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CORK Bibliography: Alcohol Use Disorders Screening Test (AUDIT)

91 citations. January 2003 to present

Prepared: March 2012

Aalto M; Alho H; Halme JT; Seppa K. AUDIT and its abbreviated versions in detecting heavy and binge drinking in a general population survey. Drug and Alcohol Dependence 103(1-2): 25-29, 2009. (23 refs.)

Background: The aim of this study was to define optimal cut points for the Alcohol Use Disorders Identification Test (AUDIT) and its abbreviated versions (AUDIT-C, AUDIT-QF, and AUDIT-3), and to evaluate how effectively these questionnaires detect heavy drinking in the general population. Methods: The study population consisted of a sub-sample of the National FINRISK Study. A stratified random sample of 3216 Finns, aged 25-64, was invited to a health check. Of these, 1851 (57.6%) completed the AUDIT and participated in person in the Timeline Followback (TLFB) interview regarding their alcohol consumption. The TLFB-based definition of heavy drinking was used as a primary gold standard (for males >= 16 standard drinks average in a week or >= 7 drinks at least once a month; for females, respectively, >= 10 and >= 5 drinks). Areas under receiving operating characteristics curves (AUROCs), sensitivities and specificities were used to compare the performance of the tests. Results and conclusions: The AUDIT and its abbreviated versions are valid for detecting heavy drinking also in a general population sample. However, performance seems to vary between the different versions and accuracy of each test is achieved only by using tailored cut points according to gender. The AUDIT and AUDIT-C are effective for both males and females. The optimal cut points for males were found to be >= 7 or 8 for AUDIT and >= 6 for AUDIT-C. Among females the optimal cut points were found to be >= 5 for AUDIT and >= 4 for AUDIT-C. The Study also indicates that AUDIT-QF among females and AUDIT-3 among males are relatively effective. The cut points for detecting all heavy drinkers (including binge drinkers without exceeding weekly thresholds) were lower than for detecting heavy drinkers excluding those who are only binge drinkers.

Aalto M; Alho H; Halme JT; Seppa K. The Alcohol Use Disorders Identification Test (AUDIT) and its derivatives in screening for heavy drinking among the elderly. International Journal of Geriatric Psychiatry 26(9): 881-885, 2011. (20 refs.)

Objective: The performance of the Alcohol Use Disorders Identification Test (AUDIT) in screening for heavy drinking among the elderly has been unsatisfactory. The aim of the present study was to determine whether tailoring the cut point improves the performance of the AUDIT and its derivatives in this age group. Methods: From a stratified random sample of 804 Finns aged 65-74 years, 517 subjects (64.3%) completed the AUDIT and the Timeline Follow-back (TLFB) interview regarding alcohol consumption. A subject was defined as a heavy drinker if consumption of >= 8 drinks (approx. 12 g) on average in a week or >= 4 drinks at least in 1 day during the prior 28 days was reported. Combinations in which both sensitivity and specificity are >= 0.8 were defined as optimal. The elderly specific AUDIT-3 is a modification in which the binge drinking threshold is >= 4 drinks. Results: Based on the TLFB, 118 subjects (22.8%) were heavy drinkers. The areas under receiving operating characteristics curves (AUROCs) were equivalent (>= 0.898) for all questionnaires. When using the standard cut point of >= 8 for the AUDIT, the sensitivity was 0.48. Lowering the cut point to >= 5 led to both a sensitivity and specificity over 0.85. The optimal cut point of the AUDIT-C was >= 4. The AUDIT-QF, AUDIT-3 and elderly specific AUDIT-3 did not provide optimal combinations of sensitivity and specificity with any cut point. Conclusions: The AUDIT and AUDIT-C are accurate in screening for heavy drinking among the elderly if the cut points are tailored to this age group.

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.

Alexander T; DiNitto DM; Tidblom I. Screening for alcohol and other drug use problems among the deaf. Alcoholism Treatment Quarterly 23(1): 63-78, 2005

No alcohol and other drug screening or diagnostic instruments have been validated for Deaf populations, although screening tools exist in other languages, such as Spanish. Deaf individuals traditionally have had difficulty understanding tests created for hearing populations because they contain wording or phrases that are unfamiliar in Deaf culture. The purpose of this study was to lay the groundwork for developing a culturally relevant alcohol and other drug screening instrument for Deaf individuals. Deaf individuals were asked about their understanding of items from two widely-used screening instruments, the CAGE and the AUDIT, which were developed for hearing individuals. Deaf participants reported difficulty with both instruments, with some words problematic for 88% of participants. Providers using these instruments should be aware of their limitations when used with Deaf individuals.

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.

Berks J; McCormick R. Screening for alcohol misuse in elderly primary care patients: A systematic literature review. (review). International Psychogeriatrics 20(6): 1090-1103, 2008. (45 refs.)

Background: Alcohol problems in the elderly are common and frequently undetected, and therefore a potential target for a screening program. Method: Using Medline, Psychinfo and reference lists from relevant publications, articles were identified testing pen-and-paper screens in the primary care population aged over 60 years. Results: Using standard definitions of alcohol problems, conventional screens adapted for use in the elderly have performances similar to screens in the younger primary care population. However, it can be argued that special screens perform better for the elderly. Conclusions: The Alcohol Use Disorders Identification Test is a useful screen for detecting harmful and hazardous drinking in the elderly while the CAGE is valuable when screening for dependence. In the future, the Alcohol-Related Problems Survey, a computer-based screen, may prove to be superior if practical implementation problems can be overcome.

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.

Boschloo L; Vogelzangs N; Smit JH; van den Brink W; Veltman DJ; Beekman ATF et al. The performance of the Alcohol Use Disorder Identification Test (AUDIT) in detecting alcohol abuse and dependence in a population of depressed or anxious persons. Journal of Affective Disorders 126(3): 441-446, 2010. (29 refs.)

Background: Alcohol use disorders are highly prevalent but often remain unrecognized among depressed and/or anxious persons. This study examines the performance of the Alcohol Use Disorder Identification Test (AUDIT) in detecting alcohol abuse and dependence in this high-risk group and compares it to that in healthy controls. Methods: Data from the Netherlands Study of Depression and Anxiety (NESDA) were used, including 1756 persons with a past-year depressive and/or anxiety disorder and 648 persons without a lifetime depressive and anxiety disorder. The performance of the AUDIT was compared against the gold standard of a CIDI-based diagnosis of past-year alcohol abuse or dependence by means of sensitivity, specificity and areas under receiver operating characteristic curves (AUCs). Results: The AUDIT accurately detected alcohol dependence in depressed and/or anxious men (AUC = 0.89) and women (AUC = = 0.88), with detected cut-off points of >= 9 and >= 6, respectively, comparable to that in healthy controls (men: AUC = 0.89; women: AUC = 0.94). However, the overall accuracy in detecting alcohol abuse was limited in depressed/anxious men (AUC = 0.74) and women (AUC = 0.78) and no adequate cut-off points with both acceptable sensitivity and specificity could be identified. Limitations: Persons with a primary diagnosis of an addiction disorder were excluded and therefore the sample may not be fully representative of the most severely addicted patients. Conclusions: These findings confirm the accuracy of the AUDIT in detecting alcohol dependence, but not alcohol abuse, in depressed and/or anxious persons. Screening for alcohol dependence in this high-risk group could improve identification of persons suffering from this impairing comorbid condition.

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.

Broyles LM; Gordon AJ; Sereika SM; Ryan CM; Erlen J. Predictive utility of brief Alcohol Use Disorders Identification Test (AUDIT) for human immunodeficiency virus antiretroviral medication nonadherence. Substance Abuse 32(4): 252-261, 2011

Alcohol use negatively affects adherence to antiretroviral therapy (ART), thus human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) care providers need accurate, efficient assessments of alcohol use. Using existing data from an efficacy trial of 2 cognitive-behavioral ART adherence interventions, the authors sought to determine if results on 2 common alcohol screening tests (Alcohol Use Disorders Identification Test-Consumption [AUDIT-C] and its binge-related question [AUDIT-3]) predict ART nonadherence. Twenty-seven percent of the sample (n = 308) were positive on the AUDIT-C and 34% were positive on the AUDIT-3. In multivariate analyses, AUDIT-C-positive status predicted ART nonadherence after controlling for race, age, conscientiousness, and self-efficacy (P = .036). Although AUDIT-3-positive status was associated with ART nonadherence in unadjusted analyses, this relationship was not maintained in the final multivariate model. The AUDIT-C shows potential as an indirect screening tool for both at-risk drinking and ART nonadherence, underscoring the relationship between alcohol and chronic disease management.

Burns E; Gray R; Smith LA. Brief screening questionnaires to identify problem drinking during pregnancy: A systematic review. (review). Addiction 105(4): 601-614, 2010. (80 refs.)

Aims: Although prenatal screening for problem drinking during pregnancy has been recommended, guidance on screening instruments is lacking. We investigated the sensitivity, specificity and predictive value of brief alcohol screening questionnaires to identify problem drinking in pregnant women. Methods: Electronic databases from their inception to June 2008 were searched, as well as reference lists of eligible papers and related review papers. We sought cohort or cross-sectional studies that compared one or more brief alcohol screening questionnaire(s) with reference criteria obtained using structured interviews to detect 'at-risk' drinking, alcohol abuse or dependency in pregnant women receiving prenatal care. Results: Five studies (6724 participants) were included. In total, seven instruments were evaluated: TWEAK (Tolerance, Worried, Eye-opener, Amnesia, Kut down), T-ACE [Take (number of drinks), Annoyed, Cut down, Eye-opener], CAGE (Cut down, Annoyed, Guilt, Eye-opener], NET (Normal drinker, Eye-opener, Tolerance), AUDIT (Alcohol Use Disorder Identification Test), AUDIT-C (AUDIT-consumption) and SMAST (Short Michigan Alcohol Screening Test). Study quality was generally good, but lack of blinding was a common weakness. For risk drinking sensitivity was highest for T-ACE (69-88%), TWEAK (71-91%) and AUDIT-C (95%), with high specificity (71-89%, 73-83% and 85%, respectively). CAGE and SMAST performed poorly. Sensitivity of AUDIT-C at score >= 3 was high for past year alcohol dependence (100%) or alcohol use disorder (96%) with moderate specificity (71% each). For life-time alcohol dependency the AUDIT at score >= 8 performed poorly. Conclusion: T-ACE, TWEAK and AUDIT-C show promise for screening for risk drinking, and AUDIT-C may also be useful for identifying alcohol dependency or abuse. However, their performance as stand-alone tools is uncertain, and further evaluation of questionnaires for prenatal alcohol use is warranted.

Cassidy CM; Schmitz N; Malla A. Validation of the Alcohol Use Disorders Identification Test and the Drug Abuse Screening Test in first episode psychosis. Canadian Journal of Psychiatry 53(1): 26-33, 2008. (26 refs.)

Objective: To determine the validity and reliability of the Alcohol Use Disorders Identification Test (AUDIT) and Drug Abuse Screening Test (DAST) for detecting alcohol and drug use disorders, respectively, in a population with first-episode psychosis (FEP). Method: Subjects with FEP completed the AUDIT and DAST and were divided into groups according to the presence or absence of a Structured Clinical Interview for DSM-IV (SCID) diagnosis of either current alcohol or drug misuse. The data were analyzed to see whether AUDIT and DAST scores were predictive of SCID diagnosis. Results: Patients with alcohol-related SCID diagnoses and those with drug-related SCID diagnoses scored significantly higher on the AUDIT and DAST, respectively, than the group without the respective SCID diagnosis (P < 0.001 in both cases). The AUDIT functioned best with a problem drinking cut-off score of 10 (sensitivity, 85%; specificity, 91%). The DAST functioned best with a problem drug use cut-off score of 3 (sensitivity, 85%; specificity, 73%). The area under the receiver operating characteristic curve was 0.86 for the AUDIT and 0.83 for the DAST. Conclusion: The DAST and AUDIT may reliably identify FEP patients with substance abuse.

Caviness CM; Hatgis C; Anderson BJ; Rosengard C; Kiene SM; Friedmann PD et al. Three brief alcohol screens for detecting hazardous drinking in incarcerated women. Journal of Studies on Alcohol and Drugs 70(1): 50-54, 2009. (28 refs.)

Objective: Screening methods for hazardous drinking have not been evaluated in a population of incarcerated women. This study examines abbreviated versions of the Alcohol Use Disorders Identification Test (AUDIT) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) heavy episodic drinking criterion in a sample of female detainees. Method: A total of 2,079 women at the Adult Correctional Institute in Rhode Island were approached for screening between February 2004 and June 2007. The AUDIT-consumption (AUDIT-C), AUDIT-3, and the NIAAA heavy episodic drinking criterion (four or more drinks on one occasion for women) were compared with the full AUDIT at different cut points. Results: More than 55% of the sample endorsed an AUDIT score of 4 or greater-the NIAAA recommended threshold for detecting hazardous drinking. The three-item AUDIT-C with a cut score of 3 yielded a classification most consistent with the AUDIT score of 4 or more; sensitivity and specificity exceeded .9, and 91.5% of participants were correctly classified. The AUDIT-3 and NIAAA episodic drinking criteria were less sensitive measures. We found no evidence of interactions between the screening instruments and age or ethnicity. Conclusions: The three-item AUDIT-C has robust test characteristics for detecting hazardous drinking in female inmates. Universal screening for hazardous drinking is recommended for incarcerated women, given their high rates of alcohol misuse.

Caviness CM; Hatgis C; Anderson BJ; Rosengard C; Kiene SM; Friedmann PD et al. Three brief alcohol screens for detecting hazardous drinking in incarcerated women. Journal of Studies on Alcohol and Drugs 70(1): 50-54, 2009. (28 refs.)

Celio MA; Vetter-O'Hagen CS; Lisman SA; Johansen GE; Spear LP. Integrating field methodology and web-based data collection to assess the reliability of the Alcohol Use Disorders Identification Test (AUDIT). Drug and Alcohol Dependence 119(1-2): 142-144, 2011. (15 refs.)

Field methodologies offer a unique opportunity to collect ecologically valid data on alcohol use and its associated problems within natural drinking environments. However, limitations in follow-up data collection methods have left unanswered questions regarding the psychometric properties of field-based measures. The aim of the current study is to evaluate the reliability of self-report data collected in a naturally occurring environment - as indexed by the Alcohol Use Disorders Identification Test (AUDIT) - compared to self-report data obtained through an innovative web-based follow-up procedure. Individuals recruited outside of bars (N = 170; mean age = 21; range 18-32) provided a BAC sample and completed a self-administered survey packet that included the AUDIT. BAC feedback was provided anonymously through a dedicated web page. Upon sign in, follow-up participants (n = 89; 52%) were again asked to complete the AUDIT before receiving their BAC feedback. Reliability analyses demonstrated that AUDIT scores - both continuous and dichotomized at the standard cut-point - were stable across field- and web-based administrations. These results suggest that self-report data obtained from acutely intoxicated individuals in naturally occurring environments are reliable when compared to web-based data obtained after a brief follow-up interval. Furthermore, the results demonstrate the feasibility, utility, and potential of integrating field methods and web-based data collection procedures.

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.

Conley TB. Court ordered multiple offender drunk drivers: Validity and reliability of rapid assessment. Journal of Social Work Practice in the Addictions 6(3): 37-51, 2006

The Alcohol Use Disorders and Associated Disabilities Interview Schedules' (AUDADIS) DSM-IV related items are used to evaluate the convergent validity of the Severity of Alcohol Dependence Questionnaire (SAD-Q), the Michigan Alcoholism Screening Test (MAST), and the Alcohol Use Disorders Identification Test (AUDIT) with persons convicted for multiple offences of driving under the influence. A total of 187 participants underwent semi-structured interviewing; of these 84% were alcohol dependent. The instruments exhibit acceptable internal consistency (all alphas > .85) as well as test/re-test reliability (all r = s .85). The MAST converged most closely with a DSM-IV diagnosis. Implications for rapid assessment instrument research as well as practice in public agencies are discussed.

Conley TB; O'Hare T. Factorial validity of the Alcohol Use Disorders Identification Test: Drunk drivers versus college students. Journal of Social Work Practice in the Addictions 6(3): 25-36, 2006

Secondary analysis was undertaken on the data from two previous studies involving the Alcohol Use Disorders Identification Test (AUDIT). Test results for 257 multiple offender drunk drivers and 505 college drinkers were compared. Exploratory factor analysis were run to examine the factorial validity of the test's hypothesized constructs. Internal consistency reliability was 87 with drunk drivers and 76 with college drinkers. Factor analyses of the AUDIT failed to validate the existence of its three hypothesized constructs regardless of sample population; a review of Eigenvalues indicates that there is a two-factor structure to the test with these populations. These factors are labeled problem drinking and hazardous drinking. The test was generally reliable. It is suggested that when using rapid assessment instruments in social work practice settings like those in the original studies, that their conceptual structure be evaluated for context specific validity.

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.

Cook S; De Stavola B; Saburova L; Kiryanov N; Vasiljev M; McCambridge J et al. Socio-demographic predictors of dimensions of the AUDIT score in A population sample of working-age men in Izhevsk, Russia. Alcohol and Alcoholism 46(6): 702-708, 2011

To investigate the relationship between socio-demographic factors and alcohol drinking patterns identified through a formal analysis of the factor structure of the Alcohol Use Disorders Identification Test (AUDIT) score in a population sample of working-age men in Russia. In 2008-2009, a sample of 1005 men aged 25-59 years living in Izhevsk, Russia were interviewed and information collected about socio-demographic circumstances. Responses to the AUDIT questions were obtained through a self-completed questionnaire. Latent dimensions of the AUDIT score were determined using confirmatory factor analysis and expressed as standard deviation (SD) units. Structural equation modelling was used to estimate the strength of association of these dimensions with socio-demographic variables. The AUDIT was found to have a two-factor structure: alcohol consumption and alcohol-related problems. Both dimensions were higher in men who were unemployed seeking work compared with those in regular paid employment. For consumption, there was a difference of 0.59 SDs, (95% confidence interval (CI): 0.23, 0.88) and for alcohol-related problems one of 0.66 SD (95% CI: 0.31, 1.00). Alcohol-related problems were greater among less educated compared with more educated men (P-value for trend=0.05), while consumption was not related to education. Similar results were found for associations with an amenity index based on car ownership and central heating. Neither dimension was associated with marital status. While we found evidence that the consumption component of AUDIT was underestimated, this did not appear to explain the associations of this dimension with socio-demographic factors. Education and amenity index, both measures of socio-economic position, were inversely associated with alcohol-related problems but not with consumption. This discordance suggests that self-reported questions on frequency and volume may be less sensitive markers of socio-economic variation in drinking than are questions about dependence and harm. Further investigation of the validity of the consumption component of AUDIT in Russia is warranted as it appears that the concept of a standard 'drink' as used in the instrument is not understood.

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.

Cremonte M; Ledesma RD; Cherpitel CJ; Borges G. Psychometric properties of alcohol screening tests in the emergency department in Argentina, Mexico and the United States. Addictive Behaviors 35(9): 818-825, 2010. (45 refs.)

The objective of this article is to report psychometric characteristics of the AUDIT, CAGE, RAPS4, and TWEAK and to compare them across three countries: Argentina, Mexico, and the United States which used a similar protocol and methodology. Probability samples of patients 18 years and older were drawn from emergency departments in Mar del Plata, Argentina (n = 780), Pachuca, Mexico (n=1624) and Santa Clara, U.S. (n=1220). Concurrent validity was assessed by comparing their performance against a diagnosis of alcohol dependence (DSM-IV) obtained through the Composite International Diagnostic Interview, and for the briefer measures, also by their correlation with the AUDIT. The internal consistency of the CAGE, RAPS4, and TWEAK scores was estimated by the KR-20 formula and by Cronbach's Alpha for the AUDIT. Corrected item-total correlation and D-values were used as item discrimination measures. In Argentina and Mexico the AUDIT and the RAPS4 showed the highest validity. Reliability of all instruments was higher in the US than in Argentina or Mexico. In all three countries, reliability of the TWEAK was lowest, while the AUDIT was highest. With a few exceptions, all items showed good discrimination powers.

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.

DeMartini KS; Carey KB. Correlates of AUDIT risk status for male and female college students. Journal of American College Health 58(3): 233-239, 2009. (33 refs.)

Objective: The current study identified gender-specific correlates of hazardous drinker status as defined by the AUDIT. Participants: A total of 462 college student volunteers completed the study in 2006. The sample was predominantly Caucasian (75%) and female (55%). Methods: Participants completed a survey assessing demographics, alcohol use patterns, and health indices. Scores of 8 or more on the AUDIT defined the at-risk subsample. Logistic regression models determined which variables predicted AUDIT risk status for men and women. Results: The at-risk participants reported higher alcohol use and related problems, elevated sleep problems and lower health ratings. High typical blood alcohol concentration (BAC), lifetime drug use, and psychosocial problems predicted risk status for males. Binge frequency and psychosocial problems predicted risk status for females. Conclusions: Different behavioral profiles emerged for men and women identified as hazardous drinkers on the AUDIT. The efficacy of brief alcohol interventions could be enhanced by addressing these behavioral correlates.

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.

Durbeej N; Berman AH; Gumpert CH; Palmstierna T; Kristiansson M; Alm C. Validation of the Alcohol Use Disorders Identification Test and the Drug Use Disorders Identification Test in a Swedish sample of suspected offenders with signs of mental health problems: Results from the Mental Disorder, Substance Abuse and Crime study. Journal of Substance Abuse Treatment 39(4): 364-377, 2010. (85 refs.)

Substance abuse is common among offenders One method widely used for the detection of substance abuse is screening. This study explored the concurrent validity of the Alcohol Use Disorders Identification Test (AUDIT) and the Drug Use Disorders Identification Test (DUDIT) screening tools in relation to (a) substance abuse and dependency diagnoses and (b) three problem severity domains of the sixth version of the Addiction Seventy Index in a sample of 181 suspected offenders with signs of mental health problems. The screening tools showed moderate to high accuracy for identification of dependency diagnoses. The AUDIT was associated with alcohol problem seventy, whereas the DUDIT was associated with drug and legal problem severity. Administering the screening tools in the current population yields valid results. However, the suggested cutoff scores should be applied with caution due to the discrepancy between present and previous findings.

Feldman N; Chatton A; Khan R; Khazaal Y; Zullino D. Alcohol-related brief intervention in patients treated for opiate or cocaine dependence: a randomized controlled study. Substance Abuse Treatment, Prevention and Policy 6: e-22, 2011. (37 refs.)

Background: Despite the importance of heavy drinking and alcohol dependence among patients with opiate and cocaine dependence, few studies have evaluated specific interventions within this group. The aim of the present study was to evaluate the impact of screening with the Alcohol Use Disorders Identification Test (AUDIT) and of brief intervention (BI) on alcohol use in a sample of patients treated for opioid or cocaine dependence in a specialized outpatient clinic. Methods: Adult outpatients treated for opioid or cocaine dependence in Switzerland were screened for excessive alcohol drinking and dependence with the AUDIT. Patients with AUDIT scores that indicated excessive drinking or dependence were randomized into two groups-treatment as usual or treatment as usual together with BI-and assessed at 3 months and 9 months. Results: Findings revealed a high rate (44%) of problematic alcohol use (excessive drinking and dependence) among patients with opiate and cocaine dependence. The number of drinks per week decreased significantly between T0 (inclusion) and T3 (month 3). A decrease in average AUDIT scores was observed between T0 and T3 and between T0 and T9 (month 9). No statistically significant difference between treatment groups was observed. Conclusions: In a substance abuse specialized setting, screening for alcohol use with the AUDIT, followed by feedback on the score, and use of alcohol BI are both possibly useful strategies to induce changes in problematic alcohol use. Definitive conclusions cannot, however, be drawn from the study because of limitations such as lack of a naturalistic group. An important result of the study is the excellent internal consistency of AUDIT in a population treated for opiate or cocaine dependence.

Foxcroft DR; Kypri K; Simonite V. Bayes' Theorem to estimate population prevalence from Alcohol Use Disorders Identification Test (AUDIT) scores. Addiction 104(7): 1132-1137, 2009. (13 refs.)

The aim in this methodological paper is to demonstrate, using Bayes' Theorem, an approach to estimating the difference in prevalence of a disorder in two groups whose test scores are obtained, illustrated with data from a college student trial where 12-month outcomes are reported for the Alcohol Use Disorders Identification Test (AUDIT). Using known population prevalence as a background probability and diagnostic accuracy information for the AUDIT scale, we calculated the post-test probability of alcohol abuse or dependence for study participants. The difference in post-test probability between the study intervention and control groups indicates the effectiveness of the intervention to reduce alcohol use disorder rates. In the illustrative analysis, at 12-month follow-up there was a mean AUDIT score difference of 2.2 points between the intervention and control groups: an effect size of unclear policy relevance. Using Bayes' Theorem, the post-test probability mean difference between the two groups was 9% (95% confidence interval 3-14%). Interpreted as a prevalence reduction, this is evaluated more easily by policy makers and clinicians. Important information on the probable differences in real world prevalence and impact of prevention and treatment programmes can be produced by applying Bayes' Theorem to studies where diagnostic outcome measures are used. However, the usefulness of this approach relies upon good information on the accuracy of such diagnostic measures for target conditions.

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; Allebeck P; Spak F; Van Minh H; Dzung TV. Alcohol use and alcohol consumption-related problems in rural Vietnam: An epidemiological survey using AUDIT. Substance Use & Misuse 43(3/4): 481-495, 2008. (33 refs.)

This study aimed to assess alcohol use and alcohol consumption-related problems in different sociodemographic groups in a rural district in Vietnam. Interviews were completed between March 2004 and July 2004. The Alcohol Use Disorder Identification Test (AUDIT) was applied to interview 3423 people, who were randomly selected in a rural district (1695 men and 1728 women). People who had an AUDIT score greater than 7 (in men) or greater than 5 (in women) were identified as having alcohol consumption-related problems. Prevalences and adjusted odds ratios of alcohol use and alcohol consumption-related problems were estimated for different subgroups of the population. Weekly and daily "binge drinking" among men were 5.7 and 3.6%, while binge drinking in women was virtually nonexistent. The prevalence of alcohol consumption-related problems was 25.5% among men and 0.7% among women. The differences between sociodemographic groups were not strong, but women who were separated, divorced, or widowed as well as those with higher education had significantly higher rates of alcohol consumption-related problems than married women and those with lower education. This study indicates an urgent need for alcohol intervention programs focused on men. However, further monitoring of alcohol use and problems among women is important to follow-up changes in consumption pattern. The study's limitations are discussed.

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.

Harris AHS; Bryson CL; Sun HL; Blough D; Bradley KA. Alcohol screening scores predict risk of subsequent fractures. Substance Use & Misuse 44(8): 1055-1069, 2009. (39 refs.)

The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C; 0-12 points) was included on health surveys in a cohort (if 32,622 general medicine outpatients from seven US Department of Veterans Affairs (VA) hospitals. Cox proportional hazards models were used to estimate the risk of fracture (mean follow-up = 1.6 years) by AUDIT-C category After adjusting for confounders, AUDIT-C scores of 8-9 and 10-12 were associated with significantly increased risks for subsequent fractures, HR (95% CI) = 1.37 (1.03 to 1.83) and 1.79 (1.38 to 2.33) respectively. These results can be used to provide feedback to patients linking their alcohol screening scores to medical outcomes-a critical component of evidence-based brief counseling for alcohol misuse. The study's limitations are noted.

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.

Jaquet A; Ekouevi DK; Bashi J; Aboubakrine M; Messou E; Maiga M et al. Alcohol use and non-adherence to antiretroviral therapy in HIV-infected patients in West Africa. Addiction 105(8): 1416-1421, 2010. (25 refs.)

Aim: To investigate the association between alcohol use and adherence to highly active antiretroviral treatment (HAART) among human immunodeficiency virus (HIV)-infected patients in subSaharan Africa. Design and setting: Cross-sectional survey conducted in eight adult HIV treatment centres from Benin, Cote d'Ivoire and Mali. Participants and measurements: During a 4-week period, health workers administered the Alcohol Use Disorders Identification Test to HAART-treated patients and assessed treatment adherence using the AIDS Clinical Trials Group follow-up questionnaire. Findings: A total of 2920 patients were enrolled with a median age of 38 years [interquartile range (IQR) 32-45 years] and a median duration on HAART of 3 years (IQR 1-4 years). Overall, 91.8% of patients were identified as adherent to HAART. Non-adherence was associated with current drinking [odds ratio (OR) 1.4; 95% confidence interval (CI) 1.1-2.0], hazardous drinking (OR 4.7; 95% CI 2.6-8.6) and was associated inversely with a history of counselling on adherence (OR 0.7; 95% CI 0.5-0.9). Conclusions: Alcohol consumption and hazardous drinking is associated with non-adherence to HAART among HIV-infected patients from West Africa. Adult HIV care programmes should integrate programmes to reduce hazardous and harmful drinking.

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.

Kaariainen J; Aalto M; Kaariainen M; Seppa K. Audit questionnaire as part of community action against heavy drinking. Alcohol and Alcoholism 43(4): 442-445, 2008. (13 refs.)

Aims: The purpose of the present study was to find out how well the alcohol questionnaire, AUDIT, as part of a wide community action was noticed, and if it had any effects especially among heavy drinkers. Methods: As part of local community action campaign ('Booze Weeks'), the AUDIT pamphlet was delivered to all households (90,000) in Tampere, Finland, and 500 randomly selected inhabitants were interviewed on telephone. Results: More than three quarters of those consuming alcohol had noticed the 'Booze Weeks' campaign and considered it necessary. Inhabitants who drank most frequently were also the most likely to have noticed the campaign and the AUDIT pamphlet. Conclusions: As part of a wide community action, home-delivered self-help material is often noticed especially by heavy drinkers. They might come to realize their own heavy drinking and seek professional treatment.

Kaarne T; Aalto M; Kuokkanen M; Seppa K. AUDIT-C, AUDIT-3 and AUDIT-QF in screening risky drinking among Finnish occupational health-care patients. Drug and Alcohol Review 29(5): 563-567, 2010. (25 refs.)

Introduction and Aims. Primary care physicians need a brief screening instrument to detect risky drinkers. In previous studies, the three first questions of the Alcohol Use Disorders Identification Test-C (AUDIT-C) and the third question on heavy episodic drinking alone (AUDIT-3) have been shown to be almost as effective as the whole AUDIT. Also, AUDIT-QF (the first two questions of AUDIT) can be a potential screening instrument. However, the validity of these short questionnaires has not been studied among the occupational health-care patients. Design and Methods. Patients visiting their doctor in six occupational health clinics were asked to fill in a health questionnaire containing AUDIT. All together 759 patients participated in the study. Risky drinking was defined as having scored of >= 10 for men or >= 8 or more for women in the AUDIT questionnaire. Validity of AUDIT-C, AUDIT-3 and AUDIT-QF were compared against the whole AUDIT. Results. Based on the whole AUDIT, 92 (24%) of the men and 33 (9%) of the women were risky drinkers. For men and women, area under the curve was relatively high for all tested questionnaires. For AUDIT-C, the best combination of sensitivity and specificity was yielded at cut-off point of 6 for men and 4 for women. Discussion and Conclusion. Short questionnaires perform almost as well as the whole AUDIT screening risky drinking among men and women. This is why they can be recommended for clinical use in busy settings. The cut-off points, however, have to be tailored for gender and culture.

Kallmen H; Wennberg P; Leifman H; Bergman H; Berman AH. Alcohol habits in Sweden during 1997-2009 with particular focus on 2005 and 2009, assessed with the AUDIT: A repeated cross-sectional study. European Addiction Research 17(2): 90-96, 2011. (17 refs.)

Aim: This study aimed to survey the changes in alcohol habits during a period with the European Union legal practices. Methods: Alcohol habits in Sweden were surveyed in the general Swedish population at four timepoints, in 1997, 2001, 2005 and 2009, using the 10-item AUDIT questionnaire. Design: Four separate randomly drawn cross-sectional samples of 1,250 individuals were surveyed at each timepoint. Results: An average of 70% of the sampled individuals responded to the AUDIT questionnaire. Men had higher total AUDIT scores than women in 2005 and 2009, but scores increased among women 61-71 years old and decreased among men 61-71 years old. Younger men and women 17-27 years old decreased their AUDIT-C consumption scores by almost 20% between 2005 and 2009. An analysis of problem drinkers (+8 for men/+6 for women) indicated that a larger proportion of elderly women drank moderately in 2009 compared with 2005, but fewer elderly women drank hazardously. Conclusions: Earlier increases in drinking levels between 1997 and 2001 may reflect a latent high demand that was restricted by low availability. When availability due to European Union harmonization increased, alcohol consumption followed suit. After a period of adaptation, alcohol consumption appears to have stabilized.

Kelly TM; Donovan JE; Chung T; Bukstein OG; Cornelius JR. Brief screens for detecting alcohol use disorder among 18-20 year old young adults in emergency departments: Comparing AUDIT-C, CRAFFT, RAPS4-QF, FAST, RUFT-Cut, and DSM-IV 2-Item Scale. Addictive Behaviors 34(8): 668-674, 2009. (46 refs.)

Background: This study compared six of the briefest screening instruments for detecting DSM-IV-defined Alcohol Use Disorder (AUD) among older adolescents treated in Emergency Departments (ED). Methods: The AUDIT-C, the RAPS4-QF, the FAST, the CRAFFT, the RUFT-Cut, and 2-Items from the Diagnostic and Statistical Manual IV of the American Psychiatric Association [American Psychiatric Association (1994). Diagnostic and Statistical Manual of Psychiatric Disorders, (1994) (DSM-IV). 4th ed. Washington D.C.: American Psychiatric Association] criteria for AUD (heretofore referred to as the DSM-IV 2-Item Scale) were evaluated against the criterion of a current DSM-IV diagnosis of either alcohol abuse or dependence. The instruments were administered to 181 alcohol-using older adolescents (57% males; age range 18-20 years) in an ED and compared using Receiver Operator Characteristic (ROC) analyses against the criterion of a current DSM-IV diagnosis of alcohol abuse or dependence. Results: Of these instruments, the DSM-IV 2-Item Scale performed best for identifying AUD (88% sensitivity and 90% specificity), followed by the FAST and the AUDIT-C. Conclusions: Two items from the DSM-IV criteria for AUD performed best for identifying ED-treated older adolescents with alcohol use disorders. The FAST and AUDIT-C performed well, but are longer and more difficult to score in the hectic environment of the Emergency Department.

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.

Kip MJ; Spies CD; Neumann T; Nachbar Y; Alling C; Aradottir S et al. The usefulness of direct ethanol metabolites in assessing alcohol intake in nonintoxicated male patients in an emergency room setting. Alcoholism: Clinical and Experimental Research 32(7): 1284-1291, 2008. (43 refs.)

Background: A major part of medical pathology in internal medicine is associated with chronic alcoholism. The aim of the current study was to investigate whether screening for Alcohol Use Disorders (AUD) can be improved through determination of direct ethanol metabolites compared to traditional biological state markers, the Alcohol Use Disorders Identification Test (AUDIT) and additional self-reports beyond the detection time period of a positive blood alcohol concentration (BAC). Methods: A total of 74 blood alcohol negative male patients who presented at the emergency room with either thoracic or gastrointestinal complaints were included. Phosphatidylethanol (PEth) was determined in whole blood, and ethyl glucuronide (EtG) in serum and urine samples. Traditional biological state markers [carbohydrate deficient transferrin (%CDT), gamma glutamyl transpeptidase (GGT), mean corpuscular volume (MCV)] were determined. The AUDIT was obtained and furthermore, all patients completed an additional self-report of alcohol consumption. Patients were divided into two (2) groups: AUDIT scores < 8 and AUDIT scores >= 8. Results: After assessment of the AUDIT, patients were allocated to one of the following groups: patients with AUDIT scores < 8 (n = 52) and with AUDIT scores >= 8 (n = 22). Twenty-five percent of the patients with AUDIT scores below the cut-off (n = 13/52) were tested positive for both PEth and UEtG. Of the patients who declared to be sober during the past 12 months, 38.5% were tested positive for PEth and UEtG. PEth discriminated similarly as %CDT for AUDIT scores >= 8 (AUC: 0.672; 95%CI 0.524 to 0.821). Self-reports of alcohol consumption were unreliable. Conclusion: Determination of direct ethanol metabolites such as PEth and UEtG provides additional evidence in screening for AUD in an ER setting. Determination of PEth might be considered complementary with or alternatively to %CDT.

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.

Krenek M; Maisto SA; Funderburk JS; Drayer R. Severity of alcohol problems and readiness to change alcohol use in primary care. Addictive Behaviors 36(5): 512-515, 2011. (21 refs.)

Screening measures for hazardous alcohol use that are efficient and can provide clinically relevant information are essential for primary care providers (PCPs). This study examined the clinical utility of the Alcohol Use Disorders Identification Test (AUDIT) and the AUDIT-Consumption (AUDIT-C) as predictors of readiness to change alcohol use in a primary care setting. In total, 114 veterans completed the AUDIT, readiness to change ruler, and an alcohol use disorders diagnostic interview. Two AUDIT-C scores were obtained; one administered during a primary care visit and one derived from the AUDIT. The AUDIT, both AUDIT-C scores, and number of dependence symptoms significantly predicted readiness to change independent of demographic variables. The AUDIT accounted for the greatest percentage of variance in readiness to change (19%). The AUDIT provides information about alcohol severity and readiness to change, which could be clinically useful for providers identifying patients for brief alcohol interventions.

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).

Leontieva L; Horn K; Helmkamp J; Furbee M; Jarrett T; Williams J. Counselors' reflections on the administration of screening and brief intervention for alcohol problems in the emergency department and 3-month follow-up outcome. Journal of Critical Care 24(2): 273-279, 2009. (30 refs.)

Objectives: The purpose of this paper was to explore how events that counselors endorsed occurring during an emergency department-based screening and brief intervention (SBI) for drinking discriminate patients who reported change in Alcohol Use Disorder Identification Test (AUDIT) domains at follow-up from those who did not. Method: Patients who scored ">5" on the AUDIT were eligible for SBI. At the end of each intervention, counselors completed the questionnaire indicating which parts of the intervention they just used. Results: Discriminant function analyses indicated that "Referral made" discriminated for alcohol intake change (Wilks' lambda = 0.993, P < .05) "Did the patient set goals during intervention?" and "Referral made" discriminated for alcohol dependency change (Wilks' lambda = 0.940 and Wilks' lambda = 0.919, P < .05, respectively). "Intention to quit" (Wilks' lambda = 0.984, P < .05) discriminated for alcohol-related harm change. Conclusions: Making referrals to addiction treatment during motivational intervention discriminated for alcohol intake and dependency change. Working on intention to quit is an important point in changing alcohol-related harm. When conducting the SBI in ED, counselors may be mindful in making appropriate referrals to address alcohol use and examine intention to quit to maximize the efficacy of the harm-reduction approach.

Li Q; Babor TF; Hao W; Chen XG. The Chinese translations of Alcohol Use Disorders Identification Test (AUDIT) in China: A systematic review. Alcohol and Alcoholism 46(4): 416-423, 2011. (66 refs.)

Aims: To systematically review the literature on the Chinese translations of the Alcohol Use Disorders Identification Test (AUDIT) and their cross-cultural applicability in Chinese language populations. Methods: We identified peer-reviewed articles published in English (n = 10) and in Chinese (n = 11) from 1980 to September 2009, with key words China, Chinese and AUDIT among PubMedicine, EBSCO, PsycInfo, FirstSearch electronic databases and two Chinese databases. Results: Five teams from Beijing, Tibet, Taiwan and Hong Kong reported their region-specific translation procedures, cultural adaptations, validity (0.93-0.95 in two versions) and reliability (0.63-0.99). These Chinese translations and short versions demonstrated relatively high sensitivity (0.880-0.997) and moderate specificity (0.709-0.934) for hazardous/harmful drinking and alcohol dependence, but low specificity for alcohol dependence among Min-Nan Taiwanese (0.58). The AUDIT and its adaptations were most utilized in workplace- and hospital-settings for screening and brief intervention. However, they were under-utilized in population-based surveys, primary care settings, and among women, adolescents, rural-to-urban migrants, the elderly and minorities. Among 12 studies from mainland China, four included both women and men, and only one in Tibet was published in English. Conclusion: There is a growing amount of psychometric, epidemiologic and treatment research using Chinese translations of the AUDIT, much of it still unavailable in the English-language literature. Given the increase in burden of disease and injury attributable to alcohol use in the Western Pacific region, the use of an internationally comparable instrument (such as the AUDIT) in research with Chinese populations presents a unique opportunity to expand clinical and epidemiologic knowledge about alcohol problem epidemics.

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.

Mann RE; Stoduto G; Vingilis E; Asbridge M; Wickens CM; Ialomiteanu A et al. Alcohol and driving factors in collision risk. Accident Analysis and Prevention 42(6): 1538-1544, 2010. (51 refs.)

In this study we examine the effect of several alcohol-related measures on self-reported collision involvement within the previous 12 months while controlling for demographic and driving exposure factors based on a large representative sample of adults in Ontario. Data are based on the 2002-2006 Centre for Addiction and Mental Health Monitor, an ongoing cross-sectional telephone survey of Ontario adults aged 18 and older (n = 8542). Three logistic regressions of self-reported collision involvement in the past 12 months were implemented, each consisting of 3 steps: (1) demographic factors and driving exposure entered, (2) driving after drinking within the last 12 months entered, and (3) one of three alcohol-related measures (AUDIT subscales of alcohol consumption, dependence and problems) entered. In each step, measures from the preceding step were included in order to control for those variables. In Step 1, age (OR = 0.989), region overall, Central East region (OR = 0.71), West region (OR = 0.67), and North region (OR = 0.67), income overall and those who did not state income (OR = 0.64), marital status overall and those married or living common law (OR = 0.60), and number of kilometers driven in a typical week (OR = 1.00) were found to be significant predictors of collision involvement. The analyses revealed that driving after drinking was a significant predictor of collision involvement in Step 2 (OR = 1.51) and each of the Step 3 models (ORs = 1.52, 1.37, 1.34). The AUDIT Consumption subscale was not a significant factor in collision risk. Both the AUDIT Dependence and AUDIT Problems subscales were significantly related to collision risk (ORs 1.13 and 1.10, respectively). These findings suggest that alcohol, in addition to its effects on collision risk through its acute impairment of driving skills, may also affect collision risk through processes involved when individuals develop alcohol problems or alcohol dependence.

Mathew T; Shields A; Yanov S; Golubchikova V; Strelis A; Yanova G. Performance of the Alcohol Use Disorders Identification Test among tuberculosis patients in Russia. Substance Use & Misuse 45(4): 598-612, 2010. (28 refs.)

The alcohol use disorders identification test (AUDIT), a screening instrument to identify individuals at risk of alcohol use-related problems, has not been validated in a Russian primary care population. We assessed the reliability, factor structure, sensitivity, and specificity of AUDIT scores among 254 subjects initiating tuberculosis treatment from 2005 to 2007 in Tomsk City. Our findings support the use of the AUDIT as a screening instrument among Russian individuals seeking primary care. We discuss implications, limitations, and future research.

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.

McCambridge J; Thomas BA. Short forms of the AUDIT in a Web-based study of young drinkers. Drug and Alcohol Review 28(1): 18-24, 2009. (25 refs.)

Introduction. The Alcohol Use Disorders Identification Test (AUDIT) is under-studied among young drinkers, as are the contributions of individual items to total AUDIT scores, and online performance of the existing briefer versions of this instrument. Design and Methods. This study examined individual items of the AUDIT, and various combinations, including the existing briefer versions, in relation to total AUDIT scores in a Web-based study of young drinkers. A total of 167 young people aged 16-24 years old who had consumed any alcohol within the previous 7 days were recruited by both offline and online methods. Results. Considered individually, items 3, 4, 5 and 8 were predictive of the majority of the variance in total AUDIT scores in this Web-based study. Existing briefer versions of the AUDIT do not better predict total scores than possible alternative combinations of items, for which acceptable levels of sensitivity and specificity for screening have been demonstrated. Conclusions. Short forms of the AUDIT, particularly those based only on consumption questions, require further validation study in online applications with young people.

Murphy P; Garavan H. Cognitive predictors of problem drinking and AUDIT scores among college students. Drug and Alcohol Dependence 115(1-2): 94- 100, 2011. (44 refs.)

Evidence from a number of substance abuse populations suggests that substance abuse is associated with a cluster of differences in cognitive processes. However, investigations of this kind in non-clinical samples are relatively few. The present study examined the ability of alcohol-attentional bias (an alcohol Stroop task), impulsive decision-making (a delay discounting task), and impaired inhibitory control (a GO-NOGO task) to: (a) discriminate problem from non-problem drinkers among a sample of college students; (b) predict scores on the Alcohol Use Disorders Identification Test (AUDIT; a measure of alcohol consumption, drinking behaviour, and alcohol-related problems) across all of the student drinkers; (c) predict AUDIT scores within the subgroups of problem and non-problem student drinkers. In logistic regression controlling for gender and age, student drinkers with elevated alcohol-attentional bias and impulsive decision-making were over twice as likely to be a problem than a non-problem drinker. Multiple regression analysis of the entire sample revealed that all three cognitive measures were significant predictors of AUDIT scores after gender and age had been controlled; the cognitive variables together accounted for 48% of the variance. Moreover, subsequent multiple regressions revealed that impaired inhibitory control was the only significant predictor of AUDIT scores for the group of non-problem drinkers, and alcohol-attentional bias and impulsive decision-making were the only significant predictors of AUDIT scores for the group of problem drinkers. Finally, both impulsive decision-making and impaired inhibitory control were significantly correlated with alcohol-attentional bias across the whole sample. Implications are discussed relating to the development of problematic drinking.

Nesvag R; Lange EH; Faerden A; Barrett EA; Emilsson B; Ringen PA et al. The use of screening instruments for detecting alcohol and other drug use disorders in first-episode psychosis. Psychiatry Research 177(1-2): 228-234, 2010. (45 refs.)

The high rate of drug abuse among patients with psychosis represents a challenge to clinicians in their treatment of the patients. Powerful screening tools to detect problematic drug use in an early phase of psychotic illness are needed. The aim of the present study was to investigate prevalence of drug use disorders and psychometric properties of the Alcohol Use Disorder Identification Test (AUDIT) and the Drug Use Disorder Identification Test (DUDIT) in 205 first-episode psychosis patients in Oslo, Norway. Internal consistency of the instruments and criterion-based validity as compared to a current DSM-IV diagnosis of abuse or dependence of alcohol or other drugs were analyzed. Fifteen percent of the men and 11% of the women had a DSM-IV diagnosis of alcohol use disorders while 33% of the men and 16% of the women had non-alcohol drug use disorders. The instruments were reliable (Cronbach's alpha above 0.90) and valid (Area under the curve above 0.83). Suitable cut-off scores (sensitivity >0.80 and specificity >0.70) were ten for men and eight for women on AUDIT and three for men and one for women on DUDIT. The results of this study suggest that AUDIT and DUDIT are powerful screening instruments for detecting alcohol and other drug use disorders in patients with first-episode psychosis.

Neumann T; Gentilello LM; Neuner B; Weiss-Gerlach E; Schurmann H; Schroder T et al. Screening trauma patients with the Alcohol Use Disorders Identification Test and biomarkers of alcohol use. Alcoholism: Clinical and Experimental Research 33(6): 970-976, 2009. (37 refs.)

Alcohol screening and brief interventions have been shown to reduce alcohol-related morbidity in injured patients. Use of self-report questionnaires such as the Alcohol Use Disorder Identification Test (AUDIT) is recommended as the optimum screening method. We hypothesized that the accuracy of screening is enhanced by combined use of the AUDIT and biomarkers of alcohol use in injured patients. The study was conducted in the emergency department of a large, urban, university hospital. Patients were evaluated with the AUDIT, and blood sampled to determine carbohydrate-deficient transferrin, gamma-glutamyl-transferase, and mean corpuscular volume. Alcohol problems were defined as presence of ICD-10 criteria for dependence or harmful use, or high-risk drinking according to World Health Organization criteria (weekly intake > 420 g in males, > 280 g in females). Screening accuracy was determined using Receiver Operating Characteristic curves. There were 787 males and 446 females in the study. Median age was 33 years. The accuracy of the AUDIT was good to excellent, whereas all biomarkers performed only fairly to poorly in males, and even worse in females. At a specificity > 0.80, sensitivity for all biomarkers was < 0.43, whereas sensitivity for the AUDIT was 0.76 for males and 0.81 for females. The addition of biomarkers added little additional discriminatory information compared to use of the AUDIT alone. Screening properties of the AUDIT are superior to %CDT, MCV, and GGT for detection of alcohol problems in injured patients and are not clinically significantly enhanced by the use of biomarkers.

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.

Olthuis JV; Zamboanga BL; Ham LS; Van Tyne K. The utility of a gender-specific definition of binge drinking on the AUDIT. Journal of American College Health 59(4): 239-245, 2011. (26 refs.)

Objective: Although binge drinking is commonly defined as the consumption of at least 5 drinks in 1 sitting for men and 4 for women, the Alcohol Use Disorders Identification Test (AUDIT) defines binge drinking as the consumption of 6 or more drinks in 1 sitting for both men and women. This study examined the effect of using gender-specific binge drinking definitions on overall AUDIT scores. Participants: Participants were 331 college men and 1224 college women. Methods: Participants completed a self-report questionnaire, which included the AUDIT. Results: Findings showed that defining binge drinking as 4 or more drinks for women, rather than 6 or more, does impact their AUDIT scores and could affect the percentage of women classified as hazardous users. Among men, AUDIT scores were unaffected by the use of a gender-specific definition of binge drinking. Conclusions: Results suggest that the AUDIT might be underidentifying hazardous users among college women.

Osterman RL; Ribak J; Bohn CM; Fargo JD; Sommers MS. Screening for hazardous/harmful drinking and depressive symptoms in an at-risk emergency department population. Journal of Addictions Nursing 20(1): 34-40, 2009. (47 refs.)

Although co-occurring alcohol use and depression have been identified in many populations, wide-spread screening for these disorders has not occurred in many Emergency Departments (EDs). Co-morbidity of alcohol use and mood disorders places a person at increased risk for psychosocial and medical-physical problems. The purpose of this study was to investigate the association between hazardous/harmful alcohol use and depressive symptoms in an urban ED population of problem drinkers and risky drivers. Cross-sectional data from the baseline interview of a randomized controlled trial of a brief intervention protocol to reduce problem drinking and risky driving in the ED population were used to test the study hypothesis. Data were collected using the Health Interview Schedule, a modification of the WHO Composite Interview Schedule, with addition of the AUDIT questionnaire and the Center for Epidemiologyogic Studies Short Depression Scale (CES-D 10). Data from a sample of 255 individuals (68% male) were used in the present study (age: M = 28.38, CES-D 10: M = 9.79, SD = 6.22, AUDIT: M = 8.10, SD = 4.13). Multiple regression analyses indicated that total CES-D 10 scores were significantly associated with total AUDIT scores, drinks per week, income, and gender [F (4, 242) = 3.81, p = .005, R2 = .06]. Total AUDIT scores were positively associated with CES-D 10 scores (p .001). Due to co-morbidities associated with co-occurring depressive symptoms and hazardous/harmful drinking, it is imperative to assess ED patients for both of these conditions to provide expedient, optimal referral and treatment for patients at risk, particularly for patients injured in vehicular collisions because of their risky driving.

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.

Rist F; Glockner-Rist A; Demmel R. The Alcohol Use Disorders Identification Test revisited: Establishing its structure using nonlinear factor analysis and identifying subgroups of respondents using latent class factor analysis. Drug and Alcohol Dependence 100(1-2): 71-82, 2009. (53 refs.)

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 anti 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 I). 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.

Rist F; Glockner-Rist A; Demmel R. The Alcohol Use Disorders Identification Test revisited: Establishing its structure using nonlinear factor analysis and identifying subgroups of respondents using latent class factor analysis. Drug and Alcohol Dependence 100(1-2): 71-82, 2009. (53 refs.)

Rooney BL; Mathiason MA; Schauberger CW. Predictors of obesity in childhood, adolescence, and adulthood in a birth cohort. Maternal and Child Health Journal 15(8): 1166-1175, 2011

Santis R; Garmendia ML; Acuna G; Alvarado ME; Arteaga O. The Alcohol Use Disorders Identification Test (AUDIT) as a screening instrument for adolescents. Drug and Alcohol Dependence 103(3): 155-158, 2009. (32 refs.)

Background: The Alcohol Use Disorders Identification Test (AUDIT) is an international screening instrument extensively employed in adult target groups. However, there is scarce information on screening with the AUDIT in adolescent Populations. The purpose of this study was to determine the cut-off point for hazardous, harmful, and dependent alcohol use through the validation of the AUDIT in a Chilean adolescent sample. Methods: The original English version of the AUDIT was translated into Spanish, using the procedure recommended by the World Health Organization. The text was then back-translated and sent to one of the original authors (Thomas Babor), who approved the translation. Students attending public schools in Santiago, Chile, self-administered the AUDIT, and those older than 15 years completed the Composite International Diagnostic Interview-Substance Abuse Module (CIDI-SAM), which served as a gold standard. Between 1 and 4 weeks after the CIDI-SAM, participants answered a second AUDIT. Results: A total of 42 female and 53 male adolescents (mean age: 15.9 [SD = 1.2]) completed the AUDIT, with a mean score of 4.3. Reliability according to Cronbach's alpha was 0.83. Test-retest correlation was also satisfactory (intra-class correlation 0.81 [95% CI 0.73-0.87]). Analysis of the receiver operating characteristic (ROC) curve yielded cut-off points for hazardous, harmful, and dependent alcohol use of 3. 5, and 7 points, respectively. Conclusions: The Chilean version of the AUDIT is a valid and reliable tool for identifying adolescents with hazardous, harmful, and dependent alcohol Use. The suggested cut-off points make screening with the AUDIT more accurate for adolescent populations.

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.

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; 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.

Sinadinovic K; Berman AH; Hasson D; Wennberg P. Internet-based assessment and self-monitoring of problematic alcohol and drug use. Addictive Behaviors 35(5): 464-470, 2010. (43 refs.)

A Swedish web-based service (www.escreen.se) offers self-assessment and self-monitoring of alcohol and drug use via on-line screening with the Alcohol Use Disorders Identification Test (AUDIT) and the Drug Use Disorders Identification Test (DUDIT) as well as in-depth risk assessment using extended versions of both tests (Alcohol-E and DUDIT-E). Users receive individualized feedback concerning their alcohol and drug consumption and can follow their alcohol and drug use over time in personal diagrams and by writing in an electronic diary. This study describes user characteristics, service utilization patterns, and psychometric test properties for 2361 individuals who created a valid account over 20 months starting in February 2007. Problematic alcohol use according to AUDIT criteria was indicated for 67.4%, while 46.0% met DUDIT criteria for problematic drug use. Men and women accessed the service equally, with a mean age of 23 years. Internal consistency reliability figures were 0.90 for 1846 first-time AUDIT users and 0.97 for 1211 first-time DUDIT users; among 213 second-time AUDIT users reliability was 0.93, and 0.96 for 97 second-time DUDIT users. Internet-based alcohol and drug monitoring could function as a self-help tool or as a complement to substance abuse treatment.

Smith GW; Shevlin M. Patterns of alcohol consumption and related behaviour in Great Britain: A latent class analysis of the Alcohol Use Disorder Identification Test (AUDIT). Alcohol and Alcoholism 43(5): 590-594, 2008. (22 refs.)

Aims: Attempts have been made to develop typologies to classify different types of alcoholism. However, limited research has focused on classifications to describe general patterns of alcohol use in general population samples. Methods: Latent class analysis was used to create empirically derived behaviour clusters of alcohol consumption and related problems from the Alcohol Use Disorder Identification Test (AUDIT) based on data from a large stratified multi-stage random sample of the population of Great Britain. Multinomial logistic regression was performed to describe these resultant classes using both demographic variables and mental health outcomes. Results: Six classes best described responses in the sample data. Three were heavy consumption groups, one with multiple negative consequences, one experiencing alcohol-related injury and social pressures to cut down and an additional class with memory loss. There was one moderate class with few negative consequences, and finally two mild consumption groups, one with alcohol-related injury and social pressure to cut down and one with no associated problems. Conclusions: Alcohol use in Great Britain can be hypothesized as reflecting six distinct classes, four of which follow a continuum of increased consumption leading to increased dependence and related problems and two that do not. Differences between alcohol use classes are apparent with reduced risk of depressive episode in moderate classes and an increased risk of anxiety disorders for the highest consumers of alcohol.

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.

Von Der Pahlen B; Santtila P; Witting K; Varjonen M; Jern P; Johansson A et al. Factor structure of the Alcohol Use Disorders Identification Test (AUDIT) for men and women in different age groups. Journal of Studies on Alcohol and Drugs 69(4): 616-621, 2008. (34 refs.)

Objective: Our main aim was to investigate the factor structure of the Alcohol Use Disorders Identification Test (AUDIT) in a Finnish population sample. Method: The AUDIT was completed by 3,125 men (mean age = 26.2 years) and 6,006 women (mean age = 26.1 years). Results: At a cutoff score of 8 or more, 49.8% of the men and 23.9% of the women would be identified as potentially engaged in excessive alcohol use. Exploratory factor analyses suggested a two-factor solution for both men and women. However, the factor structure was not invariant between men and women or in the different age groups among men. Conclusions: This is one of the largest known general population studies on alcohol use in recent years in Finland. The findings support a two-factor solution, and it is suggested that the AUDIT cutoff scores should be tailored according to age, gender, and drinking culture.

Wu SI; Huang HC; Liu SI; Huang CR; Sun FJ; Chang TY et al. Validation and comparison of alcohol-screening instruments for identifying hazardous drinking in hospitalized patients in Taiwan. Alcohol and Alcoholism 43(5): 577-582, 2008. (48 refs.)

Aim: The aim of this study was to validate the Mandarin Chinese version of different screening instruments and compare their performances for identifying hazardous drinkers in Taiwan. Methods: We compared the performance of the Mandarin Chinese versions of AUDIT, AUDIT-C (AUDIT items 1, 2 and 3), AUDIT-4 (AUDIT items 1, 2, 3 and 10), AUDIT-3 (AUDIT item 3), TWEAK, SMAST and CAGE to detect hazardous drinking in hospitalized patients in Taiwan. The results of the test instruments were blindly compared with the reference standard Schedule for Clinical Assessments in Neuropsychiatry (SCAN). Results: Of 404 patients evaluated, 100 were identified as having a hazardous drinking pattern. All screening instruments showed acceptable sensitivities (ranging from 85 to 93%) and specificities (ranging from 72 to 92%), but AUDIT and its short forms performed consistently better than the other instruments. Conclusions: The Mandarin Chinese versions of AUDIT and its derivatives perform well in screening hospitalized Taiwanese patients for hazardous drinking.