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CORK Bibliography: Alcohol Use Disorders Screening Test (AUDIT)

59 citations. January 2003 to present

Prepared: March 2008

Aalto M; Hyvonen S; Seppa K. Do primary care physicians' own AUDIT scores predict their use of brief alcohol intervention? A cross-sectional survey. Drug and Alcohol Dependence 83(2): 169-173, 2006. (15 refs.)

Background: To define whether the Alcohol Use Disorders Identification Test (AUDIT) scores of primary care physicians themselves predict their willingness to use brief alcohol intervention. Methods: Cross-sectional self-administered questionnaire survey to all 3193 physicians providing primary health care in Finland. The response rate was 1909 (59.8%). Odds ratios from multinomial regression analysis were calculated for self-reported frequency (never, occasionally or regularly) of conducting brief interventions by physicians with AUDIT scores of 0-1, 2, 3, 4, 5-7 or >= 8. Results: The prevalence of heavy drinkers based on AUDIT score (>= 8) was 14.5% among all physicians, 7.0% among females and 27.0% among males. Of the respondents 9.4% reported doing brief intervention regularly and 50.0% occasionally. AUDIT scores did not significantly predict either regular or occasional use of brief intervention. Instead, some other independent predictors for more frequent use of brief intervention were found. These included having a specialist licence in general practice or occupational health care and the location of the practice, but not gender or age. Conclusions: The present results indicate that in general heavy drinking among primary care physicians do not explain the low frequency with which brief intervention is used in primary health care.

Aalto M; Seppa K. Use of laboratory markers and the AUDIT questionnaire by primary care physicians to detect alcohol abuse by patients. Alcohol and Alcoholism 40(6): 520-523, 2005. (14 refs.)

Aims: To evaluate how often laboratory markers [Mean corpuscular volume (MCV), Gamma-glutamyl transferase, Aspartate aminotransferase, Alanine aminotransferase, or Carbohydrate-deficient transferrin (CDT)] and the Alcohol Use Disorders Identification Test (AUDIT) are used to detect alcohol abuse in primary health care. Methods: Cross-sectional self-administered questionnaire survey to all 3193 primary health care physicians in Finland. Response rate was (65.7%). Results: CDT was used at least occasionally by 43.4% of the physicians. Corresponding figures were 53.4% for conventional alcohol laboratory markers (MCV, transaminases) and 67.0% for AUDIT. Almost all the respondents used some laboratory marker to detect alcohol abuse. The use of brief alcohol intervention was associated with the greater likelihood that a physician uses different methods to detect alcohol abuse. The data also indicates that gender, age, and having a specialist licence influence activity in using different methods. Conclusions: Considering the ambivalences in relation to alcohol issues in health care, the use of CDT and AUDIT are reasonably frequent. This may indicate that tools to facilitate the work may also help in adapting new activities.

Adewuya AO. Validation of the Alcohol Use Disorders Identification Test (AUDIT) as a screening tool for alcohol-related problems among Nigerian university students. Alcohol and Alcoholism 40(6): 575-577, 2005. (15 refs.)

Aims: To investigate the screening properties of the alcohol use disorders identification test (AUDIT) in the detection of alcohol-related problems among Nigerian university students. Methods: Eight hundred and ten students completed the AUDIT. A percentage of them were assessed for alcohol-related diagnosis with structured clinical interview. Results: The AUDIT at cut-off of 5 and above could clearly identify participants with alcohol-related problems with sensitivity of 0.935 and specificity of 0.915. Conclusions: The AUDIT is a valid instrument for screening for alcohol-related problems in Nigerian university students.

Au DH; Kivlahan DR; Bryson CL; Blough D; Bradley KA. Alcohol screening scores and risk of hospitalizations for GI conditions in men. Alcoholism: Clinical and Experimental Research 31(3): 443-451, 2007. (56 refs.)

Background: Alcohol misuse is a common cause of liver disease, upper gastrointestinal (GI) bleeding, and pancreatitis, but it is not known whether alcohol screening questionnaires can identify patients at increased risk for hospitalizations due to these conditions. Objective: To evaluate the association of alcohol screening scores with the risk of subsequent hospitalization for alcohol-related GI conditions. Design: Retrospective cohort study. Participants: Male general medicine outpatients from 7 Veterans Affairs (VA) medical centers who returned mailed questionnaires. Measurements: The CAGE questionnaire (0-4 points) and the Alcohol Use Disorders Identification Test-Consumption questions (AUDIT-C; 0-12 points) were included on mailed surveys. The main outcome, "GI hospitalization," was a primary VA or Medicare discharge diagnosis indicating liver disease, upper GI bleeding, or pancreatitis. Results: Among 31,311 patients followed, a median of 3.75 years, patients with CAGE scores >= 2 points or AUDIT-C scores >= 6 points were at a significantly increased risk for GI hospitalizations. Adjusted hazard ratios (HRadj) ranged from 1.6 (95% CI 1.2-2.0) for CAGE score 2, to 1.7 (1.4-2.2) for CAGE 4, and from 1.4 (1.01-2.0) for AUDIT-C scores from 6 to 7, to 2.7 (1.9-3.8) for AUDIT-C scores from 10 to 12. Secondary analyses demonstrated that the association was the strongest among patients less than 50 years of age who reported drinking in the past year. Conclusions: Brief alcohol screening questionnaires predict subsequent hospitalizations for alcohol-related GI conditions.

Bazargan-Hejazi S; Bing E; Bazargan M; Der-Martirosian C; Hardin E; Bernstein J et al. Evaluation of a brief intervention in an inner-city emergency department. Annals of Emergency Medicine 46(1): 67-76, 2005. (56 refs.)

Study objective: This study tests the effect of a brief intervention with emergency department (ED) patients to reduce at-risk drinking. Methods: We enrolled patients aged 18 years or older who screened positive for at-risk drinking in an urban academic ED and used alternative allocation to assign them to control or intervention status. A 20-minute, semiscripted, negotiated interview was conducted with the intervention group in English and Spanish by 3 health promotion advocates (peer educators). The Alcohol Use Identification Test (AUDIT) was administered at baseline and 3 months after enrollment. Results: Among 1,036 patients screened for at-risk drinking, 295 with CAGE questionnaire score greater than I and no alcohol treatment in the past year enrolled in the study and were randomly assigned to the control arm (n=151) or the intervention arm (n=144). Follow-up was achieved with 88 patients in the intervention group and 97 patients in the control group (63% of enrollees). Among the 185 patients followed up, 64% of the intervention group versus 80% of the control group scored greater than 7 on the follow-up AUDIT (scored on a scale of 1 to 40; P <.05, odds ratio [OR] 2.35, 95% confidence interval [CI] 1.21 to 4.55). Multinomial logistic regression analysis demonstrates, after controlling for demographic characteristics and other independent variables, that assignment to intervention status decreased the odds of at-risk (moderate) drinking as defined by AUDIT scores of 7 to 18 (OR 0.42, P <.05, 95% Cl 0.19 to 0.91) but did not affect patients with AUDIT scores in the 19 to 40 range. Conclusion: Brief motivational intervention administered by peer educators to ED patients appears to reduce moderately risky drinking and associated problems.

Bernards S; Graham K; Demers A; Kairouz S; Wells S. Gender and the assessment of at-risk drinking: Evidence from the GENACIS Canada (2004-2005) telephone survey version of the AUDIT. Drug and Alcohol Dependence 88(2/3): 282-290, 2007. (33 refs.)

The alcohol use disorders identification test (AUDIT) is widely used in general population surveys as a method of determining prevalence of hazardous drinking. However, its interpretation has been questioned particularly regarding the unequal contribution of the items to the total score, specifically, that the drinking frequency item contributes disproportionately to the score and may lead to inappropriate identification of some drinkers as hazardous drinkers. To explore these issues further as well as possible gender differences in the applicability of the AUDIT, we conducted analyses using a modified version of the AUDIT (AUDIT(M)) as part of a general population survey that used random digit dialing and computer-assisted telephone interviewing. Item and factor analyses were performed separately for men and women, and the impacts of excluding the frequency of drinking item in the measurement of mean scores, percentages and types of problems for men and women were examined. We found that the AUDIT(M) items loaded onto three distinct dimensions for both men and women: frequency of drinking; usual quantity and frequency of heavy-episodic drinking; problem consequences from drinking. In addition, we found that excluding the frequency question may give a more meaningful estimate of the percent of drinkers actually at risk of experiencing problems from drinking for both men and women. Finally, although our analyses identified only minor gender differences in the structure of the AUDIT and good sensitivity for identifying problem drinkers among both men and women, significant gender differences in the types of problems experienced suggest that use and interpretation of the AUDIT should routinely take gender into consideration.

Bischof G; Grothues J; Reinhardt S; John U; Meyer C; Ulbricht S et al. Alcohol screening in general practices using the AUDIT: How many response categories are necessary? European Addiction Research 13(1): 25-30, 2007. (20 refs.)

Aims: The Alcohol Use Disorders Identification Test (AUDIT) is a common screening instrument. This study analyses if response categories of the AUDIT might be dichotomized without affecting the psychometric properties of the questionnaire. Methods: Participants between 18 and 65 years were recruited from general practices in two northern German cities. In total, 10,803 screenings were conducted (refusal rate: 5.9%). For those who were screened positive, the Munich-Composite International Diagnostic Interview (MCIDI) was used for identification of 12-month Alcohol Use Disorders and at-risk consumption (exceeding 20/30 g per day). Abstinent subjects and screening positives without diagnostic interview were excluded from the analysis, leaving a sample of 7,112 subjects. ROC-Curves were calculated separately for each item in order to identify an optimal cut-off value. Finally, a version of the AUDIT based on dichotomized items was compared to the original version and its short-form, the AUDIT version based on three questions dealing with consumption AUDIT-C. Results: As an optimal cut-off value for items on consumption, drinking at least once a week, having more than 1-2 drinks per occasion, and drinking 6 or more drinks in one sitting at least once a month were identified. For all questions on alcohol-related problems or dependence symptoms, having 'ever occurred' differed best between subjects with and without Alcohol Use Disorders or at-risk consumption. Sensitivity and specificity of the dichotomized version of the AUDIT did not differ from the original version, and both full versions performed superior compared to the AUDIT-C. Conclusion: Data indicate that the AUDIT response categories may be dichotomized without affecting its validity.

Bischof G; Reinhardt S; Grothues J; Dybek I; Meyer C; Hapke U et al. Effects of item sequence on the performance of the AUDIT in general practices. Drug and Alcohol Dependence 79(3): 373-377, 2005. (23 refs.)

Background: One important task in identifying subjects with alcohol use disorders (AUDs) in the general medical practice setting is the development of effective screening instruments. Sensitivity of screening questionnaires might differ according to the introductory items. This study compares two versions of the Alcohol Use Disorders Identification Test (AUDIT) with varied item sequence randomly applied to patients derived from a sample of general practitioners (GP) patients. Methods: Participants were recruited from general practices in two northern German cities; they received two different versions of the AUDIT, one group receiving the original version starting with three items addressing frequency and quantity of alcohol use (AUDIT1), and a second group receiving a version in which these items were put at the end of the questionnaire (AUDIT2). In total, 10.803 screenings were conducted (refusal rate: 5%). Alcohol use disorders were diagnosed using the Munich-Composite International Diagnostic Interview (M-CIDI). Results: Logistic regression analysis revealed that AUDIT1 subjects had higher scores in the consumption items of the AUDIT, whereas AUDIT2 subjects scored higher on items focussing on symptoms of alcohol dependence or abuse. Conclusion: The sequence upon which items of the AUDIT are presented influences the report of drinking patterns and symptoms of alcohol use disorders in GP patients.

Bradley KA; Bush KR; Epler AJ; Dobie DJ; Davis TM; Sporleder JL et al. Two brief alcohol-screening tests from the Alcohol Use Disorders Identification Test (AUDIT): Validation in a female Veterans Affairs patient population. Archives of Internal Medicine 163(7): 821-829, 2003. (59 refs.)

Background: Primary care physicians need a brief alcohol questionnaire that identifies hazardous drinking and alcohol use disorders. The Alcohol Use Disorders identification Test (AUDIT) questions 1 through 3 (AUDIT-C), and AUDIT question 3 alone are effective alcohol-screening tests in male Veterans Affairs (VA) patients, but have not been validated in women. Methods: Female VA patients (n = 393) completed self-administered questionnaires, including the 10-item AUDIT and a previously proposed modification to AUDIT question 3 with a sex-specific threshold for binge drinking (greater than or equal to 4 drinks/occasion), and in-person interviews with the Alcohol Use Disorder and Associated Disabilities Interview Schedule. The AUDIT-C, AUDIT question 3 alone, and the 10-item AUDIT were each evaluated with and without the sex-specific binge question and compared with past-year hazardous drinking (> 7 drinks/week or :4 drinks/occasion) and/or active Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition alcohol abuse or dependence, based on interviews. Results: Eighty-nine women (22.6%) met interview criteria for past-year hazardous drinking and/or active alcohol abuse or dependence. Standard and sex-specific AUDIT-Cs were sensitive (0.81 and 0.84, respectively) and specific (0.86 and 0.85, respectively). Their areas under the receiver operating characteristic curves were equivalent (0.91, and 0.92, respectively) and slightly higher than for the standard 10-item AUDIT (0.87). A single, sex-specific question about binge drinking (modified AUDIT question 3) had a sensitivity of 0.69 and specificity of 0.94, whereas the standard AUDIT question 3 was specific (0.96) but relatively insensitive (0.45). Conclusions: The standard and sex-specific AUDIT-Cs are effective screening tests for past-year hazardous drinking and/or active alcohol abuse or dependence in female patients in a VA study.

Bradley KA; Williams EC; Achtmeyer CE; Volpp B; Collins BJ; Kivlahan DR. Implementation of evidence-based alcohol screening in the veterans health administration. American Journal of Managed Care 12(10): 597-606, 2006. (57 refs.)

Background: Despite evidence-based guidelines, brief alcohol screening and counseling have not been routinely integrated into most primary care practices in the United States. Objective: To describe the results of the implementation of evidence-based alcohol screening by the Veterans Health Administration (VA) in 2004, as the first step toward implementation of brief alcohol counseling. Study Design: This observational study of outpatients from all 21 VA networks relied on the following 2 data sources from the VA Office of Quality and Performance: (1) Medical record reviews, designed to compare VA networks quarterly, evaluated whether established VA patients had documented screening for alcohol misuse and documented follow-up assessment for alcohol use disorders among those who screened positive for alcohol misuse (January-March 2005); and (2) Mailed patient satisfaction surveys from 2004, which oversampled patients new to the VA (response rate, > 70%), included the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questions and asked about past-year advice "to drink less or not to drink alcohol" from a VA provider. Results: Based on 10,115 medical record reviews, 93% (range, 89%-96% across networks) of outpatients were screened for alcohol misuse, and 25% (range, 11%-36%) screened positive. Among screen-positive patients, 42% (range, 5%-84%) had documented follow-up assessment, but absolute numbers of screen-positive patients evaluated were small (27-80 patients per network). Based on 235,481 patient surveys, the prevalence of alcohol misuse was 22% (range, 15%-27% across networks), and 28% (range, 20%-36%) of screen-positive patients reported receiving alcohol-related advice. Alcohol-related advice increased as AUDIT-C scores increased. Conclusion: The VA successfully implemented evidence-based alcohol screening, but the rate of follow-up among screen-positive patients remained low.

Bush KR; Kivlahan DR; Davis TM; Dobie DJ; Sporleder JL; Epler AJ et al. The TWEAK is weak for alcohol screening among female Veterans Affairs outpatients. Alcoholism: Clinical and Experimental Research 27(12): 1971-1978, 2003. (57 refs.)

Background: The optimal brief questionnaire for alcohol screening among female patients has not yet been identified. This study compared the performance of the TWEAK (tolerance, worried, eye-opener, amnesia, cutdown), the Alcohol Use Disorders Identification Test (AUDIT), and the AUDIT Consumption (AUDIT-C) as self-administered screening tests for hazardous drinking and/or active alcohol abuse or dependence among female Veterans Affairs (VA) outpatients. Methods: Women were included in the study if they received care at VA Puget Sound and completed both a self-administered survey containing the AUDIT and TWEAK screening questionnaires and subsequent in-person inter-views with the Alcohol Use Disorders and Associated Disabilities Interview Schedule. Sensitivities, specificities, positive and negative likelihood ratios, and areas under Receiver Operating Characteristic curves were computed for each screening questionnaire compared with two interview-based comparison standards: (1) active DSM-IV alcohol abuse or dependence and (2) hazardous drinking and/or active DSM-IV alcohol abuse or dependence, the more appropriate target for primary care screening. Results: Of 393 women who completed screening questionnaires and interviews, 39 (9.9%) met diagnostic criteria for alcohol abuse or dependence, and 89 (22.7%) met criteria for hazardous drinking or alcohol abuse or dependence. The TWEAK had relatively low sensitivities (0.62 and 0.44) but adequate specificities (0.86 and 0.89) for both interview-based comparison standards, even at its lowest cut-point ( 1). The AUDIT and AUDIT-C were superior, with the following areas under the receiver operating characteristic curve for active alcohol abuse or dependence and hazardous drinking and/or active alcohol abuse or dependence, respectively: AUDIT, 0.90 [95% confidence interval (CI), 0.85-0.95] and 0.87 (95% CI, 0.84-0.91); AUDIT-C, 0.91 (95% CI, 0.88-0.95) and 0.91 (95% CI, 0.88-0.94); and TWEAK, 0.76 (95% CI, 0.66-0.86) and 0.67 (95% CI, 0.60-0.74).Conclusions: The TWEAK has low sensitivity as an alcohol-screening questionnaire among female VA outpatients and should be evaluated further before being used in other female primary care populations. The three-item AUDIT-C was the optimal brief alcohol-screening questionnaire in this study.

Carey KB; Carey MP; Chandra PS. Psychometric evaluation of the Alcohol Use Disorders Identification Test and Short Drug Abuse Screening Test with psychiatric patients in India. Journal of Clinical Psychiatry 64(7): 767-774, 2003. (35 refs.)

This study evaluated the factor structure, reliability, validity, and utility of the AUDIT and the DAST-10 in an Indian psychiatric hospital. Consecutive inpatient admissions from April to December 2001 were sampled. Patients were diagnosed with substance use disorders or psychiatric disorders according to ICD-10 criteria. All patients completed both the AUDIT and the DAST-10 during their intake evaluation. Of the 2286 admissions to the hospital, 1349 were enrolled in the study; 361 patients had primary substance use disorders and 988 patients had primary psychiatric disorders. Both the AUDIT and the DAST-10 were unidimensional and internally consistent. Total scores significantly differentiated the subsamples with primary substance use from those with primary psychiatric disorders (p < .001). Using cutoff scores equal to or greater than 8 on the AUDIT and equal to or greater than 3 on the DAST-10, 10% (n = 100) of the psychiatric subsample exceeded either cutoff, whereas 99% (n = 358) of the addiction treatment subsample exceeded 1 or both cutoffs. Within the psychiatric subsample, 77% (n = 65) of the patients who were identified as high risk on the AUDIT did not receive an additional alcohol use disorder diagnosis at discharge, and 59% (n = 16) of those identified as high risk on the DAST-10 did not receive an additional discharge diagnosis of drug use disorder. The AUDIT and the DAST-10 demonstrate strong psychometric properties when used in an Indian psychiatric hospital. Routine use of these brief screens can facilitate detection of substance use disorders among psychiatric patients.

Cherpitel CJ; Ye Y; Moskalewiez J; Swiatkiewicz G. Screening for alcohol problems in two emergency service samples in Poland: Comparison of the RAPS4, CAGE and AUDIT. Drug and Alcohol Dependence 80(2): 201-207, 2005. (37 refs.)

Prior research on alcohol-related problems among emergency service patients in Poland found Substantial alcohol involvement on the part of injured males. suggesting emergency services may be a productive venue for identifying patients who could benefit from a brief intervention or referral for treatment. Performance of the RAPS4, CAGE and AUDIT against ICD-10 and DSM-IV criteria for alcohol dependence and for alcohol abuse/harmful drinking was compared in probability samples of emergency service patients from two regions of Poland. Sensitivity of the RAPS4 and AUDIT was significantly better than the CAGE for alcohol dependence among males in Warsaw, but specificity was poorer. Among females, although numbers were small, sensitivity for alcohol abuse/harmful drinking and for alcohol dependence or abuse/harmful drinking was significantly better for the RAPS4-QF than for the CAGE or AUDIT at a cut point of 8 across both sites. Performance of the AUDIT at a cut point of 3 was similar to the RAPS4-QF for females. Among males, sensitivity was higher but specificity considerably lower for the RAPS4-QF compared to the CAGE at a Cut point of I or for the AUDIT at a cut point of 8. Alternate cut points for the AUDIT optimized performance. Findings suggest some regional and gender differences in performance of screening instruments in these Polish samples, but no instrument or cut point is optimal in identifying those with alcohol use disorders. Additional cross-cultural research is needed to evaluate the performance of instruments, especially among females with alcohol use disorders.

Cook RL; Chung T; Kelly TM; Clark DB. Alcohol screening in young persons attending a sexually transmitted disease clinic: Comparison of AUDIT, CRAFT, and CAGE instruments. Journal of General Internal Medicine 20(1): 1-6, 2005. (33 refs.)

OBJECTIVE: To compare the ability of 3 brief alcohol screens (Alcohol Use Disorders Identification Test [AUDIT], CRAFFT, and CAGE) to identify adolescents and young adults with a current alcohol use disorder (AUD) and to determine whether there are gender-based or race-based differences in screening performance. DESIGN, PARTICIPANTS AND SETTING: Cross-sectional study of 358 young persons (55% males; 49% blacks; age range, 15-24 years; mean age, 20.6 years) who were attending an urban clinic for sexually transmitted diseases and reported alcohol use during the past year. MEASUREMENTS: Receiver operating characteristic (ROC) curve analysis was used to determine the ability of the 3 screens to discriminate between participants with and without AUDs detected in the Structured Clinical Interview for DSM-IV (SCID). RESULTS: One third (33%) of participants met Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria for a current AUD (24% with alcohol abuse and 9% with alcohol dependence). The AUDIT performed best at a cut score of 9 (sensitivity, 0.76; specificity, 0.79), CRAFFT at a cut score of 2 (sensitivity, 0.94; specificity, 0.33), and CAGE at a cut score of 1 (sensitivity, 0.69; specificity, 0.63). The AUDIT had the best overall performance (area under the curve [AUC], 0.84), followed closely by CRAFFT (AUC, 0.79) and then CAGE (AUC, 0.70). Performance of screens did not differ by gender. The AUDIT performed slightly better in whites than blacks, but no race-based differences were observed for the CAGE or CRAFFT. CONCLUSIONS: Clinicians should use the AUDIT or CRAFFT, rather than the CAGE, to screen young persons for AUDs. The AUDIT performs best, but its length may limit its utility in this setting. The CRAFFT is a suitable alternative, with excellent sensitivity and no gender-based or race-based differences.

Cremonte M; Cherpitel CJ. Performance of screening instruments for alcohol use disorders in emergency department patients in Argentina. Substance Use & Misuse 43(1): 125-138, 2008. (32 refs.)

The performance of the Alcohol Use Disorders Identification Test (AUDIT), CAGE, Brief Michigan Alcohol Screening Test (Brief MAST), Rapid Alcohol Problems Screen ( RAPS), Rapid Alcohol Problems Screen-Quantity and Frequency (RAPS4-QF), and TWEAK was evaluated against a diagnosis of alcohol dependence and harmful drinking or alcohol abuse from ICD-10 and DSM-IV criteria. Data were collected from a probability sample of 779 patients admitted to the emergency department of a public general hospital in Mar del Plata, Argentina, during the year 2001. The majority of the patients sampled were male. The age range was 18 to 89 years, with a mean value of 36 years and a median of 31 years. Almost half of the sample had an elementary school education or less. All instruments were more sensitive for alcohol dependence than for harmful drinking or abuse and more sensitive for men than for women. Findings suggest the RAPS4 and RAPS4-QF may be preferred when screening for alcohol use disorders in the emergency department in Argentina. The study's limitations are noted.

Cruce G; Nordstrom LG; Ojehagen A. Risky use and misuse of alcohol, drugs and cigarettes detected by screening questionnaires in a clinical psychosis unit. Nordic Journal of Psychiatry 61(2): 92-99, 2007. (44 refs.)

The use of screening instruments has been proposed to facilitate identification of risky substance use and misuse. This study aims to investigate the use of a screening procedure to identify hazardous or harmful use of alcohol, drug-related problems and riskful use of cigarettes in a clinical psychosis setting. The use of alcohol, drugs and cigarettes was examined by three self-reporting instruments: Alcohol Use Disorders Identification Test (AUDIT), Drug Use Disorders Identification Test (DUDIT) and Fagerstrom Test for Nicotine Dependence (FTND). Two hundred and forty-one out of 374 patients (64%) took part in the investigation. Eighteen per cent had a hazardous or harmful alcohol use, 9% drug-related problems and 49% were smokers. Multivariate analyses showed that women, as well as smokers had an increasing risk of having drug-related problems. The use of screening questionnaires increases the awareness that risky use of alcohol, drugs and cigarettes is common among persons with psychosis. Many persons with psychosis used alcohol, drugs and cigarettes in a risky way. It is important to identify these problems to make proper interventions due to the negative medical and social consequences of this use. Such identification may be facilitated by use of screening instruments.

De Silva P; Jayawardana P; Pathmeswaran A. Concurrent validity of the Alcohol Use Disorders Identification Test (AUDIT). Alcohol and Alcoholism 43(1): 49-50, 2008. (5 refs.)

Aims: To determine cut-offs for the Alcohol Use Disorders Identification Test (AUDIT) 10-item questionnaire, differentiating hazardous drinking (HZD) and alcohol use disorders (AUD) from low risk drinking (LRD), and AUD from HZD and LRD among married men in a Sri Lankan sample. Methods: Using 62 low risk drinkers and 88 each from hazardous drinkers and AUD, the AUDIT instrument was compared with adapted and translated versions of a beverage-specific, quantity-frequency questionnaire, and the alcohol use module of the Composite International Diagnostic Interview (CIDI), and two receiver operating characteristic (ROC) curves were plotted. Results: The area under the ROC curves to differentiate HZD + AUD from LRD and AUD from HZD + LRD were 0.96 (95% CI: 0.94-0.99) and 0.97 (95% CI: 0.95-0.99) respectively. The cut-off values of 7 and 16 were observed to have the best trade-offs between sensitivity, specificity, the ratio of positive likelihood to negative likelihood ratios, and positive predictive values. Conclusion: The AUDIT could be used to screen for LRD, HZD, and AUD among Sinhalese married men in Sri Lanka.

Dolman JM; Hawkes ND. Combining the AUDIT Questionnaire and biochemical markers to assess alcohol use and risk of alcohol withdrawal in medical inpatients. Alcohol and Alcoholism 40(6): 515-519, 2005. (24 refs.)

Aims: Alcohol consumption is often under-reported in patients admitted to general hospitals with acute illness. For alcohol-dependent individuals hospital admission results in an enforced period of abstinence with potential alcohol withdrawal symptoms, and possible life threatening complications. Early detection of alcohol use is therefore beneficial to patients and health services. The purpose of this study was to investigate the performance of the alcohol use disorders identification test (AUDIT) questionnaire in the acute medical setting, and the effect of combining routine biological markers-glutamyltransferase, alanine aminotransferase, aspartate aminotransferase, and mean corpuscular volume (MCV) on its performance in the early identification of in-patients with alcohol use disorders and at risk of developing symptoms of alcohol withdrawal. Methods: Prospective study in consecutive patients admitted to an acute medical admissions ward. All patients were screened using the AUDIT questionnaire and routine blood tests. Patients were then monitored for symptoms of withdrawal using clinical institute withdrawal assessment for alcohol (CIWA-Ar). Results: Of the 874 patients screened using the AUDIT, 98 (11%) screened positive of whom 17 (2% of the 874) experienced clinically significant alcohol withdrawal symptoms, when using serial CIWA-Ar. The AUDIT and serial CIWA-Ar detected all patients who went on to manifest acute withdrawal symptoms. There was no loss of sensitivity at an AUDIT cut-off of 13 or more compared with the lower cut-off of 8 or more. A positive predictive value of 17.3% for an AUDIT score of 8 or more in the detection of withdrawal, increased to 47.1% when found in combination with at least two abnormal biological markers whilst maintaining a sensitivity of 94.1% and specificity of 97.9%. Conclusion: These findings confirm that AUDIT is a useful alcohol screen in general medical settings and that its ability to correctly predict which patients will experience alcohol withdrawal is increased when used in combination with biological markers.

Donovan DM; Kivlahan DR; Doyle SR; Longabaugh R; Greenfield SF. Concurrent validity of the Alcohol Use Disorders Identification Test (AUDIT) and AUDIT zones in defining levels of severity among out-patients with alcohol dependence in the COMBINE study. Addiction 101(12): 1696-1704, 2006. (46 refs.)

Aims To examine among alcohol-dependent out-patient clients the concurrent validity of the Alcohol Use Disorders Identification Test (AUDIT) total score and 'zones' suggested by the World Health Organization for defining levels of severity of alcohol use problems. Design Participants were classified into AUDIT zones (AUDIT total score = 8-15, 16-19, 20-40) and compared on measures of demographics, treatment goals, alcohol consumption, alcohol-related consequences, severity of dependence, physiological dependence, tolerance, withdrawal and biomarkers of alcohol use. Setting Eleven out-patient academic clinical research centers across the United States. Participants Alcohol dependent individuals (n = 1335) entering out-patient treatment in the Combined Pharmacotherapies and Behavioral Interventions (COMBINE) study. Measurements The AUDIT was administered as part of an initial screening. Baseline measures used for concurrent validation included the Structured Clinical Interview for Diagnostic and Statistical Manual, 4th edition (DSM-IV) Disorders, the Alcohol Dependence Scale, the Drinker Inventory of Consequences, the Obsessive-Compulsive Drinking Scale, the University of Rhode Island Change Assessment, the Thoughts about Abstinence Scale, the Form-90, %carbohydrate-deficient transferrin and gamma-glutamyl transferase. Findings Indicators of severity of dependence and alcohol-related problems increased linearly with total score and differed significantly across AUDIT zones. The highest zone, with scores of 20 and above, was markedly different with respect to severity from the other two zones and members of this group endorsed an abstinence goal more strongly. Conclusions: The AUDIT total score is a brief measure that appears to provide an index of severity of dependence in a sample of alcohol-dependent individuals seeking out-patient treatment, extending its potential utility beyond its more traditional role as a screening instrument in general populations.

Doyle SR; Donovan DM; Kivlahan DR. The factor structure of the Alcohol Use Disorders Identification Test (AUDIT). Journal of Studies on Alcohol and Drugs 68(3): 474-479, 2007. (31 refs.)

Objective: Past research assessing the factor structure of the Alcohol Use Disorders Identification. Test (AUDIT) with various exploratory and confirmatory factor analytic techniques has identified one-, two-, and three-factor solutions. Because different factor analytic procedures may result in dissimilar findings, we examined the factor structure of the AUDIT using the same factor analytic technique on two new large clinical samples and on archival data from six samples studied in previous reports. Method: Responses to the AUDIT were obtained from participants who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), criteria for alcohol dependence in two large randomized clinical trials: the COMBINE (Combining Medications and Behavioral Interventions) Study (N= 1,337; 69% men) and Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity; N = 1,711; 76% men). Supplementary analyses involved six correlation matrices of AUDIT data obtained from five previously published articles. Confirmatory factor analyses based on one-, two-, and three-factor models were conducted on the eight correlation matrices to assess the factor structure of the AUDIT. Results: Across samples, analyses supported a correlated, two-factor solution representing alcohol consumption and alcohol-related consequences. The three-factor solution fit the data equally well, but two factors (alcohol dependence and harmful alcohol use) were highly correlated. The one-factor solution did not provide a good fit to the data. Conclusions: These findings support a two-factor solution for the AUDIT (alcohol consumption and alcohol-related consequences). The results contradict the original three-factor design of the AUDIT and the prevalent use of the AUDIT as a one-factor screening instrument with a single cutoff score.

Gache P; Michaud P; Landry U; Accietto C; Arfaoui S; Wenger O et al. The Alcohol Use Disorders Identification Test (AUDIT) as a screening tool for excessive drinking in primary care: Reliability and validity of a French version. Alcoholism: Clinical and Experimental Research 29(11): 2001-2007, 2005. (43 refs.)

Background: 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 Objectives: The aim of the study is to validate a French version of the Alcohol Use Disorders Identification Test (AUDIT) Methods: 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 Results: 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 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 7, for males sensitivity 83.5%, specificity 79.9%, PPV 55.0%, NPV 82.7% and with AUDIT >= 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. Conclusions: The AUDIT questionnaire remains a good screening instrument for French-speaking primary care.

Gates T; Duffy K; Moore J; Howell W; McDonald W. Alcohol screening instruments and psychiatric evaluation outcomes in military aviation personnel. Aviation, Space, and Environmental Medicine 78(1): 48-51, 2007. (17 refs.)

Introduction: Alcohol-related disorders are the most prevalent psychiatric conditions in the aviation population. Efforts to effectively screen aviators for these disorders are continually sought, as under-diagnosis may negatively impact aviation safety. This study evaluates screening tools that have been validated in non-aviators in terms of their utility for aviator patients. Methods: There were 111 male aviation patients (27 +/- 7 yr) referred for psychiatric evaluation at the Naval Aerospace Medicine Institute who completed the Self-Administered Alcohol Screening Test (SAAST), the Alcohol-Use Disorders Identification Test (AUDIT), and the Common Alcohol Logistical Scale-Revised (CAL-R) prior to evaluation by a staff psychiatrist or psychologist. Results: There were 40 patients who were qualified psychiatrically with no diagnosis and 49 patients who were disqualified for psychiatric reasons due to a non alcohol-related diagnosis. The remaining 22 patients were disqualified for psychiatric reasons with an alcohol-related diagnosis. The optimal aviator cut-off scores were consistent with those of the general population, although the cut-off score used for the SAAST was set at the published sub-threshold level to provide greater sensitivity. The sensitivity/specificity values for the SAAST, AUDIT, and CAL-R were 59%/94%, 46%/96%, and 68%/81%, respectively. Conclusion: The psychometrically sophisticated CAL-R is sensitive, specific, and has good negative predictive value, although its use requires a psychologist and its availability is limited. The SAAST and AUDIT can be administered by a flight surgeon or aviation medical examiner (AME). Given the higher sensitivity of the SAAST it may be the most beneficial if administered first. The AUDIT can be used as a follow-up diagnostic test given its higher specificity.

Giang KB; Spak F; Dzung TV; Allebeck P. The use of AUDIT to assess level of alcohol problems in rural Vietnam. Alcohol and Alcoholism 40(6): 578-583, 2005. (28 refs.)

Aims: To assess the accuracy and performance of AUDIT in detecting alcohol problems, as defined by ICD-10 and DSM-IV, in a rural district in Vietnam. Methods: The study was conducted in a rural district of Vietnam. Five hundred men and women aged 18-60 were randomly selected for interview with AUDIT and CIDI 2.1. The ICD-10 and DSM-IV criteria for harmful use/alcohol abuse and alcohol dependence were used to evaluate AUDIT. Results: Due to few cases of alcohol problems observed among women (1/282), we could only evaluate the validity of AUDIT in men. At cut-off point 7/8, AUDIT had a sensitivity of 81.8% and a specificity of 76.1% for detecting at-risk drinking. At this cut-off point, using ICD-10 criteria, the sensitivity was 100% for harmful use and 93.8% for alcohol dependence; the specificity was 69.9% for harmful use and 87.4% for alcohol dependence. The area under the ROC curve was 0.91 (0.84-0.98) for harmful use and 0.84 (0.74-0.94) for alcohol dependence (ICD-10). The agreement between ICD-10 and DSM-IV was higher for diagnosing alcohol dependence than alcohol abuse (Kappa coefficient: 0.98 vs 0.68). Conclusion: We confirmed that AUDIT is feasible to use in a rural community in a developing country. Different cut-off points are appropriate for different purposes, but for general population screening of at-risk drinking we found a cut-off point 7/8 to be optimal.

Gomez A; Conde A; Santana JM; Jorrin A. Diagnostic usefulness of brief versions of Alcohol Use Disorders Identification Test (AUDIT) for detecting hazardous drinkers in primary care settings. Journal of Studies on Alcohol 66(2): 305-308, 2005. (20 refs.)

Objective: The aim of this study was to evaluate the diagnostic usefulness of the brief versions of the Alcohol Use Disorders Identification Test (AUDIT) for detecting hazardous drinkers and to compare it with that of the full-AUDIT in primary care settings. Method: Five hundred patients were randomly selected in a primary care center. An interview on quantity-frequency was administered for assessment of weekly alcohol intake. The standard used for classification of hazardous drinkers was a weekly alcohol consumption of 280 g for men and 168 g for women. Cut-off points were 8 for the full-AUDIT, I for the AUDIT-3 (third item), 3 for the AUDIT-C (items 1, 2 and 3), 5 for the AUDIT-PC (items 1, 2, 4, 5 and 10) and 3 for the modified Fast Alcohol Screening Test (m-FAST; items 3, 5, 8 and 10). Sensitivity, specificity, positive and negative predictive values, and areas under the receiver operating characteristic (AUROC) curves were measured. Results: Diagnostic usefulness of the questionnaires for detecting hazardous drinkers was for the full-AUDIT: 81.4% sensitivity, 94.6% specificity and 0.97 AUROC curve; for the AUDIT-3: 83.1% sensitivity, 90.9% specificity and 0.89 AUROC curve; for the AUDIT-C: 100% sensitivity, 79.4% specificity and 0.97 AUROC curve; for the AUDIT-PC: 98.3% sensitivity 90.9% specificity and 0.97 AUROC curve; and for the m-FAST: 79.7% sensitivity, 93.7% specificity and 0.93 AUROC curve. Conclusions: The AUDIT-C and AUDIT-PC show a higher sensitivity, lower specificity and a similar AUROC curve than the full-AU-DIT, thus allowing their use as screening instruments that are as reliable as the original test for detecting hazardous drinkers. The AUDIT-3 and m-FAST, when compared with the full-AUDIT, performed less well, therefore limiting their use for this purpose.

Gomez A; Conde A; Santana JM; Jorrin A; Serrano IM; Medina R. The diagnostic usefulness of AUDIT and AUDIT-C for detecting hazardous drinkers in the elderly. Aging & Mental Health 10(5): 558-561, 2006. (29 refs.)

We compare the diagnostic usefulness of the Alcohol Use Disorders Identification Test (AUDIT) and the AUDIT alcohol consumption questions (AUDIT-C) for detecting hazardous drinkers between the populations over and less than 65 years in primary care settings. To assess weekly alcohol intake an interview on quantity-frequency was administered to 602 patients. Hazardous drinking was defined as a level of consumption of 280g of alcohol per week for men and 168g for women. The participants received AUDIT, AUDIT-C and CAGE questionnaires. Gamma-glutamyltransferase (GGT), mean corpuscular volume (MCV), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) values were also determined. Average weekly alcohol intake among the population aged 65 and older was 83g, and 10% were hazardous drinkers. In this age group, the sensitivities of AUDIT and AUDIT-C for detecting this type of drinkers were 67% and 100%, whereas specificities were 95% and 81% respectively. In the younger patient group, the sensitivities were 84% and 100% and the specificities 95% and 79% respectively. In conclusion, both AUDIT and AUDIT-C perform well at detecting hazardous drinkers in the group older than 65 years and that their sensitivities and specificities are comparable to those in younger ages.

Goransson M; Magnusson A; Heilig M. Identifying hazardous alcohol consumption during pregnancy: Implementing a research-based model in real life. Acta Obstetricia et Gynecologica Scandinavica 85(6): 657-662, 2006. (31 refs.)

Aims. It has been repeatedly demonstrated that hazardous alcohol use during pregnancy is rarely detected in regular antenatal care, and that detection can be markedly improved using systematic screening. A major challenge is to translate research-based strategies into regular antenatal care. Here, we examined whether a screening strategy using the Alcohol Use Disorder Test (AUDIT) and time-line follow-back (TLFB) could be implemented under naturalistic conditions and within available resources, and whether it would improve detection to the extent previously shown in a research context. Methods. Regular midwives at a large antenatal care clinic were randomized to receive brief training and then implement AUDIT and TLFB ("intervention"); or to a waiting-list control group continuing to deliver regular care ("control"). In the intervention condition, AUDIT was used to collect data about alcohol use during the year preceding pregnancy, and TLFB to assess actual consumption during the first trimester. Data were collected from new admissions over 6 months. Results. Drop out was higher among patients of the intervention group than control midwives, 14% (23/162) versus 0% (0/153), and p < 0.0001. A one-day training session combined with continuous expert support was sufficient to implement systematic screening with AUDIT and TLFB largely within resources of regular antenatal care. The use of these instruments identified patients with hazardous consumption during the year preceding pregnancy i.e. AUDIT score 6 or higher (17%, 23/139), and patients with ongoing consumption exceeding 70 g/week and/or binge consumption according to TLFB (17%, 24/139), to a significantly higher degree than regular antenatal screening (0/162). The AUDIT- and TLFB-positive populations overlapped partially, with 36/139 subjects screening positive with either of the instrument and 11/139 were positive for both. Conclusions. We confirm previous findings that alcohol use during pregnancy is more extensive in Sweden than has generally been realized. Systematic screening using AUDIT and TLFB detects hazardous use in a manner which regular antenatal care does not. This remains true under naturalistic conditions, following minimal training of regular antenatal care staff, and can be achieved with minimal resources. The proposed strategy appears attractive for broad implementation.

Hill KP; Chang G. Brief screening instruments for risky drinking in the outpatient psychiatry clinic. American Journal on Addictions 16(3): 222-226, 2007. (33 refs.)

In this pilot study, we compared two brief screening instruments, the T-ACE ( Tolerance, Annoyed, Cut down, Eye-opener) and the Alcohol Use Disorders Identification Test (AUDIT), with a clinician interview and structured clinical interview (SCID) to determine if they improved identification of risky drinking in a psychiatry clinic compared to clinician interviews. Sixteen of 50 subjects satisfied DSM-IV criteria for lifetime alcohol abuse or dependence on the SCID, and four, all T-ACE positive, were listed "correctly'' in the chart as having an alcohol problem. With a SCID gold standard, risky drinking was identified with sensitivities and specificities of 0.88 and 0.59 for the T-ACE and 0.63 and 0.85 for the AUDIT. Brief screening instruments improved the identification of risky drinking in a psychiatry clinic.

Johnsson KO; Leifman A; Berglund M. College students' drinking patterns: Trajectories of AUDIT scores during the first four years at University. European Addiction Research 14(1): 11-18, 2008. (53 refs.)

Aims: Changes in AUDIT score trajectories were examined in a student population during their first 4 years at a university, including high-risk consumers and a subsample of low-risk consumers. Method: 359 students were selected for the present study, comprising all high-risk consumers (the 27% with highest scores, i.e. 11 for males and 7 for females) and a randomized sample of low-risk consumers (n = 177 and 182, respectively). The Alcohol Use Disorder Identification Test ( AUDIT) was used as screening instrument. Trajectory analyses were made using a semiparametric group-based model. Results: In the low-AUDIT group, five distinct trajectories were identified: three stable non-risky consumption groups (83%) and two increasing groups (17%; from non-risky to risky). In the high-AUDIT group, three groups were identified: two stable high groups (58%) and one decreasing group (from risky to non-risky consumption; 41%). In the integrated model, stable risky consumption comprised 16% of the total sample, decreasing consumption 11%, increasing consumption comprised 13% and stable non-risky consumption 60% of the sample. Gender influenced the trajectories. Conclusion: The pattern of changes in risk consumption is similar to that found in corresponding US studies.

Kelly TM; Donovan JE; Chung T; Cook RL; Delbridge TR. Alcohol use disorders among emergency department-treated older adolescents: A new brief screen (RUFT-Cut) using the AUDIT, CAGE, CRAFFT, and RAPS-QF. Alcoholism: Clinical and Experimental Research 28(5): 746-753, 2004. (43 refs.)

Background: Early identification of alcohol use disorders (AUD) among emergency department (ED)-treated patients is important for facilitating intervention and further evaluation outside EDs. A number of brief screening instruments have been developed for identifying patients with AUD, but it is not clear whether they are practical and perform well with older adolescents in an ED setting. This study contrasted four brief screening instruments for detecting DSM-IV-defined AUD and tested a newly developed brief screen for use among ED-treated older adolescents.Methods: The Alcohol Use Disorders Identification Test (AUDIT), the CAGE, the CRAFFT, and a modified RAPS-QF were given to 93 alcohol-using older adolescents (55% men; aged 18-20 years) in an ED. Receiver operator characteristic analyses were used to evaluate the performance of brief screens against the criterion of a lifetime DSM-IV alcohol abuse or dependence diagnosis.Results: Of existing instruments, the AUDIT had the best overall performance in identifying AUD (sensitivity, 82%; specificity, 78%). A new, shorter screening instrument composed of two AUDIT items, two CRAFFT items, and one CAGE item (RUFT-Cut) performed as well as the AUDIT (sensitivity, 82%; specificity, 78%).Conclusions: Among existing alcohol screening instruments, the AUDIT performed best for identifying ED-treated older adolescents with alcohol use disorders. The RUFT-Cut is a brief screening instrument for AUD that shows promise for identifying ED-treated older adolescents who are in need of intervention or further evaluation. Future research should focus on use of the RUFT-Cut in other settings with larger, more diverse samples of adolescents.

Knibbe RA; Derickx M; Kuntsche S; Grittner U; Bloomfield K. A comparison of the Alcohol Use Disorder Identification Test (AUDIT) in general population surveys in nine European countries. Alcohol and Alcoholism 41(Supplement 1): 119-125, 2006. (19 refs.)

This study explored the suitability of the Alcohol Use Disorder Identification Test (AUDIT) for cross-national comparable estimates of problem drinking in general populations. On the item level the focus is on responsiveness to cross-national and gender differences. For the set of items the focus is on intercoffelations between items, indicating to what extent the AUDIT constitutes a scale. Methods: General population surveys from nine European countries were included. Cross-tabulations were used to analyse cross-national and gender differences in scores on the items. Reliability analysis was used to analyse intercoffelations between the items. Results: The items 'blackouts' (men and women) and 'guilt and remorse' (women) are the most frequently reported consequences. Gender differences tended to be smaller for 'guilt and remorse' and 'concern of others', and largest for 'morning drinking'. The reliability analysis shows that in eight of the nine countries frequency of drinking lowers the alpha. Injury and concern of others lead to a lower internal consistency in three countries. Conclusions: There was sufficient variation between countries in the pattern of responses and variation in gender differences to conclude that the set of consequence items was responsive to national and gender differences in problem drinking. Frequency of drinking was not a good indicator of problem drinking. The country differences in item total correlations of consequences might be due to differences in how these items are interpreted. Decisions on which items to include in an instrument to allow comparison of estimates of problem drinking cross-nationally require studies on how these items are interpreted in general populations of different countries.

Knight JR; Sherritt L; Harris SK; Gates EC; Chang G. Validity of brief alcohol screening tests among adolescents: A comparison of the AUDIT, POSIT, CAGE, and CRAFFT. Alcoholism: Clinical and Experimental Research 27(1): 67-73, 2003. (48 refs.)

Background: Adolescents should be screened for alcohol misuse as part of routine care. The objective of this study was to compare the criterion validity of the Alcohol Use Disorders Identification Test (AUDIT), the Problem Oriented Screening Instrument for Teenagers substance use/abuse scale (POSIT), and the CAGE and CRAFFT questions among adolescents. Methods: Fourteen- to 18-year-old patients arriving for routine healthcare at a large, hospital-based adolescent clinic completed the four screens and the criterion standard Adolescent Diagnostic Interview, which yields DSM-IV diagnoses of alcohol abuse and dependence. Receiver operating characteristic (ROC) curves were plotted to determine optimal cut-points. Areas under the ROC curves of the four screens were compared, and sensitivities and specificities were calculated. Results: Participants' past 12-month alcohol diagnostic classifications were as follows: no use (58.6%), nonproblem use (13.0%), problem use (20.8%), abuse (5.4%), and dependence (2.2%). Optimal cut-points associated with problem use or higher were 2 for AUDIT, I for POSIT, 1 for CAGE, and 1 for CRAFFT. ROC curve area of the CAGE was significantly lower compared with areas of all other screens. Sensitivities (95% confidence intervals) were AUDIT 0.88 (0.83-0.93), POSIT 0.84 (0.79-0.90), CAGE 0.37 (0.29-0.44), and CRAFFT 0.92 (0.88- 0.96); specificities were AUDIT 0.81 (0.77-0.85), POSIT 0.89 (0.86-0.92), CAGE 0.96 (0.94-0.98), and CRAFFT 0.64 (0.59- 0.69). Conclusions: The AUDIT, POSIT, and CRAFFT have acceptable sensitivity for identifying alcohol problems or disorders in this age group. The CAGE is not recommended for use among adolescents.

Kowalyszyn M; Kelly AB. Family functioning, alcohol expectancies and alcohol-related problems in a remote Aboriginal Australian community: a preliminary psychometric validation study. Drug and Alcohol Review 22(1): 53-59, 2003. (28 refs.)

While a large proportion of Aboriginal Australians do not consume alcohol, those who do frequently show severe alcohol problems, and alcohol problems are associated with family conflict and violence. The aims were to examine the internal coherence and reliability of measures of family and alcohol measures for indigenous Australians in remote communities. This study involved 99 indigenous people from a remote North Queensland community. Questions were drawn from established questionnaires and administered verbally. Principle components factor analysis revealed three coherent and reliable measures of family conflict, independence, and cohesion. Expectancies of affective change had sound internal reliability for drinkers, and covaried with alcohol problems in the expected direction. The Alcohol Use Disorders Identification Test had two distinct factors relating to consumption and problems, but quantity/frequency measures may have limited reliability due to the common practice among drinkers of sharing alcohol. These measures should facilitate the detection and initial assessment of alcohol and family problems, and may be useful for evaluating change in future interventions that target family and alcohol problems.

Leonardson GR; Kemper E; Ness FK; Koplin BA; Daniels MC; Leonardson GA. Validity and reliability of the AUDIT and CAGE-AID in northern plains American Indians. Psychological Reports 97(1): 161-166, 2005. (18 refs.)

According to the Indian Health Service, substance abuse and Type 2 diabetes are serious problems among Native Americans. To assess substance use in a medical setting, valid screening tests are needed so the Alcohol Use Disorders Identification Test (AUDIT), a simple brief screen for excessive drinking, and the CAGE-adapted to Include Drugs (CAGE-AID) for identifying primary care patients with alcohol and drug disorders were given 50 Northern Plains American Indians with diabetes. Both are short, easy to administer, have good sensitivity and specificity, and can be easily incorporated into a medical history protocol or intake procedure. Reliability coefficients were above .90 and appeared to have sufficient concurrent and divergent validity indicated by moderate correlations with the General Well-being Schedule (rs = -.39 and -.36), the Family-Adaptation, Partnership, Growth, Affection, & Resolve (r = -.47 and -.36), and the Beck Depression Inventory-II (r = .36 and .29).

Lieberman DZ. Clinical characteristics of individuals using an online alcohol evaluation program. American Journal on Addictions 14(2): 155-165, 2005. (26 refs.)

Access to treatment for substance abuse disorders is limited, and practical strategies are needed to expand opportunities for individuals to receive effective interventions. Automated or semi-automated treatments have shown promise in other disorders. Identifying the characteristics of patients who will be able to benefit from this unconventional approach will increase the likelihood of success. The current study examined 9,297 individuals using an online alcohol evaluation program. Subjects had high scores on the Alcohol Use Disorders Identification Test (AUDIT) and a substantial amount of ambivalence about the possible harm that their drinking caused, but they also had very low levels of self-identification as actual problem drinkers.

Lima CT; Friere ACC; Silva APB; Teixeira RM; Farrell M; Prince M. Concurrent and construct validity of the AUDIT in an urban Brazilian sample. Alcohol and Alcoholism 40(6): 584-589, 2005. (36 refs.)

Aims: To assess the concurrent and the construct validity of the Alcohol Use Disorders Identification Test (AUDIT) in an urban Brazilian sample. Methods: A random sample of 166 clients of a health management organization, participated in this study. They were visited in their households and completed a self-report questionnaire, which included the AUDIT. Later, they answered the alcohol-related disorders (ARDs) Section of the Composite International Diagnostic Interview. The receiver operating curve (ROC) was used to find the best cut-off point for ICD-10 diagnosis of ARDs. Confirmatory factor analysis was run to assess the construct validity. Results: The ROC analysis showed the same cut-off point (7/8) for ICD-10 diagnosis of ARDs found in previous studies carried out in primary care settings, including in Brazil, with a sensitivity of 100% and a specificity of 76%. The confirmatory factor analysis suggested a two-factor structure. The first factor measured consumption and the second factor alcohol-related problems. Conclusions: The results supported the use of the self-reported version of the AUDIT in epidemiologic studies, and showed a similar cut-off point for detection of ARDs and hazardous drinking.

McCambridge J; Day M. Randomized controlled trial of the effects of completing the Alcohol Use Disorders Identification Test questionnaire on self-reported hazardous drinking. Addiction 103(2): 241-248, 2008. (25 refs.)

Aims The direct effects of screening on drinking behaviour have not previously been evaluated experimentally. We tested whether screening reduces self-reported hazardous drinking in comparison with a non-screened control group. Design: Two-arm randomized controlled trial (RCT), with both groups blinded to the true nature of the study. Setting and participants A total of 421 university students aged 18-24 years, recruited in five London student unions. Interventions Both groups completed a brief pen-and-paper general health and socio-demographic questionnaire, which for the experimental group also included the 10-item Alcohol Use Disorders Identification Test (AUDIT) screening questionnaire. Measurements: The primary outcome was the between-group difference in AUDIT score at 2-3-month follow-up. Eight secondary outcomes comprised other aspects of hazardous drinking, including dedicated measures of alcohol consumption, problems and dependence. Findings: A statistically significant effect size of 0.23 (0.01-0.45) was detected on the designated primary outcome. The marginal nature of the statistical significance of this effect was apparent in additional analyses with covariates. Statistically significant differences were also obtained in three of eight secondary outcomes, and the observed effect sizes were not dissimilar to the known effects of brief interventions. Conclusions: It is unclear to what extent these findings represent the effects of screening alone, a Hawthorne effect in which drinking behaviour has changed in response to monitoring, or whether they indicate reporting bias. These possibilities have important implications both for the dissemination of screening as an intervention in its own right and for behavioural intervention trials methodology.

Mendoza-Sassi RA; Beria JU. Prevalence of alcohol use disorders and associated factors: A population-based study using AUDIT in southern Brazil. Addiction 98(6): 799-804, 2003. (20 refs.)

Aims: To assess the prevalence of potential alcohol use disorders and associated factors using the Alcohol Use Disorders Identification Test (AUDIT). Design Cross-sectional study. Setting: A town in southern Brazil. Participants: A representative sample of 1260 people aged 15 and over. Measurements:s Demographic, socioeconomic, smoking habit and mental health data were collected. Logistic regression was used in the multivariate analysis, and odds ratios (ORs) and 95% confidence intervals (Cls) were calculated. Findings Overall prevalence of 'alcohol use disorder was 7.9%, with 14.5% prevalence among men and 2.4% among women. The risk of alcohol misuse increased across social class (P linear trend = 0.03) and compared with the highest classes (A and B), groups C through E had ORs of 1.48, 1.51 and 2.36, respectively. Males had an OR of 6.89 (CI 3.61-13.16) compared with women. A linear trend was found (P = 0.001) between smoktng categories, and smokers (OR 3.27; Cl 1.91-5.58) and ex-smokers (OR 1.30; Cl 0.56-2.98) were at higher risk than non-smokers. Those with minor psychiatric disorders had a 2.48 OR (CI 1.35-4.56) of presenting a positive test. Conclusions: The AUDIT detected a high prevalence of potential alcohol use disorders in the population sampled. Those identified are potential targets for preventive measures implemented through health policies.

Neumann T; Neuner B; Gentilello LM; Weiss-Gerlach E; Mentz H; Rettig JS et al. Gender differences in the performance of a computerized version of the Alcohol Use Disorders Identification Test in subscritically injured patients who are admitted to the emergency department. Alcoholism: Clinical and Experimental Research 28(11): 1693-1701, 2004. (53 refs.)

Objective: The Alcohol Use Disorder Identification Test (AUDIT) has been recommended as a screening tool to detect patients who are appropriate candidates for brief, preventive alcohol interventions. Lower AUDIT cutoff scores have been proposed for women; however, the appropriate value remains unknown. The primary purpose of this study was to determine the optimal AUDIT cutpoint for detecting alcohol problems in subcritically injured male and female patients who are treated in the emergency department (ED). An additional purpose of the study was to determine whether computerized screening for alcohol problems is feasible in this setting. Methods: The study was performed in the ED of a large, urban university teaching hospital. During an 8-month period, 1205 male and 722 female injured patients were screened using an interactive computerized lifestyle assessment that included the AUDIT as an embedded component. World Health Organization criteria were used to define alcohol dependence and harmful drinking. World Health Organization criteria for excessive consumption were used to define high-risk drinking. The ability of the AUDIT to classify appropriately male and female patients as having one of these three conditions was the primary outcome measure. Results: Criteria for any alcohol use disorder were present in 17.5% of men and 6.8% of women. The overall accuracy of the AUDIT was good to excellent. At a specificity >0.80, sensitivity was 0.75 for men using a cutoff of 8 points and 0.84 for women using a cutoff of 5 points. Eighty-five percent of patients completed computerized screening without the need for additional help. Conclusions: Different AUDIT scoring thresholds for men and women are required to achieve comparable sensitivity and specificity when using the AUDIT to screen injured patients in the ED. Computerized AUDIT administration is feasible and may help to overcome time limitations that may compromise screening in this busy clinical environment.

Nevitt JR; Lundak J; Galardi G. Profile of adolescent alcohol offenders in two rural midwestern counties. Psychological Reports 98(2): 379-384, 2006. (25 refs.)

Screening tools specifically developed for use with adolescents may be more sensitive predictors of relapse or recidivism than self-report inventories typically used to screen adults. 70 adolescents in a program for drunk drivers in two counties in southeastern Nebraska were given both the CRAFFT and the Alcohol Use Disorder Identification Test questionnaires during routine alcohol-dependency evaluations. The Michigan Alcoholism Screening Test was also given to 28 subjects selected at random. 11 boys and 6 girls did not successfully complete the program. Significant correlations obtained for AUDIT scores for both the CRAFFT (r(69) = .65, p < .01) and failure to complete diversion (r(69) = .23, p < .05). Subjects were grouped by age (18 and younger and over 18 years) and by sex. A 2 x 2 analysis of variance for scores on the AUDIT indicated significant main effects for both age (F-1,F-66 = 4.86, p < .05) and sex (F-1.66 = 5.96, p < .01). MAST and CRAFFT scores showed no age or sex differences. The AUDIT might be included in drug and alcohol assessments with similar samples of adolescents.

O'Hare T. Comparing the AUDIT and 3 drinking indices as predictors of personal and social drinking problems in freshman first offenders. Journal of Alcohol and Drug Education 49(3): 37-61, 2005. (38 refs.)

The current study of 376 college freshman adjudicated the first time for breaking university drinking rules tested the predictive power of four alcohol consumption and problem drinking indices recent changes in drinking (the Alcohol Change Index; ACI), heavy drinking, binge drinking index, and the Alcohol Use Disorders Identification Test (AUDIT) with two subscales of the College Alcohol Problem Scale (personal and social problems) as criterion measure. In addition, the ACI, heavy drinking, and the binge-drinking index were tested for receiver operating characteristics (ROC) (sensitivity, specificity, false positive rate, positive predictive value and the area under the curve) using the AUDIT as criterion. Results demonstrated that the AUDIT was the best predictor of personal and social problems, and the binge showed the best ROC data with the AUDIT as criteria. Recommendations for use of brief instruments are suggested.

O'Hare T; Sherrer MV; LaButti A; Emrick K. Validating the Alcohol Use Disorders Identification Test with persons who have a serious mental illness. Research on Social Work Practice 14(1): 36-42, 2004. (34 refs.)

Objective/Method: The use of brief reliable, valid, and practical measures of substance use is critical for conducting individual assessments and program evaluation for integrated mental health-substance abuse services for persons with serious mental illness. This investigation examines the internal consistency reliability, concurrent validity and receiver operating characteristics of the Alcohol Use Disorders Identification Test (AUDIT) with 149 mentally ill adults in community programs. Results/Conclusions: Results suggest that the AUDIT is a reliable screening tool and shows good concurrent validity with other measures of alcohol abuse and psychosocial difficulties. In addition, receiver operating characteristics suggest that, for this population, a lower cutoff score (greater than or equal to 3) leads to more accurate detection of an alcohol use disorder (based on the Alcohol Use Scale) than the traditional cutoff (greater than or equal to 8). This article discusses implications for using screens routinely as part of assessment and evaluation with this population.

Pal HR; Jena R; Yadav D. Validation of the Alcohol Use Disorders Identification Test (AUDIT) in urban community outreach and de-addiction center samples in North India. Journal of Studies on Alcohol 65(6): 794-800, 2004. (27 refs.)

Objective: The Alcohol Use Disorders Identification Test (AUDIT) developed by the World Health Organization for screening disorders related to alcohol use has been shown to have robust psychometric properties. This study compared the performance of AUDIT with that of the Short Michigan Alcoholism Screening Test (SMAST) in a region of North India. Method: A total of 297 consecutive subjects who had used alcohol in the past year were recruited from a de-addiction center (DAC) (n = 97) and a community outreach setting (n = 200) in West Delhi. Using International Classification of Diseases, Tenth Edition (ICD-10) criteria, the relative effectiveness of the AUDIT and the SMAST in identifying alcohol-use-related disorders was assessed and compared. Internal consistency and interscale correlations were evaluated, along with sensitivity, specificity and ROC curve analyses. Results: The AUDIT had very high Internal reliability (alpha 0.92) in this Indian sample. There was, in general, good correlation between the total and factor scores of the AUDIT and SMAST (ranging from 0.28 to 0.97), which were higher in the community than in the DAC sample. The AUDIT (area under the curve [AUC] = 0.883) and SMAST (AUC = 0.870) were similar in detecting harmful use of alcohol. The AUDIT optimal cutoff score was 16 (sensitivity 85.3, specificity 89.4) for ICD-10 harmful use and 24 (sensitivity 69.4, specificity 87.5) for ICD-10 alcohol dependence. Conclusions: The AUDIT and SMAST seem to be comparable in their ability to screen subjects with alcohol use disorders. The AUDIT score for screening harmful use in the sample appears to be higher than previously reported. The utility of such high cutoff for screening subjects for intervention is obvious, but it is quite likely that some positive cases might be missed.

Philpot M; Pearson N; Petratou V; Dayanandan R; Silverman M; Marshall J. Screening for problem drinking in older people referred to a mental health service: A comparison of CAGE and AUDIT. Aging & Mental Health 7(3): 171-175, 2003. (26 refs.)

The aim of the study was to evaluate the validity of the Alcohol Use Disorders Identification Test (AUDIT), the five-item version (AUDIT-5) and the CAGE as screening tests for problem drinking in mentally ill older people. The study was of prospective cross-sectional design with questionnaire survey and interview and included all consecutive referrals to an old age psychiatry service fulfilling inclusion criteria. Sensitivity, specificity and positive predictive values and areas under the receiver operating characteristic curves (AUROC) for the AUDIT, AUDIT-5, and CAGE were the primary outcome measures. Using clinical criteria as the gold standard, the AUDIT, AUDIT-5 and CAGE had AUROCs of 0.961, 0.964, and 0.780 respectively. The AUDIT-5 performed best of the three scales with a sensitivity of 75.0%, specificity of 97.2% and positive predictive value of 83.3% when using a 4/5 cut-point. The AUDIT-5 performed as well as the AUDIT and better than the CAGE in identifying problem drinking in this sample. The AUDIT-5 may be a useful addition to the specialist mental health assessment of older people.

Reid MC; Tinetti ME; O'Connor PG; Kosten TR; Concato J. Measuring alcohol consumption among older adults: A comparison of available methods. American Journal on Addictions 12(3): 211-219, 2003. (28 refs.)

We determined levels of agreement and concordance between five alcohol measures among older veterans from a VA primary care clinic (N = 303) and community-dwelling Medicare beneficiaries (N = 511). 511). The individuals recruited for the study had not been previously identified for alcohol use. Quantity-frequency questions, a binge drinking question, the Alcohol Use Disorders Identification Test, CAGE, and questions on lifetime consumption were administered to all current drinkers. To assess agreement between the measures, we conducted pairwise comparisons (eg, QF vs. CAGE) by determining the percentage of participants who screened positive on both measures and calculated kappa values to determine concordance. Only modest levels of agreement and concordance were found between the measures. The use of any individual measure may fail to detect many older adults with important alcohol exposures. Until optimal methods for measuring alcohol exposures in elderly adults are defined, we suggest that a combination of measures be used when obtaining alcohol histories in older persons.

Schlesinger CM; Ober C; McCarthy MM; Watson JD; Seinen A. The development and validation of the Indigenous Risk Impact Screen (IRIS): a 13-item screening instrument for alcohol and drug and mental health risk. Drug and Alcohol Review 26(2): 109-117, 2007. (18 refs.)

The study aimed to assess the psychometric properties of the Indigenous Risk Impact Screen ( IRIS) as a screening instrument for determining (i) the presence of alcohol and drug and mental health risk in Indigenous adult Australians and ii) the cut-off scores that discriminate most effectively between the presence and absence of risk. A cross-sectional survey was used in clinical and nonclinical Indigenous and non-Indigenous services across Queensland Australia. A total of 175 Aboriginal and Torres Strait Islander people from urban, rural, regional and remote locations in Queensland took part in the study. Measures included the Indigenous Risk Impact Screen (IRIS), the Severity of Dependence Scale (SDS), the Alcohol Use Disorders Identification Test (AUDIT) and the Leeds Dependence Questionnaire (LDQ). Additional Mental Health measures included the Depression Anxiety and Stress Scale ( DASS- 21) and the Self- Report Questionnaire ( SRQ). Principle axis factoring analysis of the IRIS revealed two factors corresponding with (i) alcohol and drug and (ii) mental health. The IRIS alcohol and drug and mental health subscales demonstrated good convergent validity with other well- established screening instruments and both subscales showed high internal consistency. A receiver operating characteristics (ROC) curve analysis was used to generate cut-offs for the two subscales and t- tests validated the utility of these cut-offs for determining risky levels of drinking. The study validated statistically the utility of the IRIS as a screen for alcohol and drug and mental health risk. The instrument is therefore recommended as a brief screening instrument for Aboriginal and Torres Strait Islander people.

Selin KH. Alcohol Use Disorder Identification Test (AUDIT): What does it screen? Performance of the AUDIT against four different criteria in a Swedish population sample. Substance Use & Misuse 41(14): 1881-1899, 2006. (27 refs.)

The purpose of this article was to examine the kinds of alcohol use disorder the AUDIT most accurately screens for since the literature is inconsistent in the use of the AUDIT. Sometimes it is viewed as a measure of hazardous or harmful drinking and sometimes as a measure of dependence. The performance of its subsets (consumption items, AUDIT-C; and problem items, AUDIT-P) and of the full AUDIT (AUDIT-10) was tested against four criteria: high-volume drinking, alcohol-related social problems, alcohol-related health problems, and alcohol dependence. A general population sample of 600 Swedish subjects was interviewed during the winter 2000-01. The results document that, at the recommended cutoff score of 8+, the AUDIT-10 performed well against all four criteria, even if less well against the alcohol-related health problems. The AUDIT-C also performed well against all the problem criteria, showing high areas under the ROC curve, even though significantly lower than the full scale. When measuring high-volume drinking, the AUDIT-C outperformed the full instrument. Scoring at least 1 on the AUDIT-P improved sensitivity of the instrument when screening for social problems and dependence and made it a satisfactory measure of health problems. It is suggested that, when using the full AUDIT to screen for problems more severe than high-volume drinking, the criterion of scoring at least 1 on the AUDIT-P should be applied in combination with a cutoff score on the AUDIT-C.

Selin KH. Test-retest reliability of the Alcohol Use Disorder Identification Test in a general population sample. Alcoholism: Clinical and Experimental Research 27(9): 1428-1435, 2003. (21 refs.)

Background: A number of different screening tests are frequently used in alcohol research, but our knowledge about the reliability of many of them is quite limited. Recently, this problem has received more attention. This article examines the test-retest reliability of one of these instruments-the Alcohol Use Disorder Identification Test (AUDIT)-in a general population sample. Methods: A general population sample (n = 457) was tested and, after approximately 1 month, was retested by using the AUDIT. Correlation between the two tests has been examined with the intraclass correlation coefficient and the K coefficient in analysis of dichotomous variables. Specificity and sensitivity at a number of different cutoff scores have also been analyzed by using the first test as a criterion. Results: On the item level, the correlations ranged between 0.6 and 0.8. The overall reliability of total AUDIT scores was 0.84. When stratified by gender, age, and consumer status, the total score reliability approximated 0.80 for all the categories except low alcohol consumers (0.51). Agreement using the recommended cutoff score of 8+ was also examined. The reliability (K) observed in the whole sample was 0.691, which was interpreted as a substantial agreement. By this cutoff, 91% were correctly classified at retest compared with the first test. AUDIT 8+ showed higher reliability for males, young people, and moderate consumers and low reliability among low consumers. In terms of reliability, the most optimal cutoff for women turned out to be 6 or more. Conclusions: According to these results, the test-retest reliability of AUDIT is high. the next step might be to examine to what extent the findings apply within health-care settings, which is what the test originally was designed for.

Shevlin M; Smith GW. The factor structure and concurrent validity of the Alcohol Use Disorder Identification Test based on a nationally representative UK sample. Alcohol and Alcoholism 42(6): 582-587, 2007. (44 refs.)

Aims: To assess the psychometric structure and construct validity of the alcohol use disorder identification test (AUDIT) in a Great Britain population sample. Methods: A stratified multi-stage random sample of 7849 participants completed the AUDIT as part of a computer assisted interview. Confirmatory factor analyses were conducted testing one to three factor models. The factors in these models were correlated with demographic variables and scores relating to perceived wellbeing, verbal IQ, and neurotic and psychosis symptoms to assess construct validity of the factor solutions. Results: A two factor solution was deemed to appropriately fit the data, measuring alcohol consumption and alcohol related problems. Correlations between the two factors on demographic, wellbeing, neurosis and psychosis symptomology were significantly different. Conclusions: The two factor solution suggests an advantage to investigating factor specific cut off scores for both consumption and alcohol related problems given their difference in predictive validity on both health and demographic variables.

Shields AL; Caruso JC. Reliability generalization of the Alcohol Use Disorders Identification Test. Educational and Psychological Measurement 63(3): 404-413, 2003. (35 refs.)

The present study evaluated the reliability of scores from the Alcohol Use Disorders Identification Test (AUDIT) in a reliability generalization study. This reliability generalization had two primary goals: (a) to characterize the typical reliability of scores for the AUDIT, and (b) to examine factors that may be related to the reliability of AUDIT scores. The median internal consistency reliability across 24 samples was .81, with a range of .59 to .91. Results suggest that the AUDIT is capable of generating generally reliable scores across some varied sample conditions. After controlling for score variability, no sample characteristic was a statistically significantly predictor of score reliability and effects were small. Only 17 of 104 empirical journal articles contained adequate psychometric information to be included in the present study.

Shields AL; Guttmannova K; Caruso JC. An examination of the factor structure of the Alcohol Use Disorders Identification Test in two high-risk samples. Substance Use & Misuse 39(7): 1161-1182, 2004

The Alcohol Use Disorders Identification Test (AUDIT) was examined by employing confirmatory factor analytic techniques to data from two samples collected 1998-1999: college students (n=465) and court-referred, substance use treatment outpatients (clinical sample: n=135). Despite the fact that the AUDIT was originally designed as a three-factor measure (consumption, dependence, and consequences), previous studies have lent support to one- and two-factor models. The results of this study support a two-factor model (alcohol consumption and dependence/consequences) in both samples. As further evidence that the two-factor model is appropriate, a psychometric evaluation suggested that the AUDIT generated reliable scores in both groups when used as either a one- or two-factor measure, but not when three scores are derived in the student sample.

Sorocco KH; Ferrell SW. Alcohol use among older adults. Journal of General Psychology 133(4): 453-467, 2006. (46 refs.)

Alcohol use problems among older adults have been called the "invisible epidemic." As the population of older adults continues to grow, there is an increased need to reexamine alcohol use in this population. The authors provide an overview on alcohol use in the over-60 age group. The main areas of focus included research on the prevalence of drinking in that population, as well as comments on the best practices in assessment and psychological treatment. Several screening assessments have been recommended for use with older adults, such as the CAGE questionnaire, Michigan Alcohol Screening Test-Geriatric version, Alcohol-Related Problems Survey, and the Alcohol Use Disorders Identification Test. The authors note age-appropriate psychological treatment interventions that include brief interventions, family interventions, motivational counseling, and cognitive behavioral therapies. Barriers to assessment and treatment are also discussed.

Torres LAPD; Fernandez-Garcia JA; Arias-Vega R; Muriel-Palomino M; Marquez-Rebollo E; Ruiz-Moral R. Validity of AUDIT test for detection of disorders related with alcohol consumption in women. Medicina Clinica 125(19): 727-730, 2005. (12 refs.)

BACKGROUND AND OBJECTIVE: Early detection of patients with alcohol problems is important in clinical practice. The AUDIT (Alcohol Use Disorders Identification Test) questionnaire is a valid tool for this aim, especially in the male population. The objective of this study was to validate how useful is this questionnaire in females patients and to assess their test cutt-off point for the diagnosis of alcohol problems in women. PATIENTS AND METHOD: 414 woman were recruited in 2 health center and specialized center for addiction treatment. The AUDIT test and a semistructrured interview (SCAN as gold standard) were performed to all patients. Internal consistence and criteria validity was assessed. RESULTS: Cronbach alpha was 0.93 (95% confidence interval [CI], 0.921-0.941). When the DSM-IV was taken as reference the most useful cutt-off point was 6 points, with 89.6% (95% 10 Cl, 76.11-96.02) sensitivity and 95.07% (95% Cl, 92.18-96.97) specificity. When CIE-10 was taken as reference the sensitivity was 89.58% (95% Cl, 76.56-96.10) and the specificity was 95.33% (95% Cl, 92.48-97.17). CONCLUSIONS: AUDIT is a questionnaire with good psychometrics properties and is valid for detecting dependence and risk alcohol consumption in women.

Tuunanen M; Aalto M; Seppa K. Binge drinking and its detection among middle-aged men using AUDIT, AUDIT-C and AUDIT-3. Drug and Alcohol Review 26(3): 295-299, 2007. (17 refs.)

Binge (heavy episodic) drinking is common, but there is little knowledge on how this drinking pattern could be detected. This study compares three structured questionnaires among binge drinking middle-aged men. All 45-year-old men in the city of Tampere, Finland, were asked to fill in the Alcohol Use Disorders Identification Test (AUDIT). Based on the interview on their drinking the men were divided into non-binging moderate drinkers (n = 352), binging moderate drinkers (n = 130), non-binging heavy drinkers (n = 10) and binging heavy drinkers (n = 63). The complete AUDIT, AUDIT-C (first three AUDIT questions inquiring quantity-frequency) and AUDIT-3 (the third binging-frequency question of AUDIT) in detecting binge drinking were compared. The complete AUDIT was effective in detecting binge drinkers by a cut-off score of >= 8 or >= 7. The optimal cut-off score for AUDIT-C was >= 6 and that for AUDIT-3 >= 2. The area under the curve (AUC) among all risky drinkers (binging moderate and binging heavy and non-binging heavy drinkers) for AUDIT was 0.824 (95% CI 0.789-0.859), for AUDIT-C 0.829 (95% CI 0.795-0.864) and for AUDIT-3 0.779 (0.739-0.818). The complete AUDIT and its short versions are applicable in populations where binging is the dominant drinking pattern, but the cut-off scores should be tailored to individual cultures.