Alcohol Use Disorders Identification Test Items Research Articles

Alcohol use and its association with suicide attempt, suicidal thoughts and non-suicidal self-harm in two successive, nationally representative English household samples.

Alcohol use is a risk factor for suicidal behaviour, yet the nature of the relationship is unclear. Most research on the topic is conducted in clinical populations, with few studies exploring this association across the general population. We investigated the association between specific domains of alcohol use and suicide attempt, suicidal thoughts and non-suicidal self-harm in a general population sample. A total of 14 949 adults who completed the 2007 or 2014 Adult Psychiatric Morbidity Survey were included. We measured alcohol use with the Alcohol Use Disorders Identification Test (AUDIT). Domains of alcohol use relating to risk categories, weekly consumption, binge drinking, dependence symptoms, harmful effects and concern from others were derived from relevant AUDIT items. Self-reported past year suicide attempt, suicidal thoughts and non-suicidal self-harm were measured with the Clinical Interview Schedule, Revised. We found a linear association between total AUDIT score and outcomes. Three of six specific domains of alcohol use (dependence symptoms, harmful effects of drinking and binge drinking) were associated with increased odds of all three outcomes. There was no association of outcomes with the other domains of alcohol use. We found evidence of a linear association between total AUDIT score and suicide attempt, suicidal thoughts and non-suicidal self-harm in a representative English general population sample. Our analyses suggest that where alcohol use significantly disrupts day-to-day functioning, this may underpin the relationship between alcohol use and suicide-related outcomes to a greater extent than higher alcohol consumption. Longitudinal research is needed to further understand these relationships.

Excessive alcohol consumption and binge drinking in college students.

BackgroundBinge drinking (BD) refers to a pattern of alcohol consumption characterized by the consumption of large amounts of alcohol in a short period of time followed by periods of abstinence. This drinking pattern is prevalent worldwide, mainly among young people. Excessive alcohol consumption is the spectrum of consumption patterns that may have or have had health consequences, and includes the concepts of risky alcohol use, harmful alcohol use and alcohol dependence according to Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), the latter two are currently grouped into alcohol use disorder (AUD) according to the fifth edition of the DSM (DSM-5). Due to the high prevalence of BD among young people, especially university students, as well as the important consequences of its practice, a study was conducted to evaluate excessive alcohol consumption and its relationship with the practice of BD in university students.MethodsA cross-sectional study was conducted among students (aged 18–30 years) enrolled in the academic year 2018–2019 at the Faculty of Nursing at a university in northern Spain. Data collection included sociodemographic information, and alcohol use information, collected using a semi-structured questionnaire. To measure the excessive alcohol consumption, this study used the Alcohol Use Disorders Identification Test (AUDIT).ResultsA total of 142 participants were included, of which 88.03% were women. Up to 38.03% were classified as BD. Up to 14.77% of non-BD participants and 66.67% of BD participants were classified as risky drinkers (AUDIT Total geq 8 in men or geq 6 in women) (p < 0.001). Up to 3.41% of the non-BD and 24.07% of the BD were drinkers with harmful alcohol use and probable alcohol dependence (AUDIT Total geq 13) (p < 0.001). A total of 5.68% of non-BD and 42.59% of BD were AUD drinkers (AUDIT Total geq 9 in males or geq 8 in females) (p < 0.001). In addition, statistically significant differences were found between the BD and non-BD groups in the responses to each of the AUDIT items, as well as in the total score and also in the scores of the three domains of the questionnaire.ConclusionsExcessive alcohol consumption is frequent among university students, especially among those who practice BD.

The Alcohol Use Disorders Identification Test (AUDIT) in Adolescents: Using a Model-Based Approach to Identify Patterns of Alcohol Misuse

Objective To explore the latent structure of the Alcohol Use Disorders Identification Test (AUDIT) among adolescents of different school grades (age strata). Methods: Data derived from two simultaneous run cohort studies from the “Adolescent Nutritional Assessment Longitudinal Study-ELANA” conducted in private and public schools of Rio de Janeiro/Brazil. Participants comprised 564 seventh-graders and 419 ninth-graders, respectively sampled in 2011 and 2013 from cohort 1, and 730 eleventh-graders sampled in 2011 from cohort 2. Latent class factor analytical (LCFA) models were applied to the AUDIT items to identify internally homogeneous latent groups of individuals representing distinct patterns of alcohol use, and optimal group-separating cutoffs. The classification agreement was also evaluated. Results: Three and two groups (classes) were found for the eleventh and the earlier grades, respectively. These best-fitting models held a very high degree of class separation (entropy >0.9). By contrasting the AUDIT’s raw scores (0–10) with the model-based latent classes, the cutoff separating the base (milder) category was found between scores 0 and 1 in all grades. The eleventh-graders differed from the others by showing a third and more intense category of alcohol use (cutoff between 4 and 5). The classification agreement was almost perfect in eleventh-graders (98.6%) and perfect in the earlier grades (100%). Conclusions: Findings show that the AUDIT may be adequately used in adolescents of different ages and school grades, although the number of homogeneous categories may differ accordingly. Besides, raw scores may be pragmatically used to identify groups with confidence by applying specific optimal cutoffs.

Item-Level Genome-Wide Association Study of the Alcohol Use Disorders Identification Test in Three Population-Based Cohorts.

Genome-wide association studies (GWASs) of the Alcohol Use Disorders Identification Test (AUDIT), a 10-item screen for alcohol use disorder (AUD), have elucidated novel loci for alcohol consumption and misuse. However, these studies also revealed that GWASs can be influenced by numerous biases (e.g., measurement error, selection bias), which may have led to inconsistent genetic correlations between alcohol involvement and AUD, as well as paradoxically negative genetic correlations between alcohol involvement and psychiatric disorders and/or medical conditions. The authors used genomic structural equation modeling to elucidate the genetics of alcohol consumption and problematic consequences of alcohol use as measured by AUDIT. To explore these unexpected differences in genetic correlations, the authors conducted the first item-level and the largest GWAS of AUDIT items (N=160,824) and applied a multivariate framework to mitigate previous biases. The authors identified novel patterns of similarity (and dissimilarity) among the AUDIT items and found evidence of a correlated two-factor structure at the genetic level ("consumption" and "problems," rg=0.80). Moreover, by applying empirically derived weights to each of the AUDIT items, the authors constructed an aggregate measure of alcohol consumption that was strongly associated with alcohol dependence (rg=0.67), moderately associated with several other psychiatric disorders, and no longer positively associated with health and positive socioeconomic outcomes. Lastly, by conducting polygenic analyses in three independent cohorts that differed in their ascertainment and prevalence of AUD, the authors identified novel genetic associations between alcohol consumption, alcohol misuse, and health. This work further emphasizes the value of AUDIT for both clinical and genetic studies of AUD and the importance of using multivariate methods to study genetic associations that are more closely related to AUD.

Can the AUDIT consumption items distinguish lower severity from high severity patients seeking treatment for alcohol use disorder?

Brief screening tools based on the Alcohol Use Disorders Identification Test (AUDIT) consumption items (e.g., AUDIT-C and AUDIT-3) are commonly used in general medical settings to identify at-risk drinkers who may benefit from alcohol interventions. Conversely, in specialty alcohol treatment settings with a high volume of self-referrals, there may be a need for brief screening tools that can help to identify patients who are unlikely to require intensive treatments, but there has been little research on the use of AUDIT-C or AUDIT-3 in this context. The current study examined the utility of brief screeners comprised of the AUDIT consumption items for distinguishing lower-severity patients from high severity patients in a cohort of individuals self-referring to specialty alcohol treatment. Participants were adults seeking treatment for alcohol problems (N = 853) at a large public psychiatric hospital in Toronto, Canada, who completed the full 10-item AUDIT as part of an initial telephone screening with hospital staff. Results of receiver operating characteristic curve analyses showed that both the AUDIT-C and the AUDIT-3 demonstrated adequate accuracy (area under the curve; AUC > 0.85) for distinguishing lower-severity patients (defined as those in AUDIT zones I, II, and III) from high-severity patients (defined as those in AUDIT zone IV). Exploratory analyses showed that the addition of AUDIT item 4 (impaired control) to the AUDIT-C and AUDIT-3 significantly improved classification accuracy (AUCs = 0.95; ps < .001), and the resulting brief screeners had cut-points with good sensitivity and specificity (i.e., >80%). Results support the potential utility of brief screeners comprised of the AUDIT consumption items for distinguishing lower-severity from high severity individuals seeking specialty alcohol treatment services, which may assist with the initial screening and triage process. The addition of AUDIT item 4 improved the performance of the AUDIT-C and AUDIT-3 in this context. Future research validating these findings against external criteria, including comprehensive diagnostic information, is required.

Alcohol consumption of UK members of parliament: cross-sectional survey

ObjectivesThis study examined the prevalence of risky drinking by members of parliament (MPs), as well as the relationship between risky drinking and age, years spent as an MP, working outside...

Comparing short versions of the Alcohol Use Disorders Identification Test (AUDIT) in a military cohort

BackgroundThe Alcohol Use Disorders Identification Test (AUDIT) is widely used for monitoring harmful alcohol consumption among high-risk populations. A number of short versions of AUDIT have been developed for use...

Brief Counseling for Alcohol Misuse Among Trauma Patients: Two Interventions and Influence of Baseline Use

This study examined whether baseline trauma patient characteristics and randomized participation in 1 of 2 brief interventions predicted changes in alcohol use at 6 months postintervention. Higher total Alcohol Use Disorders Identification Test (AUDIT) scores predicted greater changes, and specific AUDIT items were significant predictors.

Identification of heavy drinking in the 10-item AUDIT: Results from a prospective study among 18–21 years old non-dependent German males

BackgroundAlcohol consumption is pivotal for the subsequent development of alcohol use disorders (AUD). The Alcohol Use Disorders Identification Test (AUDIT) is a recommended AUD screening tool for prevention and primary care settings. The objectives of this study were to test how many participants with heavy drinking are unidentified by the AUDIT, if proportions of unidentified participants vary over time, and whether this unidentified risk group (URG) was clinically relevant in terms of drinking behavior reports and AUD risk factors, as well as future adverse outcomes, such as craving, dependence symptoms, or depression. MethodsOur prospective cohort study followed 164 German males aged 18–19years without an alcohol dependence diagnosis over 24months. Only men were included due to higher AUD prevalence and gender-specific differences in metabolism, drinking patterns, and progression to AUD. All participants were screened via telephone interview and answered questionnaires both in person and via internet. Heavy drinking was classified using the AUDIT consumption score (AUDIT-C≥4.50). Standardized AUD diagnoses and symptoms, as well as alcohol use-related outcome criteria were assessed via standardized Composite International Diagnostic Interview (CIDI), and self-report questionnaires. ResultsOne in four participants (22–28% across all four follow-ups) reported heavy drinking but was unidentified by AUDIT total score (i.e. score<8), thus qualifying for URG status. The URG status did not fluctuate considerably across follow-ups (repeated-measures ANOVA, p=0.293). URG participants identified at the six-month follow-up did not generally differ from participants without URG status in terms of AUD family history or temperament (multivariate ANOVA, p=0.114), except for anxiety sensitivity (pBonferroni<0.001). After two years, URG participants reported a similar level of adverse outcomes compared to low-risk participants (multivariate ANOVA, p=0.438), but less alcohol-related problems and less loss of control due to craving compared to high-risk participants (pBonferroni≤0.007). ConclusionsDespite the considerable number of heavy-drinking individuals unidentified by AUDIT total scores, an additional classification according to AUDIT-C values did not prove useful. Combining AUDIT and AUDIT-C scores might not be sufficient for identifying AUD risk groups among young adult German males. There is an urgent need for a replication of our findings among female participants.

The Alcohol Use Disorders Identification Test (AUDIT): A review of graded severity algorithms and national adaptations

Babor, T., &amp; Robaina, K. (2016). The Alcohol Use Disorders Identification Test (AUDIT): A review of graded severity algorithms and national adaptations. The International Journal Of Alcohol And Drug Research, 5(2), 17-24. doi:http://dx.doi.org/10.7895/ijadr.v5i2.222Aims: Since it was first released in 1989, the Alcohol Use Disorders Identification Test (AUDIT) has generated a large amount of research to evaluate its psychometric properties. The purpose of this review is to critically evaluate the literature relevant to applications of the AUDIT in screening, brief intervention, and treatment referral programs, and identify national adaptations of the AUDIT to country-specific health, education, and reimbursement needs.Methods: Methods comprised a search of the world literature published since 2004, combined with review articles published since 1997.Findings: We identified 431 studies of the AUDIT, including 386 articles, 26 review papers, and 11 book chapters since 2004, with a six-fold increase in the last decade. The factor structure of the AUDIT items remains unclear, but the weight of evidence supports a two-factor model. Despite the translation of the AUDIT into numerous languages, the alcohol consumption questions were rarely adapted to suit cultural or national conditions. Although numerous studies have supported the recommended cutoff thresholds for a possible alcohol use disorder, only three studies evaluated the classification accuracy of the AUDIT’s graded severity system.Conclusions: Further development of the AUDIT score’s severity zones is needed to guide intervention selection in clinical settings.

The Alcohol Use Disorders Identification Test (AUDIT): A review of graded severity algorithms and national adaptations

Babor, T., &amp; Robaina, K. (2016). The Alcohol Use Disorders Identification Test (AUDIT): A review of graded severity algorithms and national adaptations. The International Journal Of Alcohol And Drug Research, 5(2), 17-24. doi:http://dx.doi.org/10.7895/ijadr.v5i2.222Aims: Since it was first released in 1989, the Alcohol Use Disorders Identification Test (AUDIT) has generated a large amount of research to evaluate its psychometric properties. The purpose of this review is to critically evaluate the literature relevant to applications of the AUDIT in screening, brief intervention, and treatment referral programs, and identify national adaptations of the AUDIT to country-specific health, education, and reimbursement needs.Methods: Methods comprised a search of the world literature published since 2004, combined with review articles published since 1997.Findings: We identified 431 studies of the AUDIT, including 386 articles, 26 review papers, and 11 book chapters since 2004, with a six-fold increase in the last decade. The factor structure of the AUDIT items remains unclear, but the weight of evidence supports a two-factor model. Despite the translation of the AUDIT into numerous languages, the alcohol consumption questions were rarely adapted to suit cultural or national conditions. Although numerous studies have supported the recommended cutoff thresholds for a possible alcohol use disorder, only three studies evaluated the classification accuracy of the AUDIT’s graded severity system.Conclusions: Further development of the AUDIT score’s severity zones is needed to guide intervention selection in clinical settings.

The Alcohol Use Disorders Identification Test (AUDIT): A review of graded severity algorithms and national adaptations

Babor, T., &amp; Robaina, K. (2016). The Alcohol Use Disorders Identification Test (AUDIT): A review of graded severity algorithms and national adaptations. The International Journal Of Alcohol And Drug Research, 5(2), 17-24. doi:http://dx.doi.org/10.7895/ijadr.v5i2.222Aims: Since it was first released in 1989, the Alcohol Use Disorders Identification Test (AUDIT) has generated a large amount of research to evaluate its psychometric properties. The purpose of this review is to critically evaluate the literature relevant to applications of the AUDIT in screening, brief intervention, and treatment referral programs, and identify national adaptations of the AUDIT to country-specific health, education, and reimbursement needs.Methods: Methods comprised a search of the world literature published since 2004, combined with review articles published since 1997.Findings: We identified 431 studies of the AUDIT, including 386 articles, 26 review papers, and 11 book chapters since 2004, with a six-fold increase in the last decade. The factor structure of the AUDIT items remains unclear, but the weight of evidence supports a two-factor model. Despite the translation of the AUDIT into numerous languages, the alcohol consumption questions were rarely adapted to suit cultural or national conditions. Although numerous studies have supported the recommended cutoff thresholds for a possible alcohol use disorder, only three studies evaluated the classification accuracy of the AUDIT’s graded severity system.Conclusions: Further development of the AUDIT score’s severity zones is needed to guide intervention selection in clinical settings.

Screening accuracy of brief alcohol screening instruments in a general hospital setting.

The aim of this study was to examine the screening accuracy of four brief alcohol screening instruments in a general hospital setting. Ten outpatient clinics were recruited to ensure a representative mix of demographics (e.g. sex, age and diagnosis). The staff at the reception desk handed out pre-sorted envelopes with questionnaires and information letters to the visitors. The questionnaires consisted of the 10-item Alcohol Use Disorders Identification Test (AUDIT), the Weekly Consumption Question (WCQ), the Heavy Episodic Drinking (HED) question and two questions on sex and age. Sensitivity and specificity were calculated for the AUDIT-C, AUDIT-3, WCQ and HED using the full 10-item AUDIT for comparison, with cut-off points of ⩾6 for women and ⩾8 for men. In all, 898 questionnaires were included (52% women). According to the full AUDIT, 12.0% of the women and 14.8% of the men were drinking above the hazardous level. Corresponding percentages for the brief screening instruments for women and men, respectively, were as follows: AUDIT-C: 17.2% and 27.4%; the AUDIT-3: 6% and 16.2%; the WCQ: 2% and 1.6%; and the HED screener: 12.9% and 21.2%. CONCLUSIONS THE AUDIT-C MAY BE USED AS A BRIEF SCREENER IN A GENERAL HOSPITAL SETTING THE WCQ, AS A STAND-ALONE SCREENING TOOL, MAY UNDERESTIMATE HAZARDOUS DRINKING HABITS SCREENING RESULTS FROM THE AUDIT-3 AND THE HED SHOULD BE INTERPRETED WITH CAUTION WHEN APPLIED TO WOMEN BECAUSE OF THE RISK OF UNDERESTIMATION.

Heavy alcohol use in patients on highly active antiretroviral therapy: What responses are needed?

Alcohol has a negative effect on antiretroviral therapy (ART) adherence and HIV treatment outcomes. As part of formative work for a project to test the efficacy of an alcohol-focused intervention to reduce alcohol consumption and improve HIV treatment outcomes, we investigated the extent of problem drinking among patients at ART clinics in Tshwane, South Africa (SA), using the Alcohol Use Disorders Identification Test (AUDIT). The finding that a third of drinkers reported hazardous drinking, roughly 10% reported harmful drinking, and a further 10% were possibly alcohol dependent replicates the findings of similar research in the Western Cape and Gauteng provinces of SA. It also points to the need for more routine screening of ART patients for problematic alcohol use. The 10-item AUDIT may be too time consuming for health workers in busy ART clinics to administer and score, necessitating even briefer screening instruments for assessing hazardous and harmful drinking.

Evaluating Shortened Versions of the AUDIT as Screeners for Alcohol Use Problems in a General Population Study

Background: Efficient alcohol screening measures are important to prevent or treat alcohol use disorders (AUDs). Objectives: We studied different versions of the Alcohol Use Disorders Identification Test (AUDIT) comparing their performance to the full AUDIT and an AUD measure as screeners for alcohol use problems in Goa, India. Methods: Data from a general population study on 743 male drinkers aged 18–49 years are reported. Drinkers completed the AUDIT and an AUD measure. We created shorter versions of the AUDIT by (a) collapsing AUDIT item responses into three and two categories and (b) deleting two items with the lowest factor loadings. Each version was evaluated using factor, reliability and validity, and differential item functioning (DIF) analysis by age, education, standard of living index (SLI), and area of residence. Results: A single factor solution was found for each version with lower factor loadings for items on guilt and concern. There were no significant differences among the different AUDIT versions in predicting AUD. No significant DIF was found by education, SLI or area of residence. DIF was observed for the alcohol frequency item by age. Conclusions/Importance: The AUDIT may be used with dichotomized response options without loss of predictive validity. A shortened eight-item dichotomized scale can adequately screen for AUDs in Goa when brevity is of paramount importance, although with lower predictive validity. Although the frequency item was endorsed more by older men, there is no evidence that the AUDIT items perform differently in other groups of male drinkers in Goa.

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.

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.

The 5-item Alcohol Use Disorders Identification Test (AUDIT-5): An Effective Brief Screening Test for Problem Drinking, Alcohol Use Disorders and Alcohol Dependence

To identify an optimal brief version of the Alcohol Use Disorders Identification Test (AUDIT) and to evaluate its effectiveness as a screening test for problem drinking (PD), alcohol use disorders (AUD) and alcohol dependence (AD). A multicenter trial was conducted from March, 2010, to January, 2012, in 101 normal comparison, 203 risky drinking, 92 alcohol abuse and 101 AD men aged below 65 years of age in a Korean population. For the purposes of screening, risky drinking, alcohol abuse and AD were grouped: all the three grouped as PD and the latter two grouped as AUD. Logistic regression analysis was used to determine the items among the 10-item AUDIT that provided information predictive of PD, AUD and AD. Receiver operating characteristic (ROC) curve analysis was performed to investigate the discrimination ability of the brief versions of AUDIT, 10-item AUDIT and Cut-down, Annoyed, Guilt, Eye-opener as a screen for PD, AUD and AD. Areas under the ROC curve were compared between tests according to the method suggested by Hanley and McNeil. The 5-item AUDIT (AUDIT-5: AUDIT items 2, 4, 5, 9 and 10) was obtained by stepwise multiple regression analyses for each screening. AUDIT-5 exhibited an AUD screening accuracy significantly superior to that of the 10-item AUDIT, but other brief versions of AUDIT and CAGE did not. Furthermore, AUDIT-5 had a high PD and AD screening accuracy equivalent to that of the 10-item AUDIT. These results strongly support the usefulness of AUDIT-5 for screening of PD, AUD and AD in clinical settings in Korean male populations.

Brief alcohol screening in a clinical psychiatric population: Special attention needed

Abbreviated versions of the Alcohol Use Disorders Identification Test (AUDIT) and single-item screeners show promising results but have not previously been investigated in a clinical psychiatric setting. The aim of the present study was to investigate the capacity of three brief screening methods to detect hazardous drinking in a psychiatric treatment-seeking population. Data were collected from consecutive patients (n = 1811) visiting a general psychiatric clinic. The screening capacity of the heavy episodic drinking (HED) screener, AUDIT item # 3 (AUDIT-3) and the three consumption items of AUDIT (AUDIT-C) was compared to the result of the full 10-item AUDIT with cut-off points 6 for women and 8 for men. The HED screener and AUDIT-3 with recommended cut-offs captured low rates of hazardous drinkers when compared to the full AUDIT. Lowering the cut-offs created rates far above those of the full AUDIT. AUDIT-C with recommended cut-off limits categorised nearly the same rates of men as the full AUDIT but much higher rates of women. Raising the cut-off for women approached the detection rate of AUDIT-C closely to that of the full AUDIT. The findings of this study suggest that the HED screener is not sensitive enough in the clinical psychiatric setting. When designing alcohol screening measures to be used all over health-care organisations, special attention should be paid to psychiatric patients. If a somewhat more extensive screening tool is used, the full AUDIT is recommended.

Screening Patients in Busy Hospital-Based HIV Care Centers for Hazardous and Harmful Drinking Patterns: The Identification of an Optimal Screening Tool

Because many HIV care providers fail to detect patients' hazardous drinking, we examined the potential use of the AUDIT-C, the first 3 of the 10 items comprising the Alcohol Use Disorders Identification Test (AUDIT), to efficiently screen patients for alcohol abuse. To perform this examination, we used Item Response Theory (IRT) involving individual AUDIT items and AUDIT instruments completed by patients (N = 400) at a Designated AIDS Center (DAC) in New York City. At various AUDIT-C cutoff scores, specificities and sensitivities were then examined using the AUDIT as a ''gold standard.'' For cutoff scores on the AUDIT from 4 to 8, cutoff scores on the AUDIT-C of 3 and 4, respectively, resulted in sensitivities between .94-.98 and .81-.89, respectively, and specificities between .82-.91 and .91-1.0, respectively. In busy HIV care centers, the AUDIT-C with cutoff scores of 3 or 4 is a reasonable alternative to the full AUDIT as an alcohol screening instrument.

The Alcohol Use Disorders Identification Test revisited: Establishing its structure using nonlinear factor analysis and identifying subgroups of respondents using latent class factor analysis

Background Previous research used principal components as well as exploratory and confirmatory factor analysis to establish continuous dimensions underlying answers to the 10-items of the Alcohol Use Disorders Identification Test (AUDIT). The majority of these studies conclude that one consumption dimension and an adverse consequences dimension explain the answers to the AUDIT sufficiently. However, most of the methods used presuppose normal answer distributions and linear relations between indicators and constructs, which are unrealistic assumptions for AUDIT answer. Objectives First, to investigate the continuous factor analytic structure underlying the answers to all AUDIT items. Second and third, to assess the impact of consumption as well as age and gender on AUDIT consequences dimension. Fourth and fifth, to categorize respondents into subgroups based on the AUDIT consequences items and adjusting the subgroups for differences in consumption, age and gender. Sixth, to describe the subgroups with respect to further adverse consequences of drinking. Methods Nonlinear factor and latent class factor analyses models were applied to the AUDIT answers of N = 6259 patients of 26 general practitioners in a city area in Germany. Consumption items as well as age and gender were included as predictors of answers to the AUDIT consequences items. Results Nonlinear factor analyses suggested two continuous correlated factors reflecting the adverse consequences of alcohol use: (1) harmful alcohol use, (2) alcohol dependence (aim 1). Consumption items did not prove to be reasonable construct indicators, but adverse consequences were predicted by consumption (aim 2), and also by age and gender (aim 3). Latent class factor analysis identified four subgroups based on the AUDIT consequences items (aim 4): one not affected (66%), and three subgroups defined by either harmful (15%) or dependent (9%), or combined harmful and dependent use (10%). These groups differed also with respect to further alcohol use consequences. Adjusting the subgroups for differences in consumption, age and gender (aim 5) reduced the non-affected subgroup and increased the subgroup with harmful and dependent use. Conclusions The AUDIT items cover three separable domains, i.e. consumption, harmful and dependent use, as originally intended. Hence, assessment of alcohol use does not substitute for assessing adverse consequences, as assumed in short versions of the AUDIT comprising only the AUDIT consumption items. Further, the dimensional as well as the LCFA subgroup solution imply that the respondents cannot be ordered along a single severity dimension without loss of information.