Hypertension and alcohol: a cross-sectional study comparing PEth with AUDIT and AUDIT-C in primary care

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

Screening and brief intervention (SBI) is a public health intervention that has been shown to be effective in reducing heavy alcohol consumption. The aim of this study is to estimate the cost-effectiveness of implementing universal alcohol SBI in primary care in Canada. We developed a microsimulation model of alcohol consumption and its effects on 18 alcohol-related causes of death. The model simulates a Canadian population. The model simulates individuals and their alcohol consumption on a continuous scale starting from age 17years to death. The reference case assumes no SBI in Canada. The base case assumes screening was conducted using the Alcohol Use Disorders Identification Test (AUDIT) at a threshold score of 8. Additional analyses included evaluating SBI using the AUDIT at threshold scores between 4 and 8 or the Derived Alcohol Use Disorders Identification Test (AUDIT-C) at threshold scores between 3 and 7. The model estimates the direct health-care costs, life years gained and quality-adjusted life years (QALY) gained, which are then used to estimate the incremental cost-effectiveness ratio (ICER) of SBI versus no SBI. SBI with AUDIT (at a threshold score of 8) had an ICER of $8729/QALY. Our results suggest that using AUDIT thresholds between 8 and 4, inclusive, would be cost-effective for the whole population, as well as for men and women individually. Our results suggest that the AUDIT-C would be cost-effective at thresholds of 7 to 3, inclusive, for men, women and the whole population. In Canada, screening and brief intervention via Alcohol Use Disorders Identification Test (AUDIT) and Derived Alcohol Use Disorders Identification Test (AUDIT-C) to reduce heavy alcohol consumption appears to be cost-effective for men and women at Alcohol Use Disorders Identification Test (AUDIT) thresholds of 8 and lower and at Derived Alcohol Use Disorders Identification Test (AUDIT-C) thresholds of 7 and lower.

Alcohol and drug use among bartenders: An at risk population?

Ask the Expert: Substance-Related and Addictive Disorders

IntroductionThe Alcohol Use Disorders Identification Test (AUDIT) has been used in various global settings as a rapid, reliable screening instrument to detect risky and hazardous alcohol consumption. However, there remain populations where the AUDIT has not been validated. Nurses make up a substantial proportion of healthcare workers globally, and their experiences during the recent pandemic response have indicated that risky and hazardous alcohol consumption has occurred among this occupational group. The objective of this study was to validate the AUDIT amongst a cohort of nurses.MethodsThis paper uses a dataset of Australian nurses (n = 1,159) who completed the AUDIT as part of a nationwide survey on alcohol consumption conducted between July and October 2021. A three-step factor analysis method was used to determine the validity and reliability of the AUDIT as a screen for risky and hazardous alcohol consumption among Australian nurses.ResultsInitial confirmatory factor analysis found poor performance on items 5, 6 and 9 of the AUDIT. Further exploratory factor analysis confirmed these results, additionally finding other items (1 and 10) that contributed marginally to the AUDIT performance among nurses. A final Goodness-of-Fit test on the remaining five items in the AUDIT was significant (:{chi:}^{2}left(dfright):= 59.871(5), p < 0.001), suggesting that a five-item AUDIT scale is reliable amongst nurses.ConclusionThe factor analysis process confirmed that that original 10-item AUDIT was not valid and reliable to screen for risky and hazardous alcohol consumption among nurses in Australian settings. A modified, five item version of the AUDIT tool (the AUDIT-N) was a substantially better fit for use in a cohort of Australian nurses, although further testing for construct validity is required prior to deployment. Our findings have applicability for the use of the AUDIT in future workforce surveys of alcohol consumption among not only nurses, but the wider population of healthcare workers.

OBJECTIVES/SPECIFIC AIMS: Suggestibility, defined as the inclination to accept and internalize messages, has not been assessed much in relation to alcohol use. Prior research has shown that suggestibility to social cues and peer influence may play a role in driving alcohol consumption. Our previous work has shown associations between suggestibility and alcohol consumption in social drinkers. This study aims to examine how suggestibility and social susceptibility are related to ideas alcohol consumption and consequences across the spectrum of alcohol use and misuse. We hypothesize that those with higher suggestibility and social susceptibility reports will also have higher alcohol consumption and consequences, and that the impact of susceptibility is lower in dependent compared to non-dependent drinkers. METHODS/STUDY POPULATION: Study participants enrolled in the NIAAA screening and assessment protocol (N=157) completed questionnaires on suggestibility and alcohol consumption, The Multidimensional Iowa Suggestibility Scale (MISS) is a 95-question self-report assessment of suggestibility which draws from subcategories of consumer suggestibility, perceivability, physiological suggestibility, physiological reactivity, and peer conformity. Alcohol measures included 90-day Timeline Followback interviews and the Alcohol Use Disorder Identification Test (AUDIT). Participants also underwent the Structured Clinical Interviews for DSM-IV or DSM-5 disorders, and were stratified into two groups: alcohol dependent (N = 86) and non-dependent (N=71). Median split by age was additionally used to explore age’s relationship with suggestibility and alcohol with the under 36 (N = 45) and over 36 (N = 26) non-dependent groups. RESULTS/ANTICIPATED RESULTS: Initial analyses showed marked differences between the dependent and non-dependent groups in the relationship between the MISS total score and AUDIT total score. The non-dependent group showed significant positive correlations between MISS and AUDIT scores (r = 0.460, p &lt; 0.001), while the dependent group did not show any correlation between MISS and AUDIT scores. Further examination of these relationships in the nondependent group revealed that MISS scores were also significantly positively correlated with AUDIT subscores of consumption, harm, and dependence. Age was found to have a significant negative correlation with MISS score (r = −0.354, p &lt; 0.01). To better understand the role of age, the sample was split based on the median age (36 yrs), and analyzed separately. Results indicated robust relationships between MISS score and AUDIT (r = 0.457, p &lt; 0.01) in the younger age group. In addition, the younger age group also showed significant relationships between MISS score and 90-day TLFB measures of total drinks, days drinking, and heavy drinking days. DISCUSSION/SIGNIFICANCE OF IMPACT: In non-dependent individuals, there was a significant positive relationship between suggestibility and alcohol measures, and these effects were amplified in younger individuals. No relationship was found between suggestibility and alcohol measures in the alcohol dependent individuals. This may be related to a greater impact of social and external contextual cues in younger social drinkers compared to dependent drinkers where tolerance and craving may have greater impact on alcohol consumption. These findings have important implications for traits that may put individuals at risk for developing harmful patterns of alcohol use and misuse. Future analyses will aim to examine biobehavioral underpinnings of the relationship between suggestibility and alcohol consumption.

Alcohol consumption can influence an individual's quality of life, with the impact varying based on several factors such as the amount of alcohol consumed, frequency of consumption, individual tolerance, and overall health. Slovakia is among the countries with the highest incidence of liver cirrhosis in the world, with alcohol representing a significant risk factor. Therefore, it is important to identify at-risk groups and the potential impact of various factors. The primary objective of this study is to examine the relationship between alcohol consumption and quality of life among college students in the Slovak Universities. A cross-sectional study was conducted in December 2021 and January 2022. The study included college students with an average age of 22.3 years. Participants were surveyed about their alcohol consumption and quality of life using the standardized Alcohol Use Disorders Identification Test (AUDIT) and EuroQol-5D (EQ-5D) questionnaires. These questionnaires were distributed through online school systems. In the study, 88.7% of the students reported drinking alcohol. A low AUDIT score was recorded for 67.1% of the total participants (2573 students). A medium score was found in 23.3% of the participants (893 students). High scores were identified in 2.4% of the participants (92 students), and very high scores were found in 2.2% of the total participants (86 students). Mild pain was reported in 33.8% of cases, while moderate pain was reported in 5.2% of cases. Mild depression and anxiety were reported in 31.1% of the cases, and moderate depression and anxiety were reported in 13.5% of the cases. There is a statistically significant relationship between AUDIT and EuroQOL variables (p < 0.001). This suggests that the association between alcohol use (measured by AUDIT) and health-related quality of life (measured by EuroQOL) is unlikely to be due to chance. Higher alcohol consumption was associated with a poorer quality of life in Slovak college students. Our results suggest a meaningful connection between alcohol consumption behaviors and overall quality of life, highlighting the potential impact of alcohol use on health outcomes. Further research is warranted to explore the nature and causality of this relationship, which could inform interventions aimed at improving health-related quality of life through alcohol use reduction strategies. The association between higher alcohol consumption and poorer quality of life in Slovak college students raises important questions about causality and the complex interplay between alcohol consumption and one’s overall well-being. The significant relationship between higher alcohol consumption and poorer quality of life suggests the need for targeted public health interventions aimed at reducing alcohol consumption among college students. Programs focusing on awareness and education about the negative impacts of excessive drinking could be implemented to promote healthier lifestyles.

Alcohol Use and Anxiety: Diagnostic and Management Issues

DIAGNOSIS AND MANAGEMENT OF ALCOHOL PROBLEMS

Objective To evaluate the efficacy and relative costs of different screening methods for the identification of alcohol use disorders in an opportunistic screening programme in primary care in the United...

Background: AUDIT is constructed to be able to identify hazardous drinking and less severe alcohol-related problems. The original AUDIT was shown to have a cut-off score of 8 and above for identifying hazardous or harmful alcohol consumption. The aim of this study was to establish the optimal cut-off point of the Persian version of Alcohol Use Disorders Identification Test (AUDIT) in psychiatric out-patients. Methods: Participants were a sample of consecutive patients at Imam Hossein Hospital (Tehran/Iran). They consisted of 99 patients, 49 of them diagnosed with alcohol dependency and 50 patients randomly selected from a sample of patients using alcohol but with other primary diagnoses. All statistics including means and standard deviations as well as medians and interquartile range were calculated in SPSS 24 software environment. Results: A Receiver Operating Curve analysis showed that by using a 20-point cut-off, the AUDIT had an optimal combination of sensitivity (.92) and specificity (.74). The rate of discrimination was .88. Conclusions: Given the high sensitivity and acceptable specificity of the AUDIT, the test can be used as an effective instrument for identification of alcohol use disorders in the Persian psychiatric out-patient population. Furthermore, the receiver operating curve found in this study resembles the one found in previous studies despite the differences in alcohol cultures between Iran and countries with higher alcohol consumption.

Excessive drinking is a major problem in Western countries. AUDIT (Alcohol Use Disorders Identification Test) is a 10-item questionnaire developed as a transcultural screening tool to detect excessive alcohol consumption and dependence in primary health care settings. The aim of the study is to validate a French version of the Alcohol Use Disorders Identification Test (AUDIT). We conducted a validation cross-sectional study in three French-speaking areas (Paris, Geneva and Lausanne). We examined psychometric properties of AUDIT as its internal consistency, and its capacity to correctly diagnose alcohol abuse or dependence as defined by DSM-IV and to detect hazardous drinking (defined as alcohol intake >30 g pure ethanol per day for men and >20 g of pure ethanol per day for women). We calculated sensitivity, specificity, positive and negative predictive values and Receiver Operator Characteristic curves. Finally, we compared the ability of AUDIT to accurately detect "alcohol abuse/dependence" with that of CAGE and MAST. 1207 patients presenting to outpatient clinics (Switzerland, n = 580) or general practitioners' (France, n = 627) successively completed CAGE, MAST and AUDIT self-administered questionnaires, and were independently interviewed by a trained addiction specialist. AUDIT showed a good capacity to discriminate dependent patients (with AUDIT > or =13 for males, sensitivity 70.1%, specificity 95.2%, PPV 85.7%, NPV 94.7% and for females sensitivity 94.7%, specificity 98.2%, PPV 100%, NPV 99.8%); and hazardous drinkers (with AUDIT > or =7, for males sensitivity 83.5%, specificity 79.9%, PPV 55.0%, NPV 82.7% and with AUDIT > or =6 for females, sensitivity 81.2%, specificity 93.7%, PPV 64.0%, NPV 72.0%). AUDIT gives better results than MAST and CAGE for detecting "Alcohol abuse/dependence" as showed on the comparative ROC curves. The AUDIT questionnaire remains a good screening instrument for French-speaking primary care.

Relation Between Self-Reported Physical Activity Level, Fitness, and Cardiometabolic Risk

BackgroundMany primary care patients with raised blood pressure or depression drink potentially hazardous levels of alcohol. Brief interventions (BI) to reduce alcohol consumption may improve comorbid conditions and reduce the risk of future alcohol problems. However, research has not established their effectiveness in this patient population. This study aimed to establish the feasibility of definitive trials of BI to reduce excessive drinking in primary care patients with hypertension or mild to moderate depression.MethodsThirteen general practices in North East England were randomized to the intervention or control arm of one of two parallel pilot trials. Adult patients drinking excessively and diagnosed with hypertension or mild-to-moderate depression received the Alcohol Use Disorders Identification Test (AUDIT) by postal survey. Consenting respondents scoring more than 7 on AUDIT (score range 0 to 40) received brief alcohol consumption advice plus an information leaflet (intervention) or an information leaflet alone (control) with follow-up at six months. Measurements included the numbers of patients eligible, recruited, and retained, and the AUDIT score and systolic/diastolic blood pressure of each patient or the nine-item Patient Health Questionnaire (PHQ-9) score. Acceptability was assessed via practitioner feedback and patient willingness to be screened, recruited, and retained at follow-up.ResultsIn the hypertension trial, 1709 of 33,813 adult patients (5.1%) were eligible and were surveyed. Among the eligible patients, 468 (27.4%) returned questionnaires; 166 (9.6% of those surveyed) screened positively on AUDIT and 83 (4.8% of those surveyed) were recruited (50.0% of positive screens). Sixty-seven cases (80.7% of recruited patients) completed follow-up at six months. In the depression trial, 1,044 of 73,146 adult patients (1.4%) were eligible and surveyed. Among these eligible patients, 215 (20.6%) responded; 104 (10.0% of those surveyed) screened positively on AUDIT and 29 (2.8% of those surveyed) were recruited (27.9% of positive screens). Nineteen cases (65.5% of recruited patients) completed follow-up at six months.ConclusionsRecruitment and retention rates were higher in the hypertension trial than in the depression trial. A full brief intervention trial appears feasible for primary care patients with hypertension who drink excessively. High AUDIT scores in the depression trial suggest the importance of alcohol intervention in this group. However, future work may require alternative screening and measurement procedures.Trial registrationCurrent Controlled Trials ISRCTN89156543; registered 21 October 2013.

Alcohol use disorders are common conditions that have enormous social and economic consequences. Genome-wide association analyses were performed to identify genetic variants associated with a proxy measure of alcohol consumption and alcohol misuse and to explore the shared genetic basis between these measures and other substance use, psychiatric, and behavioral traits. This study used quantitative measures from the Alcohol Use Disorders Identification Test (AUDIT) from two population-based cohorts of European ancestry (UK Biobank [N=121,604] and 23andMe [N=20,328]) and performed a genome-wide association study (GWAS) meta-analysis. Two additional GWAS analyses were performed, a GWAS for AUDIT scores on items 1-3, which focus on consumption (AUDIT-C), and for scores on items 4-10, which focus on the problematic consequences of drinking (AUDIT-P). The GWAS meta-analysis of AUDIT total score identified 10 associated risk loci. Novel associations localized to genes including JCAD and SLC39A13; this study also replicated previously identified signals in the genes ADH1B, ADH1C, KLB, and GCKR. The dimensions of AUDIT showed positive genetic correlations with alcohol consumption (rg=0.76-0.92) and DSM-IV alcohol dependence (rg=0.33-0.63). AUDIT-P and AUDIT-C scores showed significantly different patterns of association across a number of traits, including psychiatric disorders. AUDIT-P score was significantly positively genetically correlated with schizophrenia (rg=0.22), major depressive disorder (rg=0.26), and attention deficit hyperactivity disorder (rg=0.23), whereas AUDIT-C score was significantly negatively genetically correlated with major depressive disorder (rg=-0.24) and ADHD (rg=-0.10). This study also used the AUDIT data in the UK Biobank to identify thresholds for dichotomizing AUDIT total score that optimize genetic correlations with DSM-IV alcohol dependence. Coding individuals with AUDIT total scores ≤4 as control subjects and those with scores ≥12 as case subjects produced a significant high genetic correlation with DSM-IV alcohol dependence (rg=0.82) while retaining most subjects. AUDIT scores ascertained in population-based cohorts can be used to explore the genetic basis of both alcohol consumption and alcohol use disorders.