Facilitating Screening and Brief Interventions in Primary Care: A Systematic Review and Meta-Analysis of the Audit as an Indicator of Alcohol Use Disorders

Abstract

Background: The Alcohol Use Disorders Identification Test (AUDIT) is relatively quick to administer and was developed for use in primary health care settings to identify hazardous drinking and potential alcohol use disorders (AUDs). We aimed to examine the AUDIT as a screening tool for AUDs and alcohol dependence, determine the optimal cut-points and determinants, and apply these cut-points to estimate, by sex and country, the number of people needed to be screened in order to treat one individual with an AUD. Methods: We conducted a systematic literature search for original quantitative studies that administered the AUDIT, identified the prevalence of current AUDs, reported the sensitivity and specificity of the AUDIT by sex, and specified the cut-point(s) used to obtain the respective sensitivity and specificity estimates. Several electronic bibliographic databases (CINAHL, Embase, ERIC, Medline, PsycINFO, Scopus, and Web of Science) were systematically searched for studies published before September 1, 2018, without language or geographic restrictions. We performed cut-point-specific random-effects meta-analyses for both sensitivity and specificity for both sexes, conducted random-effects meta-regression models to determine potential determinants, and estimated true and false positive and true and false negative proportions, as well as the number of people needed to be screened to treat one individual with an AUD. Findings: A total of 36 studies were retained for data extraction. Standard drink size was found to affect the optimal cut-point for identifying AUDs among men, but not among women. The performance of the AUDIT is affected by the prevalence of AUDs; it performs less well in identifying women compared to men, and countries with a low prevalence have higher false positive rates compared to countries with a higher prevalence. Interpretation: The AUDIT does not perform well as a screening tool for identifying individuals with an AUD. Alternative forms of screening should be considered and evaluated for use in primary health care settings. Funding: Funding for this research was provided by the Pan American Health Organization. Declaration of Interest: We declare no competing interests.