Identifying Aboriginal-specific AUDIT-C and AUDIT-3 cutoff scores for at-risk, high-risk, and likely dependent drinkers using measures of agreement with the 10-item Alcohol Use Disorders Identification Test.

Bianca Calabria,Anton Clifford,Anthony P Shakeshaft,Donna Bliss,Katherine M Conigrave,Julaine Allan,Lynette Simpson

doi:10.1186/1940-0640-9-17

Abstract

BackgroundThe Alcohol Use Disorders Identification Test (AUDIT) is a 10-item alcohol screener that has been recommended for use in Aboriginal primary health care settings. The time it takes respondents to complete AUDIT, however, has proven to be a barrier to its routine delivery. Two shorter versions, AUDIT-C and AUDIT-3, have been used as screening instruments in primary health care. This paper aims to identify the AUDIT-C and AUDIT-3 cutoff scores that most closely identify individuals classified as being at-risk drinkers, high-risk drinkers, or likely alcohol dependent by the 10-item AUDIT.MethodsTwo cross-sectional surveys were conducted from June 2009 to May 2010 and from July 2010 to June 2011. Aboriginal Australian participants (N = 156) were recruited through an Aboriginal Community Controlled Health Service, and a community-based drug and alcohol treatment agency in rural New South Wales (NSW), and through community-based Aboriginal groups in Sydney NSW. Sensitivity, specificity, and positive and negative predictive values of each score on the AUDIT-C and AUDIT-3 were calculated, relative to cutoff scores on the 10-item AUDIT for at-risk, high-risk, and likely dependent drinkers. Receiver operating characteristic (ROC) curve analyses were conducted to measure the detection characteristics of AUDIT-C and AUDIT-3 for the three categories of risk.ResultsThe areas under the receiver operating characteristic (AUROC) curves were high for drinkers classified as being at-risk, high-risk, and likely dependent.ConclusionsRecommended cutoff scores for Aboriginal Australians are as follows: at-risk drinkers AUDIT-C ≥ 5, AUDIT-3 ≥ 1; high-risk drinkers AUDIT-C ≥ 6, AUDIT-3 ≥ 2; and likely dependent drinkers AUDIT-C ≥ 9, AUDIT-3 ≥ 3. Adequate sensitivity and specificity were achieved for recommended cutoff scores. AUROC curves were above 0.90.

Highlights

The Alcohol Use Disorders Identification Test (AUDIT) is a 10-item alcohol screener that has been recommended for use in Aboriginal primary health care settings
Sample characteristics One hundred and fifty-six Aboriginal Australian participants took part in the surveys, of whom 20 were excluded from the analyses: 16 because they did not answer all 10 items of AUDIT, and 4 were excluded in error
A156 Aboriginal Australian participants took part in the surveys, of whom 20 were excluded from the analyses: 16 because they did not answer all 10 items of AUDIT, and four were excluded in error

Summary

Introduction

The Alcohol Use Disorders Identification Test (AUDIT) is a 10-item alcohol screener that has been recommended for use in Aboriginal primary health care settings. A key limitation of AUDIT for routine screening in Aboriginalspecific [7,15] and mainstream [16] health care settings has been the time it takes respondents to complete all 10 items. Two shorter versions of AUDIT, AUDIT-C (comprising the first three items of AUDIT) and AUDIT-3 (the third item of AUDIT), have been shown to perform well in identifying problem drinking when compared with a ‘gold standard’ measure of problem drinking, for example, with DSM-IV alcohol dependence criteria [17], in nonIndigenous-specific health care settings [14]

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