe prevalence of alcohol use disorder (AUD) is very high in Korea. To identify AUD in the busy practice setting, brevity of screening tools is very important. We derived the brief Alcohol Use Disorders Identification Test (AUDIT) and evaluated its performance as a brief screening test.MethodsOne hundred male drinkers from Kangbuk Samsung Hospital primary care outpatient clinic and psychiatric ward for alcoholism treatment completed questionnaires including the AUDIT, cut down, annoyed, guilty, eye-opener (CAGE), and National Alcoholism Screening Test (NAST) from April to July, 2007. AUD (alcohol abuse and dependence), defined by a physician in accordance with Diagnostic and Statistical Manual of Mental Disorders-IV, was used as a diagnostic criteria. To derive the brief AUDIT, factor analysis was performed using the principal component extraction method with a varimax rotated solution. Receiver operating characteristic (ROC) curve analysis was performed to investigate the discrimination ability of the brief AUDIT. Areas under the ROC curve were compared performance of screening questionnaires with 95% confidence intervals.ResultsThe derived brief AUDIT consists of 4 items: frequency of heavy drinking (item 3), impaired control over drinking (item 4), increased salience of drinking (item 5), and alcohol-related injury (item 9). Brief AUDIT exhibited an AUD screening accuracy better than CAGE, and equally to that of NAST. Areas under the ROC curves were 0.87 (0.80-0.94), 0.76 (0.66-0.85), and 0.81 (0.73-0.90) for the brief AUDIT, CAGE, and NAST for AUD, and 0.97 (0.95-0.99), 0.93 (0.88-0.98) and 0.93 (0.88-0.98) for alcohol dependence.ConclusionThe new brief AUDIT seems to be effective in detecting male AUD in the primary care setting in Korea. Further evaluation for women and different age groups is needed.

AUDIT and AUDIT-C as screening instruments for alcohol problem use in adolescents

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

Alcohol Use and Anxiety: Diagnostic and Management Issues

Assessing the adoption, acceptability and fidelity of the alcohol use disorders test for alcohol use disorders screening in HIV clinics in Malawi.

BackgroundThe Alcohol Use Disorders Identification Test (AUDIT) was developed for use in primary health care settings to identify hazardous and harmful patterns of alcohol consumption, and is often used to screen for alcohol use disorders (AUDs). This study examined the AUDIT as a screening tool for AUDs.MethodsA systematic literature search was performed of electronic bibliographic databases (CINAHL, Embase, ERIC, MEDLINE, PsycINFO, Scopus, and Web of Science) without language or geographic restrictions for original quantitative studies published before September 1, 2018, that assess the AUDIT's ability to screen for AUDs. Random‐effects meta‐regression models were constructed by sex to assess the potential determinants of the AUDIT's specificity and sensitivity. From these models and ecological data from the Global Information System on Alcohol and Health, the true‐ and false‐positive and true‐ and false‐negative proportions were determined. The number of people needed to be screened to treat 1 individual with an AUD was estimated for all countries globally where AUD data exist, using a specificity of 0.95.ResultsA total of 36 studies met inclusion criteria for the meta‐regression. The AUDIT score cut‐point was significantly associated with sensitivity and specificity. Standard drink size was found to affect the sensitivity and specificity of the AUDIT for men, but not among women. The AUDIT performs less well in identifying women compared to men, and countries with a low prevalence of AUDs have higher false‐positive rates compared to countries with a higher AUD prevalence.ConclusionsThe AUDIT does not perform well as a screening tool for identifying individuals with an AUD, especially in countries and among populations with a low AUD prevalence (e.g., among women), and thus should not be used for this purpose.

The most widely used screening instrument for alcohol use disorders (AUD) is the Alcohol Use Disorders Identification Test (AUDIT) which, although initially developed for use in primary care, is increasingly used in general population studies. Previous studies that have assessed the screening properties and the factorial structure of AUDIT were mostly based on clinical samples and did not take into consideration the possible differences in AUDIT factorial properties between subgroups according to age, sex and mental health status. Aim of the current study was to explore the distribution of AUDIT and AUDIT-Consumption (AUDIT-C) scores and the factorial structure of AUDIT in subgroups of participants according to sex, age and the presence of mental health disorder. Descriptive statistics and Exploratory/Confirmatory Factor Analysis of AUDIT were extracted in a general population representative sample of 4,894 Greek participants. Different cut-offs are suggested in order to screen 10% of the population with the highest severity of AUD into the aforementioned subgroups. Generally, a cut-off between 10-12 at AUDIT score is suggested for screening the 10% with the highest severity of alcohol use problems in subgroups of frequent alcohol consumers (e.g. younger males) and a cut-off between 4-5 would screen the 5% with the highest severity of alcohol use problems in subgroups of low alcohol-consumers (e.g. older women). A cut-off of 3 in AUDIT-C score is suggested for screening 25% of individuals with the heaviest alcohol consumption. The traditional three-factor model does not explain better the factorial structure of AUDIT compared to the 2-factors model. The AUDIT is a reliable instrument for assessing AUD and heavy alcohol consumption in the Greek general population. Age, sex and the presence of mental health disorders should be taken into consideration when selecting cut-offs for screening purposes in non-clinical samples.