AUDIT-C as a brief screen for alcohol misuse in primary care

Health Services Research & Development, VA Puget Sound Health Care System, Seattle, WA 98101, USA.
Alcoholism Clinical and Experimental Research (Impact Factor: 3.31). 07/2007; 31(7):1208-17. DOI: 10.1111/j.1530-0277.2007.00403.x
Source: PubMed

ABSTRACT The Alcohol Use Disorders Identification Test Consumption (AUDIT-C) questions have been previously validated as a 3-item screen for alcohol misuse and implemented nationwide in Veterans Affairs (VA) outpatient clinics. However, the AUDIT-C's validity and optimal screening threshold(s) in other clinical populations are unknown.
This cross-sectional validation study compared screening questionnaires with standardized interviews in 392 male and 927 female adult outpatients at an academic family practice clinic from 1993 to 1994. The AUDIT-C, full AUDIT, self-reported risky drinking, AUDIT question #3, and an augmented CAGE questionnaire were compared with an interview primary reference standard of alcohol misuse, defined as a Diagnostic and Statistical Manual, 4th ed. alcohol use disorder and/or drinking above recommended limits in the past year.
Based on interviews with 92% of eligible patients, 128 (33%) men and 177 (19%) women met the criteria for alcohol misuse. Areas under the receiver operating characteristic curves (AUROCs) for the AUDIT-C were 0.94 (0.91, 0.96) and 0.90 (0.87, 0.93) in men and women, respectively (p=0.04). Based on AUROC curves, the AUDIT-C performed as well as the full AUDIT and significantly better than self-reported risky drinking, AUDIT question #3, or the augmented CAGE questionnaire (p-values <0.001). The AUDIT-C screening thresholds that simultaneously maximized sensitivity and specificity were > or =4 in men (sensitivity 0.86, specificity 0.89) and > or =3 in women (sensitivity 0.73, specificity 0.91).
The AUDIT-C was an effective screening test for alcohol misuse in this primary care sample. Optimal screening thresholds for alcohol misuse among men (> or =4) and women (> or =3) were the same as in previously published VA studies.

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    • "Validation studies of the AUDIT-C have not been conducted in resource-limited settings, although it is commonly used (Peltzer et al., 2007). In primary care populations in the United States, the AUDIT-C identified unhealthy drinkers with a sensitivity of 0.73 and specificity of 0.91 using a cutoff of ≥3 for women, and a sensitivity of 0.86 and specificity of 0.89 using a cutoff of ≥4 for men (Bradley et al., 2007). Among HIV-infected adults also in the United States, and using the full 10-item AUDIT as the gold standard, the AUDIT-C had a sensitivity of 0.81 to 0.89 and specificity of 0.91 to 1.0 using a cutoff of 4, and sensitivity of 0.94 to 0.98 and specificity of 0.82 to 0.91 at a cutoff of 3 for detecting unhealthy drinking (Strauss and Rindskopf, 2009). "
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    ABSTRACT: In Sub-Saharan Africa (SSA), HIV-infected patients may underreport alcohol consumption. We compared self-reports of drinking to phosphatidylethanol (PEth), an alcohol biomarker. In particular, we assessed beverage-type-adjusted fractional graduated frequency (FGF) and quantity frequency (QF) measures of grams of alcohol, novel nonvolume measures, and the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C). We analyzed cohort entry data from the Biomarker Research of Ethanol Among Those with HIV cohort study (2011 to 2013). Participants were HIV-infected past-year drinkers, newly enrolled into care. Self-report measures included FGF and QF grams of alcohol, the AUDIT-C, number of drinking days, and novel adaptations of FGF and QF methods to expenditures on alcohol, time spent drinking, and symptoms of intoxication. PEth levels were measured from dried blood spots. We calculated Spearman's rank correlation coefficients of self-reports with PEth and bias-corrected bootstrap 95% confidence intervals (CIs) for pairwise differences between coefficients. A total of 209 subjects (57% men) were included. Median age was 30; interquartile range (IQR) 25 to 38. FGF grams of alcohol over the past 90 days (median 592, IQR 43 to 2,137) were higher than QF grams (375, IQR 33 to 1,776), p < 0.001. However, both measures were moderately correlated with PEth: ρ = 0.58, 95% CI 0.47 to 0.66 for FGF grams and 0.54, 95% CI 0.43 to 0.63 for QF grams (95% CI for difference -0.017 to 0.099, not statistically significant). AUDIT-C, time drinking, and a scale of symptoms of intoxication were similarly correlated with PEth (ρ = 0.35 to 0.57). HIV-infected drinkers in SSA likely underreport both any alcohol consumption and amounts consumed, suggesting the need to use more objective measures like biomarkers when measuring drinking in this population. Although the FGF method may more accurately estimate drinking than QF methods, the AUDIT-C and other nonvolume measures may provide simpler alternatives. Copyright © 2015 by the Research Society on Alcoholism.
    Alcoholism Clinical and Experimental Research 07/2015; DOI:10.1111/acer.12781 · 3.31 Impact Factor
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    • "t al . , 1998 ; Gual et al . , 2002 ) , including epidemiological studies such as the Health barometer ( in French : " Baromètre de Santé " ) , but does not have a French validation known to date . A score equal or superior to four for males and equal or superior to three for females indicates alcohol consump - tion at risk of becoming dependent ( Bradley et al . , 2007 ) ."
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    ABSTRACT: Substance use as well as use of video games is frequent among young people. The purpose of this research was to study the links between the use of video games and the consumption of various substances such as alcohol, tobacco or cannabis at adolescence. In order to do so, 1423 students from middle and high schools filled an auto-questionnaire that included questions on age, gender, year of study, use of video games and consumptions of alcohol (AUDIT-C), tobacco (HSI) and cannabis (CAST). We found that 92.1% of teens use video games and 17.7% have a problematic use of video games (PUVG). Furthermore, results show that substance consumption seems frequent with 19.8% and 8.3% of participants having hazardous alcohol and cannabis consumptions respectively and 5.2% having a moderate to high tobacco dependence. Video gamers consumed significantly more alcohol and gamers with PUVG started their substance consumption (alcohol, tobacco and cannabis) earlier. PUVG was found to be negatively correlated to age at first substance consumption, but positively correlated to the time spent playing video games. However, it was not correlated to risks of substance dependence (scores of AUDIT-C, HSI and CAST). Finally, our results are consistent with the literature, in regard to frequency of substance use and use of video games in adolescence. These data will allow for a better consideration of prevention strategies and future care in this particular field.
    Frontiers in Psychology 04/2015; 6(501). DOI:10.3389/fpsyg.2015.00501 · 2.80 Impact Factor
    • "Use of the AUDIT enabled us to capture both a metric of quantity of alcohol consumed and alcohol behaviors that indicate an individual is at risk of alcohol dependence. Heavy drinking was measured using the AUDIT-C, the subset of questions limited to frequency and amount of alcohol consumed, with a cut-point of four or more in accordance with past studies in South Africa and elsewhere (Bradley et al., 2007; Bush et al., 1998; Desmond et al., 2012; Peltzer et al., 2010). Individuals at risk of AUD were identified through a score of eight or above on the full AUDIT (Myer et al., 2008; Peltzer, 2006). "
    Society for Epidemiologic Research 47th Annual Meeting, Seattle, Washington; 06/2014
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