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Alcohol Use Disorders Identification Test

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The Alcohol Use Disorders Identification Test (AUDIT) is a ten-item introspective self-report or interview inventory constructed by a World Health Organization-sponsored collaborative project to determine if an individual may be at risk for alcohol abuse problems.[1][2] The somewhat subjective rating scale was validated in a study drawing patients from six countries. Several research studies have found that the AUDIT screening tool is a reliable and valid measure in identifying alcohol abuse problem behaviors.[1][3] While there is some evidence that the AUDIT gives accurate results in adolescents and young adults, the responses of older adults are less reliable and valid.[4] Severity of dependence and alcohol-related problems increase linearly with the AUDIT total score.[5]

Psychometrics

Internal Consistency A Cronbach alpha coefficient of 0.80 has been reported for the 10-item AUDIT scale.[6] High Cronbach alpha coefficients have been reported for the three drinking behavior items 4-6 (0.93), and for the two adverse psychological reactions items 7-8 (0.81).[7] For the AUDIT-C, the Cronbach alpha coefficient has been reported as 0.98.[8] These high levels of item homogeneity suggest that the AUDIT scale is a narrow measure of problematic alcohol use.[9]

Test-Retest Reliability Dependability and stability evidence currently unavailable. See[10] However, in line with the Spearman-Brown prophecy formula, reliability of the AUDIT over varying intervals of time is likely to be low for such a brief 10-item scale.[11] The AUDIT-C exhibited a test-retest correlation of only 0.63 across a 2-week interval, suggesting that the reliability of the AUDIT-C scale is low.[8]

Predictive Validity In a review of 11 measures of "at-risk, hazardous, or harmful drinking" behaviors, the AUDIT was found to effectively identify individuals exhibiting these behaviors, but it was less effective than the 4-item CAGE in detecting alcohol abuse and dependence.[12] A short-form, items 1-3 (AUDIT-C) provides a very brief measure of alcohol consumption.[13][14] Sensitivity and specificity for the AUDIT-C has been found to be 0.98 and 0.94, respectively.[6][2][7]

Concurrent Validity Correlations with other alcoholism scales appear to be variable, ranging from 0.31 to 0.89.[1]

Discriminant Validity Evidence currently unavailable.

Constrict Validity Evidence currently unavailable.

Item breakdown, scoring and interpretation

Scoring the AUDIT is based on a 0-4 point scale. Six of the ten items ask about frequency of alcohol abuse behaviors, scored on a 5-point Likert-type response scale:

  • 0 points: "Never"
  • 1 point: "Less than monthly"
  • 2 points: "Monthly"
  • 3 points: "Weekly"
  • 4 points: "Daily, or almost daily"

The other four questions vary in participant response choice but are scored on a 0-4 point scale.

Domain breakdown

The questions measure different domains of alcohol consumption problems. The breakdown is as follows:

  • 1-3: Measure frequency in alcohol consumption
  • 4-6: Measure alcohol dependence
  • 7-10: Measure alcohol related problems

Interpretation of scores

In order to score the AUDIT, responses for each item are summed and then interpreted based on the following criteria.[1]

  • A score of 8 or more in men (7 in women) indicates a strong likelihood of hazardous or harmful alcohol consumption.
  • A score of 20 or more is suggestive of alcohol dependence (although some authors quote scores of more than 13 in women and 15 in men as indicating likely dependence).[15]

See also

Limitations

Valid responses to the 10 highly transparent self-report items are entirely dependent on honest responding of the individual, unhindered by motivational and response distortion,[18] which is likely to be an issue with adult problem drinkers who are psychologically defensive and/or in denial that they "have a drinking problem".[4] Unconscious psychological defence mechanisms reduce anxiety.[19] 

Also, the sequence of AUDIT items has been shown to influence individuals' reports of their drinking patterns and symptoms of alcohol use disorders.[20]

References

  1. ^ a b c d Bohn, MJ; Babor, TF; Kranzler, HR (July 1995). "The Alcohol Use Disorders Identification Test (AUDIT): validation of a screening instrument for use in medical settings". Journal of studies on alcohol. 56 (4): 423–32. doi:10.15288/jsa.1995.56.423. PMID 7674678.
  2. ^ a b Kitchens, JM (14 December 1994). "Does this patient have an alcohol problem?". JAMA. 272 (22): 1782–7. doi:10.1001/jama.1994.03520220076034. PMID 7966928.
  3. ^ Daeppen, JB; Yersin, B; Landry, U; Pécoud, A; Decrey, H (May 2000). "Reliability and validity of the Alcohol Use Disorders Identification Test (AUDIT) imbedded within a general health risk screening questionnaire: results of a survey in 332 primary care patients". Alcoholism: Clinical and Experimental Research. 24 (5): 659–65. doi:10.1111/j.1530-0277.2000.tb02037.x. PMID 10832907.
  4. ^ a b "Screening for alcohol use and alcohol related problems". NIAAA Publications. Retrieved 23 September 2015.
  5. ^ Donovan, DM; Kivlahan, DR; Doyle, SR; Longabaugh, R; Greenfield, SF (December 2006). "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 (Abingdon, England). 101 (12): 1696–704. doi:10.1111/j.1360-0443.2006.01606.x. PMID 17156168.
  6. ^ a b Moussas, G. et al. (2009). The Alcohol Use Disorders Identification Test (AUDIT): Reliability and Validity of the Greek version. Annals of General Psychiatry, 8, Open Access. [1] [Retrieved 12 November 2017]
  7. ^ a b Saunders, JB; Aasland, OG; Babor, TF; de la Fuente, JR; Grant, M (June 1993). "Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption--II". Addiction (Abingdon, England). 88 (6): 791–804. doi:10.1111/j.1360-0443.1993.tb02093.x. PMID 8329970.
  8. ^ a b Osaki, Y. et al. (2014). Reliability and validity of the Alcohol Use Disorders Identification Test — Consumption in screening for adults with alcohol use disorders and risky drinking in Japan. Asian Pacific Journal of Cancer Prevention, 15, 6571-6574. doi.org/10.7314/APJCP2014.15.16.6571
  9. ^ Boyle, G.J. (1991). Does item homogeneity indicate internal consistency or item redundancy in psychometric scales? Personality and Individual Differences, 12, 291-294.
  10. ^ Cattell, R.B. (1973). Personality and Mood by Questionnaire (p. 354). San Francisco, CA: Jossey-Bass.
  11. ^ Boyle, G.J., Saklofske, D.H., & Matthews, G. (2015). (Eds.), Measures of Personality and Social Psychological Constructs. Amsterdam: Elsevier/Academic Press. ISBN 9-780123-869159 doi.org/10.1016/B978-0-12-386915-9.00001-2 [2]
  12. ^ Fiellin, DA; Reid, MC; O'Connor, PG (10 July 2000). "Screening for alcohol problems in primary care: a systematic review". Archives of Internal Medicine. 160 (13): 1977–89. doi:10.1001/archinte.160.13.1977. PMID 10888972.
  13. ^ Bush, K; Kivlahan, DR; McDonell, MB; Fihn, SD; Bradley, KA (14 September 1998). "The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test". Archives of Internal Medicine. 158 (16): 1789–95. doi:10.1001/archinte.158.16.1789. PMID 9738608.
  14. ^ Bradley, KA; McDonell, MB; Bush, K; Kivlahan, DR; Diehr, P; Fihn, SD (November 1998). "The AUDIT alcohol consumption questions: reliability, validity, and responsiveness to change in older male primary care patients". Alcoholism: Clinical and Experimental Research. 22 (8): 1842–9. doi:10.1097/00000374-199811000-00034. PMID 9835306.
  15. ^ AUDIT: The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Care, second edition, by Thomas F. Babor, John C. Higgins-Biddle, John B. Saunders, and Maristela G. Monteiro. Retrieved June 24, 2006.
  16. ^ Reoux, Joseph P.; Malte, Carol A.; Kivlahan, Daniel R.; Saxon, Andrew J. (20 September 2002). "The Alcohol Use Disorders Identification Test (AUDIT) Predicts Alcohol Withdrawal Symptoms During Inpatient Detoxification". Journal of Addictive Diseases. 21 (4): 81–91. doi:10.1300/J069v21n04_08. PMID 12296504.
  17. ^ Williams, Kendal; Mitchell, Matthew (6 November 2013). "Inpatient Alcohol Withdrawal: Time to Prevent the Preventable?". Journal of General Internal Medicine. 29 (1): 7–9. doi:10.1007/s11606-013-2642-7. PMC 3889962. PMID 24197633.
  18. ^ Boyle, G.J. (1985). Self report measures of depression: Some psychometric considerations. British Journal of Clinical Psychology, 24, 45-59.
  19. ^ Freud, A. (1937). The Ego and the Mechanisms of Defence. London: Hogarth Press and Institute of Psycho-Analysis. (Revised editions: 1966 (US), 1968 (UK))
  20. ^ Bischof, G (2005). "Effects of item sequence on the performance of the AUDIT in general practices". Drug and Alcohol Dependence. 79 (3): 373–377. doi:10.1016/j.drugalcdep.2005.03.002. PMID 16102379.
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