AUDIT Derivatives

Publication Date Language Abstracts Access
Aalto, M., Alho, H., Halme, J.T., Seppä, K.
AUDIT and its abbreviated versions in detecting heavy and binge drinking in a general population survey. Drug and Alcohol Dependence Volume 103, Issue 1-2, 1 July 2009, Pages 25-29
2009 English 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.esults 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.   Via Publisher
Aalto, M., Alho, H., Halme, J.T., Seppä, K.
The Alcohol Use Disorders Identification Test (AUDIT) and its derivatives in screening for heavy drinking among the elderly. International Journal of Geriatric Psychiatry, Volume 26, Issue 9, September 2011, Pages 881-885
2011 English 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. 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.  Via Publisher
Aalto, M., Tuunanen, M., Sillanaukee, P., Seppä, K.
Effectiveness of structured questionnaires for screening heavy drinking in middle-aged women. Alcoholism: Clinical and Experimental Research, Volume 30, Issue 11, November 2006, Pages 1884-1888
2006 English Background: There is a need for an effective and feasible alcohol screening instrument. The aim of the study was to evaluate how the abbreviated versions of the Alcohol Use Disorders Identification Test (AUDIT) questionnaire perform in comparison with the original AUDIT and what the optimal cutoffs are when screening for heavy drinking among women. Methods: All the 40-year-old women in the city of Tampere, Finland, are invited yearly for a health screening. From 1 year, data from 894 women (response rate 68.2%) invited for a health screening were utilized in the study. The original 10-item AUDIT, AUDIT-C, Five Shot, AUDIT-PC, AUDIT-3, AUDIT-QF, and CAGE were evaluated against the Timeline Followback. Consumption of at least 140 g of absolute ethanol per week on average during the past month was considered heavy drinking. Results: In the Timeline Followback, the mean±SD weekly reported alcohol consumption was 45±67 g (range 0-936 g) of absolute ethanol. Of the women, 6.2% (55/894) were heavy drinkers. The optimal combination of sensitivity and specificity was reached for the AUDIT with cutoff ≥6, for the AUDIT-C with cutoff ≥5, for the Five Shot with cutoff ≥2.0, for the AUDIT-PC with cutoff ≥4, and for the AUDIT-QF with cutoff ≥4. When choosing the optimal cutoffs, the AUDIT-C, the Five Shot, the AUDIT-PC, and the AUDIT-QF performed as well as the 10-item AUDIT. With these cutoffs, sensitivities were 0.84 to 0.93 and specificities were 0.83 to 0.90. The AUDIT-3 and the CAGE did not perform as well as the other questionnaires. Conclusions: The 10-item AUDIT, AUDIT-C, Five Shot, AUDIT-PC, and AUDIT-QF seem to be equally effective tools in screening for heavy drinking among middle-aged women. However, their applicability is achieved only if the cutoffs are tailored according to gender. Via Publisher
Au, D.H., Kivlahan, D.R., Bryson, C.L., Blough, D., Bradley, K.A.
Alcohol screening scores and risk of hospitalizations for GI conditions in men. Alcoholism: Clinical and Experimental Research, Volume 31, Issue 3, March 2007, Pages 443-451
2007 English 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 (HR adj ) 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.  Via Publisher
Bazzo, S., Battistella, G., Riscica, P., (...), Geromel, M., Czerwinsky, L.
Reliability of a self-report Italian version of the AUDIT-C questionnaire, used to estimate alcohol consumption by pregnant women in an obstetric setting. Rivista di Psichiatria, Volume 50, Issue 2, 1 March 2015, Pages 89-94
2015 English Aim. Alcohol consumption during pregnancy can result in a range of harmful effects on the developing foetus and newborn, called Fetal Alcohol Spectrum Disorders (FASD). The identification of pregnant women who use alcohol enables to provide information, support and treatment for women and the surveillance of their children. The AUDIT-C (the shortened consumption version of the Alcohol Use Disorders Identification Test) is used for investigating risky drinking with different populations, and has been applied to estimate alcohol use and risky drinking also in antenatal clinics. The aim of the study was to investigate the reliability of a self-report Italian version of the AUDIT-C questionnaire to detect alcohol consumption during pregnancy, regardless of its use as a screening tool. Results. Overall, about one third of women recalled alcohol consumption at least once during the current pregnancy. The questionnaire had an internal consistency of 0.565 for the group of the year 2010, of 0.516 for the year 2011, and of 0.542 for the overall group. The highest itemtotal correlations' coefficient was 0.687 and the highest inter-item correlations' coefficient was 0.675. As for the discriminatory power of the questionnaire, the highest Ferguson's delta coefficient was 0.623. Conclusions. These findings suggest that the Italian self-report version of the AUDIT-C possesses unsatisfactory reliability to estimate alcohol consumption during pregnancy when used as self-report questionnaire in an obstetric setting. Open Access
Bell, S., Britton, A.
Reliability of a retrospective decade-based life-course alcohol consumption questionnaire administered in later life. Addiction, Volume 110, Issue 10, 1 October 2015, Pages 1563-1573
2015 English Background and aims: Retrospective measures of alcohol intake are becoming increasingly popular; however, the reliability of such measures remains uncertain. This study assessed the reliability of a retrospective decade-based life-course alcohol consumption questionnaire, based on the standardized Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) administered in older age in a well-characterized cohort study. Design, setting, participants and measurements: A retrospective alcohol life-grid was administered to 5980 participants (72% male, mean age 70 years) in the Whitehall II study covering frequency of drinking, number of drinks in a typical drinking day and frequency of consuming six or more drinks in a single drinking occasion in the teens (16-19years) through to the 80s. A subsample of 385 individuals completed a repeat survey to determine test-retest reliability. Retrospective measures were also compared with prospectively ascertained information and used to predict objectively measured systolic blood pressure to test their predictive validity. Findings: Across all decades of life, test-retest reliability was generally good (κ range = 0.62-0.78 for frequency, 0.55-0.62 for usual number of drinks and 0.57-0.65 for frequency of consuming six or more drinks in a single occasion). The concordance between prospective and retrospective measures was consistently moderate to high. The life-grid method performed better than a single question in identifying life-time abstainers. Retrospective measures were also related to systolic blood pressure in the manner anticipated. Conclusion: A retrospective decade-based AUDIT-C grid administered in older age provides a relatively reliable measure of alcohol consumption across the life-course. Open Access
Bischof, G., Reinhardt, S., Grothues, J., (...), John, U., Rumpf, H.-J.
Effects of item sequence on the performance of the AUDIT in general practices. Drug and Alcohol Dependence, Volume 79, Issue 3, 1 September 2005, Pages 373-377
2005 English 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 Via Publisher
Bowring, A.L., Gouillou, M., Hellard, M., Dietze, P.
Comparing short versions of the AUDIT in a community-based survey of young people. BMC Public Health, Volume 13, Issue 1, 2013, Article number 301
2013 English Background: The 10-item Alcohol Use Disorders Identification Test (AUDIT-10) is commonly used to monitor harmful alcohol consumption among high-risk groups, including young people. However, time and space constraints have generated interest for shortened versions. Commonly used variations are the AUDIT-C (three questions) and the Fast Alcohol Screening Test (FAST) (four questions), but their utility in screening young people in non-clinical settings has received little attention. Results: We recruited 640 participants (68% female) reporting drinking in the previous 12 months. Median AUDIT-10 score was 10 in males and 9 in females, and 127 (20%) were classified as having at least high-level alcohol problems according to WHO classification.The FAST scored consistently high across statistical measures; it explained 85.6% of variance in AUDIT-10, correlation with AUDIT-10 was 0.92, and Cronbach's alpha was 0.66. A number of novel four-item AUDIT variations scored similarly high. Comparatively, the AUDIT-C scored substantially lower on all measures except internal consistency. Conclusions: Numerous abbreviated variations of the AUDIT may be a suitable alternative to the AUDIT-10 for classifying high-level alcohol problems in a community-based population of young Australians. Four-item AUDIT variations scored more consistently high across all evaluated statistics compared to three-item combinations. Novel AUDIT versions may be more effective than many established shortened versions as an alternative screening tool to the AUDIT-10 to measure hazardous or harmful alcohol consumption in this population. Open Access
Bradley, K.A., Bush, K.R., Epler, A.J., Dobie, D.J., Davis, T.M., Sporleder, J.L., Maynard, C., Burman, M.L., Kivlahan, D.R.
Two brief alcohol-screening tests from the Alcohol Use Disorders Identification Test (AUDIT): Validation in a female Veterans Affairs patient population. Archives of Internal Medicine, Volume 163, Issue 7, 14 April 2003, Pages 821-829.
2003 English Background: Primary care physicians need a brief alcohol questionnaire that identifies hazardous drinking and alcohol use disorders. The Alcohol Use Disorders Identification Test (AUDIT) questions 1 through 3 (AUDIT-C), and AUDIT question 3 alone are effective alcohol-screening tests in male Veterans Affairs (VA) patients, but have not been validated in women.Conclusions: The standard and sex-specific AUDIT-Cs are effective screening tests for past-year hazardous drinking and/or active alcohol abuse or dependence in female patients in a VA study. Open Access
Bradley, K.A., McDonell, M.B., Bush, K., (...), Diehr, P., Fihn, S.D.
The AUDIT alcohol consumption questions: Reliability, validity, and responsiveness to change in older male primary care patients. Alcoholism: Clinical and Experimental Research, Volume 22, Issue 8, November 1998, Pages 1842-1849
1998 English Objectives: To determine the reliability, validity, and responsiveness to change of AUDIT (Alcohol Use Disorders Identification Test) questions 1 to 3 about alcohol consumption in a primary care setting. Measures: Three self‐administered AUDIT consumption questions were compared with a telephone‐administered version of the trilevel World Health Organization interview about alcohol consumption. Results: Of 393 eligible patients, 264 (67%) completed interviews. Test‐retest reliability—Correlations between baseline and repeat measures 3 months later for four dimensions of consumption according to the AUDIT, ranged from 0.65 to 0.85, among patients who indicated they had not changed their drinking (Kendall's Tau‐b). Criterion validity—Correlations between AUDIT and interview for four dimensions of alcohol consumption ranged from 0.47 to 0.66 (Kendall's Tau‐b). Discriminative validity—The AUDIT questions were specific (90 to 93%), but only moderately sensitive (54 to 79%), for corresponding criteria for heavy drinking. Responsiveness to change—The AUDIT consumption questions had a Guyatt responsiveness statistic of 1.04 for detecting a change of 7 drinks/week, suggesting excellent responsiveness to change. Conclusions: AUDIT questions 1 to 3 demonstrate moderate to good validity, but excellent reliability and responsiveness to change. Although they often underestimate heavy alcohol consumption according to interview, they performed adequately to be used as a proxy measure of consumption in a clinical trial of heavy drinkers in this population. Via Publisher
Bradley, K.A., Rubinsky, A.D., Lapham, G.T., (...), Williams, E.C., Kivlahan, D.R.
Predictive validity of clinical AUDIT-C alcohol screening scores and changes in scores for three objective alcohol-related outcomes in a Veterans Affairs population. Addiction (Abingdon, England), Volume 111, Issue 11, 1 November 2016, Pages 1975-1984
2016 English AIMS: To evaluate the association between Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) alcohol screening scores, collected as part of routine clinical care, and three outcomes in the following year (Aim 1), and the association between changes in AUDIT-C risk group at 1-year follow-up and the same outcomes in the subsequent year (Aim 2). DESIGN: Cohort study.SETTING: Twenty-four US Veterans Affairs (VA) healthcare systems (2004-07), before systematic implementation of brief intervention.PARTICIPANTS: A total of 486 115 out-patients with AUDIT-Cs documented in their electronic health records (EHRs) on two occasions ≥ 12 months apart ('baseline' and 'follow-up').CONCLUSIONS: When AUDIT-C screening is conducted in clinical settings, baseline AUDIT-C scores and score increases to moderate-severe alcohol misuse at follow-up screening appear to have predictive validity for HDL cholesterol, alcohol-related gastrointestinal hospitalizations and physical trauma. Decreasing AUDIT-C scores collected in clinical settings appear to have predictive validity for only HDL. Via Publisher
Broyles, L.M., Gordon, A.J., Sereika, S.M., Ryan, C.M., Erlen, J.A.
Predictive utility of brief Alcohol Use Disorders Identification Test (AUDIT) for human immunodeficiency virus antiretroviral medication nonadherence. Substance Abuse, Volume 32, Issue 4, 2011, Pages 252-261
2011 English 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, AUDITC- 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 AUDITC shows potential as an indirect screening tool for both at-risk drinking and ART nonadherence, underscoring the relationship between alcohol and chronic disease management. Via Publisher
Broyles, L.M., Gordon, A.J., Sereika, S.M., Ryan, C.M., Erlen, J.A.
Do words matter? incongruent responses to inconsistently worded AUDIT-C alcohol screening instruments. Substance Abuse, Volume 32, Issue 4, 2011, Pages 202-209
2011 English The first 3 questions of the Alcohol Use Disorders Identification Test (AUDIT-C) are often used as a brief alcohol screening instrument. However, the implications of common modifications made to the original AUDITquestions and response options have not been considered. The authors examined existing data from a randomized controlled trial of 310 persons with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) that was testing the efficacy of 2 antiretroviral medication adherence interventions. Logistic regression was used to model the probability of participants having inconsistent AUDIT-C item responses. Three patterns of conflicting responses to the AUDIT-C items were identified. Common item modifications resulted in 14% (n = 48) of theparent study sample reporting conflicting responses across related AUDIT-C items. The odds of having conflicting data were 3 times greater in opioid users (odds ratio [OR] = 3.139, 95% confidence interval [CI] = 1.267-7.777, P = .01) and greater in persons with higher levels of conscientiousness (OR = 1.053, 95% CI = 1.006-1.103, P = .03). Inconsistent question format and response options may impede proper scoring and interpretation of the AUDIT-C. Further discussion and consensus building are needed on the psychometrically ideal version of the AUDIT-C. Via Publisher
Bush, K., Kivlahan, D.R., McDonell, M.B., Fihn, S.D., Bradley, K.A.
The AUDIT Alcohol Consumption Questions (AUDIT-C) - An Effective Brief Screening Test for Problem Drinking. Archives of Internal Medicine. , 1998, Vol.158(16), p.1789-1795
1998 English Objective:  To evaluate the 3 alcohol consumption questions from the Alcohol Use Disorders Identification Test (AUDIT-C) as a brief screening test for heavy drinking and/or active alcohol abuse or dependence. Conclusions: Three questions about alcohol consumption (AUDIT-C) appear to be a practical, valid primary care screening test for heavy drinking and/or active alcohol abuse or dependence. Open Access
Calabria, B., Clifford, A., Shakeshaft, A.P., (...), Bliss, D., Allan, J.
Identifying Aboriginal-specific AUDIT-C and AUDIT-3 cutoff scores for at-risk, high-risk, and likely dependent drinkers using measures of agreement with the 10-item Alcohol Use Disorders Identification Test. Addiction Science & Clinical Practice, Volume 9, 2014, Page 17
2014 English BACKGROUND: The Alcohol Use Disorders Identification Test (AUDIT) is a 10-item alcohol screener that has been recommended for use in Aboriginal primary health care settings. The time it takes respondents to complete AUDIT, however, has proven to be a barrier to its routine delivery. Two shorter versions, AUDIT-C and AUDIT-3, have been used as screening instruments in primary health care. This paper aims to identify the AUDIT-C and AUDIT-3 cutoff scores that most closely identify individuals classified as being at-risk drinkers, high-risk drinkers, or likely alcohol dependent by the 10-item AUDIT.CONCLUSIONS: Recommended cutoff scores for Aboriginal Australians are as follows: at-risk drinkers AUDIT-C ≥ 5, AUDIT-3 ≥ 1; high-risk drinkers AUDIT-C ≥ 6, AUDIT-3 ≥ 2; and likely dependent drinkers AUDIT-C ≥ 9, AUDIT-3 ≥ 3. Adequate sensitivity and specificity were achieved for recommended cutoff scores. AUROC curves were above 0.90. Open Access
Carretero, M.Á.G., Ruiz, J.P.N., Delgado, J.M.M., González, C.O.
Validation of the Alcohol Use Disorders Identification Test in university students: AUDIT and AUDIT-C | [Validación del test para la identificación de trastornos por uso de alcohol en población universitaria: AUDIT y AUDIT-C]. Adicciones, Volume 28, Issue 4, 2016, Pages 194-204
2016 Spanish/English The aim of this study was to determine the psychometric properties of the Alcohol Use Disorders Identification Test (AUDIT and AUDIT-C) in order to detect problems related to the consumption of alcohol in the university population. The sample consisted of 1309 students. A Weekly Alcohol Consumption Diary was used as a gold standard; Cronbach’s Alpha, the Kappa index, Spearman’s correlation coefficient and exploratory factor analysis were applied for diagnostic reliability and validity, with ROC curves used to establish the different cut-off points. Binge Drinking (BD) episodes were found in 3.9% of men and 4.0% of women with otherwise low-risk drinking patterns. AUDIT identified 20.1% as high-risk drinkers and 6.4% as drinkers with physical-psychological problems and probable alcohol dependence. Cronbach’s alpha of 0.75 demonstrates good internal consistency. The best cut-off points for high-risk drinking students were 8 for males and 6 for females. As for problem drinkers and probable ADS, 13 was the best cut-off point for both sexes. In relation to AUDIT-C, 5 and 4 were the best cut-off points for males and females with high-risk patterns, respectively. The criterion validity of AUDIT and AUDIT-C to detect binge drinking episodes was found to have a moderate K value. The results obtained show that AUDIT has good psychometric properties to detect early alcohol abuse disorders in university students; however, it is recommended that the cut-off point be reduced to 8 in men. AUDIT-C improves its predictive value by raising the cut-off point by one unit. Items 2 and 3 should be reviewed to increase its predictive value for BD. Open Access
Cortés-Tomás, M.-T., Giménez-Costa, J.-A., Motos-Sellés, P., Sancerni-Beitia, M.-D.
Different versions of the Alcohol Use Disorders Identification Test (AUDIT) as screening instruments for underage binge drinking. Drug and Alcohol Dependence, Volume 158, 1 January 2016, Pages 52-59
2016 English Background: The changes experienced in recent years in the conceptualization of binge drinking (BD) make it necessary to revise the usefulness of the existing instruments for its detection among minors. The AUDIT and its abbreviated versions have shown their utility in different populations and consumption ranges, but there has been little research into their use in the detection of BD among adolescents. This study tests the capacity of the AUDIT, AUDIT-C and AUDIT-3 to identify BD adolescents, indicating the optimal cut-off points for each sex. Methods: High school students self-administered the AUDIT and completed a weekly self-report of their alcohol intake. BD is classified into different groups according to parameters like the quantity consumed and its frequency in the past six months, adjusting the cut-off points for each case. Results: The results obtained with a sample of 634 adolescents (15-17 years old/52.2% female) indicate that cut-off points of 4 on the AUDIT and 3 on the AUDIT-C show the best fit. Dividing the sample by sexes, the AUDIT and the AUDIT-C would detect BD males with scores of 5 and 4, respectively (with the AUDIT-C being more sensitive), and BD females with a score of 3 on both (the more sensitive being the AUDIT). Conclusions: All three versions are adequate to classify BD adolescents but none of them made it possible to safely differentiate binge drinkers with different consumption intensities. Via Publisher
Crawford, E.F., Fulton, J.J., Swinkels, C.M., Beckham, J.C., Calhoun, P.S.
Diagnostic efficiency of the AUDIT-C in U.S. veterans with military service since September 11, 2001. Drug and Alcohol Dependence, Volume 132, Issue 1-2, 1 September 2013, Pages 101-106
2013 English Background: Alcohol screening with the 3-item Alcohol Use Disorders Identification Test (AUDIT-C) has been implemented throughout the U.S. Veterans Health Administration. Validation of the AUDIT-C, however, has been conducted with samples of primarily older veterans. This study examined the diagnostic efficiency of the AUDIT-C in a younger cohort of veterans who served during Operation Enduring Freedom and/or Operation Iraqi Freedom (OEF/OIF). Results: Both measures performed well in detecting alcohol use disorders. In the full sample, the AUDIT had a better AUC (908; .881-935) than the AUDIT-C (859; .826-893; p < .0001). It is notable that this same result was found among men but not women, perhaps due to reduced power. Diagnostic efficiency statistics for the AUDIT and AUDIT-C were consistent with results from older veteran samples. The diagnostic efficiency of both measures did not vary with race or age. Conclusions: Both the AUDIT and AUDIT-C appear to be valid instruments for identifying alcohol abuse or dependence among the most recent cohort of U.S. veterans with service during OEF/OIF within research settings Via Publisher
Dawson, D.A., Grant, B.F., Stinson, F.S.
The AUDIT-C: Screening for alcohol use disorders and risk drinking in the presence of other psychiatric disorders. Comprehensive Psychiatry, Volume 46, Issue 6, November 2005, Pages 405-416
2005 English This article examines the performance of the AUDIT-C, as embedded in a large national survey, as a screener for alcohol use disorders (AUDs) and risk drinking among individuals with past-year psychopathology. The analysis is based on data collected in personal interviews from a representative population sample of US adults. The study population consisted of past-year drinkers with any past-year mood disorder (n = 2818), any past-year anxiety disorder (n = 3173), or any personality disorder (n = 4389). Screening performance was evaluated by means of sensitivity, specificity, and areas under receiver operating characteristic curves (AUCs). The AUCs for the AUDIT-C were from 0.888 to 0.893 for alcohol dependence, from 0.864 to 0.876 for any AUD, and from 0.941 to 0.951 for any AUD or risk drinking-all on a par with those observed in the general population. Among men, cut points of either ≥5 or ≥6 points (the former favoring sensitivity and the latter favoring specificity) were optimal for detecting dependence, and cut points of ≥5 points were optimal for any AUD and for any AUD or risk drinking. Among women, a cut point of ≥4 points was optimal for the outcomes of both alcohol dependence and any AUD, whereas a cut point of ≥3 points was preferable for detecting any AUD or risk drink Via Publisher
Dawson, D.A., Grant, B.F., Stinson, F.S., Zhou, Y.
Effectiveness of the derived Alcohol Use Disorders Identification Test (AUDIT-C) in screening for alcohol use disorders and risk drinking in the US general population. Alcoholism, clinical and experimental research. , 2005, Vol.29(5), p.844-854
2005 English The three consumption questions from the Alcohol Use Disorders Identification Test (AUDIT‐C) are increasingly used as a screener for alcohol use disorders (AUDs) and risk drinking.Conclusions: The derived AUDIT‐C performs well in screening for AUDs and risk drinking. The use of variable cut points for men and women improves its sensitivity and specificity. Validation in a realistic screening situation, in which the AUDIT‐C questions are asked as stand‐alone and not embedded items, is a critical future step. Via Publisher
Dawson, D.A., Smith, S.M., Saha, T.D., Rubinsky, A.D., Grant, B.F.
Comparative performance of the AUDIT-C in screening for DSM-IV and DSM-5 alcohol use disorders. Drug and Alcohol Dependence, Volume 126, Issue 3, 1 December 2012, Pages 384-388
2012 English Objective: Under the proposed DSM-5 revision to the criteria for alcohol use disorder (AUD), a substantial proportion of DSM-IV AUD cases will be lost or shifted in terms of severity, with some new cases added. Accordingly, the performance of the AUDIT-C in screening for DSM-IV AUD cannot be assumed to extend to DSM-5 AUD. The objective of this paper is to compare the AUDIT-C in screening for DSM-IV and DSM-5 AUD. Results: Optimal AUDIT-C cutpoints were identical for DSM-IV and DSM-5 AUD: ≥4 for any AUD, ≥3 or ≥4 for abuse/moderate AUD and ≥4 or ≥5 for dependence/severe AUD. Screening performance was slightly better for DSM-5 severe AUD than DSM-IV dependence but did not differ for other diagnoses. At optimal screening cutpoints, positive predictive values were slightly higher for DSM-5 overall AUD and moderate AUD than for their DSM-IV counterparts. Sensitivities were slightly higher for DSM-5 severe AUD than DSM-IV dependence. Optimal screening cutpoints shifted upwards for past-year drinkers but continued to be identical for DSM-IV and DSM-5 disorders. Conclusions: Clinicians should not face any major overhaul of their current screening procedures as a result of the DSM-5 revision and should benefit from fewer false positive screening results. Via Publisher
Delaney, K.E., Lee, A.K., Lapham, G.T., (...), Chavez, L.J., Bradley, K.A.
Inconsistencies between alcohol screening results based on AUDIT-C scores and reported drinking on the AUDIT-C questions: prevalence in two US national samples. Addiction Science & Clinical Practice, Volume 9, 2014, Page 2
2014 English The AUDIT-C is an extensively validated screen for unhealthy alcohol use (i.e. drinking above recommended limits or alcohol use disorder), which consists of three questions about alcohol consumption. AUDIT-C scores ≥4 points for men and ≥3 for women are considered positive screens based on US validation studies that compared the AUDIT-C to "gold standard" measures of unhealthy alcohol use from independent, detailed interviews. However, results of screening--positive or negative based on AUDIT-C scores--can be inconsistent with reported drinking on the AUDIT-C questions. For example, individuals can screen positive based on the AUDIT-C score while reporting drinking below US recommended limits on the same AUDIT-C. Alternatively, they can screen negative based on the AUDIT-C score while reporting drinking above US recommended limits. Such inconsistencies could complicate interpretation of screening results, but it is unclear how often they occur in practice. This study used AUDIT-C data from respondents who reported past-year drinking on one of two national US surveys: a general population survey (N = 26,610) and a Veterans Health Administration (VA) outpatient survey (N = 467,416). Gender-stratified analyses estimated the prevalence of AUDIT-C screen results--positive or negative screens based on the AUDIT-C score--that were inconsistent with reported drinking (above or below US recommended limits) on the same AUDIT-C. Among men who reported drinking, 13.8% and 21.1% of US general population and VA samples, respectively, had screening results based on AUDIT-C scores (positive or negative) that were inconsistent with reported drinking on the AUDIT-C questions (above or below US recommended limits). Among women who reported drinking, 18.3% and 20.7% of US general population and VA samples, respectively, had screening results that were inconsistent with reported drinking. This study did not include an independent interview gold standard for unhealthy alcohol use and therefore cannot address how often observed inconsistencies represent false positive or negative screens. Up to 21% of people who drink alcohol had alcohol screening results based on the AUDIT-C score that were inconsistent with reported drinking on the same AUDIT-C. This needs to be addressed when training clinicians to use the AUDIT-C. Open Access
DeMartini, K.S., Carey, K.B.
Optimizing the use of the AUDIT for alcohol screening in college students. Psychological Assessment, Volume 24, Issue 4, December 2012, Pages 954-963
2012 English The screening and brief intervention modality of treatment for at-risk college drinking is becoming increasingly popular. A key to effective implementation is use of validated screening tools. Although the Alcohol Use Disorders Identification Test (AUDIT) has been validated in adult samples and is often used with college students, research has not yet established optimal cutoff scores to screen for at-risk drinking. Four hundred and one current drinkers completed computerized assessments of demographics, family history of alcohol use disorders, alcohol use history, alcohol-related problems, and general health. Of the 401 drinkers, 207 met criteria for at-risk drinking. Receiver operating characteristic (ROC) curve analysis revealed that the area under the ROC (AUROC) of the AUDIT was .86 (95% CI [.83, .90]). The first 3 consumption items of the AUDIT (AUDIT-C; AUROC = .89, 95% CI [.86, .92] ) performed significantly better than the AUDIT in the detection of at-risk drinking in the whole sample, and specifically for females. Gender differences emerged in the optimal cutoff scores for the AUDIT-C. A total score of 7 should be used for males, and a score of 5 should be used for females. These empirical guidelines may enhance identification of at-risk drinkers in college settings.  Via Publisher
Dreher-Weber, M., Laireiter, A.-R., Kühberger, A., (...), Lang, S., Wurst, F.M.
Screening for Hazardous Drinking in Nursing Home Residents: Evaluating the Validity of the Current Cutoffs of the Alcohol Use Disorder Identification Test—Consumption Questions by Using Ethyl Glucuronide in Hair. Alcoholism: Clinical and Experimental Research, Volume 41, Issue 9, September 2017, Pages 1593-1601
2017 English Background: Because of physiological changes, elderly people are much more exposed to the adverse effects of alcohol. Therefore, hazardous drinking is defined at lower levels as compared to younger adults. This work aimed to evaluate the validity of the current cutoff levels of the Alcohol Use Disorder Identification Test—Consumption (AUDIT-C) questions to detect hazardous drinking in the elderly by using ethyl glucuronide in hair (HEtG). Methods: In a border region between Austria and Germany, 344 nursing home residents were included from 33 of the 107 nursing homes. Residents were asked to answer the AUDIT-C questions, hair samples were obtained, and nursing staff members were asked for their assessments of the residents' alcohol consumption. Hair samples were analyzed for HEtG using gas chromatography–mass spectrometry. Receiver-operating characteristic (ROC) curve analysis was performed to determine the validity of cutoff values for the AUDIT-C to detect an alcohol consumption of ≥10 g of alcohol/d. Results: A total of 11.3% of the nursing home residents (n = 344) drank ≥10 g of alcohol/d (4.9% >60 g of alcohol/d, 6.4% 10 to 60 g of alcohol/d, 88.7% <10 g of alcohol/d)). For the drinking limit of ≥10 g of alcohol/d, ROC curve analysis showed a balanced sensitivity and specificity, with an AUDIT-C cutoff of ≥4 for men (sensitivity: 70%, specificity: 83.6%; AUC = 0.823, CI = 0.718 to 0.928, p < 0.001) and ≥2 for women (sensitivity: 73.7%, specificity: 81.9%; AUC = 0.783, CI = 0.653 to 0.914, p < 0.001). Nursing staff (n = 274) underestimated alcohol consumption and evaluated 40% of the chronic-excessive alcohol consumers (>60 g of alcohol/d) as being abstinent. Conclusions: Our data suggest that an AUDIT-C cutoff of ≥4 for men and ≥2 for women can be recommended to detect the consumption of ≥10 g of alcohol/d in the elderly. Because the nursing staff to a large extent underestimates the alcohol consumption among nursing home residents, further teaching of the staff, improvement of screening instruments for the elderly, and the use of objective biomarkers might be helpful for recognizing hazardous drinking and can thus help improve the quality of life of the elderly. Via Publisher
Frank, D., DeBenedetti, A.F., Volk, R.J., (...), Kivlahan, D.R., Bradley, K.A.
Effectiveness of the AUDIT-C as a screening test for alcohol misuse in three race/ethnic groups. Journal of General Internal Medicine, June 2008, Volume 23, Issue 6, pp 781–787
2008 English Background: The Alcohol Use Disorders Identification Test—Consumption (AUDIT-C) is a brief validated screen for risky drinking and alcohol abuse and dependence (alcohol misuse). However, the AUDIT-C was validated in predominantly White populations, and its performance in different racial/ethnic groups is unclear. Objective: To evaluate the validity of the AUDIT-C among primary care patients from the predominant racial/ethnic subgroups within the United States: White, African American, and Hispanic. Measurements and Main Results: Race/ethnicity was self-reported. Areas under the receiver operating curve (AuROCs) evaluated overall AUDIT-C performance in the 3 racial/ethnic groups compared to diagnostic interviews for alcohol misuse. AUDIT-C sensitivities and specificities at recommended screening thresholds were compared across racial/ethnic groups. AuROCs were greater than 0.85 in all 3 groups, with no significant differences across racial/ethnic groups in men (P = .43) or women (P = .12). At previously recommended cut points, there were statistically significant differences by race in AUDIT-C sensitivities but not specificities. In women, the sensitivity was higher in Hispanic (85%) than in African-American (67%; P = .03) or White (70%; P = .04) women. In men, the sensitivity was higher in White (95%) than in African-American men (76%; P = .01), with no significant difference from Hispanic men (85%; P = .11). Conclusions: The overall performance of the AUDIT-C was excellent in all 3 racial/ethnic groups as reflected by high AuROCs. At recommended cut points, there were significant differences in the AUDIT-C’s sensitivity but not in specificity across the 3 racial/ethnic groups. Via Publisher
Gómez, A., Conde, A., Santana, J.M., (...), Serrano, I.M., Medina, R.
The diagnostic usefulness of AUDIT and AUDIT-C for detecting hazardous drinkers in the elderly. Aging and Mental Health, Volume 10, Issue 5, 1 September 2006, Pages 558-561
2006 English 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. Via Publisher
Gómez, A., Conde, A., Santana, J.M., Jorrín, 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, Volume 66, Issue 2, March 2005, Pages 305-308
2005 English 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. Conclusions: The AUDIT-C and AUDIT-PC show a higher sensitivity, lower specificity and a similar AUROC curve than the full-AUDIT, 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. Via Publisher
Gordon AJ, Maisto SA, McNeil M, Kraemer KL, Conigliaro RL, Kelley ME, Conigliaro J.
Three questions can detect hazardous drinkers. Journal of Family Practice, Volume 50, Issue 4, 2001, Pages 313-320
2001 The researchers evaluated the Alcohol Use Disorders Identification Test (AUDIT), the first 3 questions of the AUDIT (AUDIT-C), the third AUDIT question (AUDIT-3), and quantity-frequency questions for identifying hazardous drinkers in a large primary care sample. In a large primary care sample, a 3-question version of the AUDIT identified hazardous drinkers as well as the full AUDIT when such drinkers were defined by quantity-frequency criterion. This version of the AUDIT may be useful as an initial screen for assessing hazardous drinking behavior. Via Publisher
Gual, A., Segura, L., Contel, M., Heather, N., Colom, J.
AUDIT-3 and AUDIT-4: Effectiveness of two short forms of the Alcohol Use Disorders Identification Test. Alcohol and Alcoholism Volume 37, Issue 6, November 2002, Pages 591-596
2002 English Aims: To identify suitable short versions of the Alcohol Use Disorders Identification Test (AUDIT) and to evaluate their effectiveness as screening tests for ‘risky drinking’ among men and women in primary health care (PHC) settings.Results: AUDIT-3 and AUDIT-4 performed similarly to AUDIT-10 in detecting risky drinking and had equivalent receiver operating characteristics curves and their areas under the curve. Conclusions: Both short forms of AUDIT seem to be as effective as the full AUDIT for detecting risky drinking among men and women in PHC settings. Open Access
Hagman, B.T.
Toward efficient screening for DSM-5 Alcohol Use disorders in college students: Performance of the AUDIT-C. Addictive Disorders and their Treatment, Volume 14, Issue 1, 6 March 2015, Pages 1-15
2015 English Objectives: The newly implemented Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 Alcohol Use Disorder (AUD) criteria may significantly alter how AUDs are identified in our alcohol screening efforts. The Alcohol Use Disorders and Identification Test-Consumption (AUDIT-C) is a 3-item alcohol screening instrument that has been used extensively to identify those at-risk for an AUD. At present, research on the AUDIT-C to screen for AUDs in college students using the new DSM-5 guidelines has received no attention. The present study evaluated the performance of the AUDIT-C in screening for DSM-5 AUDs in college students. Methods and Materials: Participants (N=1697) were past-year drinkers and recruited from 3 universities in the Southeastern, United States. Results: The AUDIT-C performed slightly better in the detection of DSM-5 AUDs [areas under receiving operating characteristic curve (AUROC)=0.764; SE=0.014] in comparison with DSM-IV AUDs (AUROC=0.734; SE=0.014). Alternatively, the AUDIT-C performed most optimally in the detection of heavy binge drinking (AUROC=0.913; SE=0.008) and any binge drinking (AUROC=0.862; SE=0.009) in comparison with the detection of DSM-5 AUDs. Sex differences emerged in the identification of optimal AUDIT-C cut-off scores for detecting DSM-5 AUDs. Conclusions: Overall, preliminary findings indicate that the AUDIT-C provides reasonably good discrimination in the detection of DSM-5 AUDs in college students. Continued research is warranted to ensure the stability of the current study findings. Via Publisher
Harris, A.H.S., Bradley, K.A., Bowe, T., Henderson, P., Moos, R.
Associations between AUDIT-C and mortality vary by age and sex. Population Health Management, Volume 13, Issue 5, 1 October 2010, Pages 263-268
2010 English We sought to determine the sex- and age-specific risk of mortality associated with scores on the 3-item Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) questionnaire using data from a national sample of Veterans Health Administration (VHA) patients. Men (N=215,924) and women (N=9168) who completed the AUDIT-C in a patient survey were followed for 24 months. AUDIT-C categories (0, 1-4, 5-8, 9-12) were evaluated as predictors of mortality in logistic regression models, adjusted for age, race, education, marital status, smoking, depression, and comorbidities. For women, AUDIT-C scores of 9-12 were associated with a significantly increased risk of death compared to the AUDIT-C 1-4 group (odds ratio [OR] 7.09; 95% confidence interval [CI] =2.67, 18.82). For men overall, AUDIT-C scores of 5-8 and 9-12 were associated with increased risk of death compared to the AUDIT-C 1-4 group (OR 1.13, 95% CI=1.05, 1.21, and OR 1.63, 95% CI=1.45, 1.84, respectively) but these associations varied by age. These results provide sex- and age-tailored risk information that clinicians can use in evidence-based conversations with patients about the health-related risks of their alcohol consumption. This study adds to the growing literature establishing the AUDIT-C as a scaled marker of alcohol-related risk or "vital sign" that might facilitate the detection and management of alcohol-related risks and problems. Via Publisher
Hodgson, R., Alwyn, T., John, B., Thom, B., Smith, A.
The Fast Alcohol Screening Test. Alcohol and Alcoholism Volume 37, Issue 1, 2002, Pages 61-66.
2002 English Using the Alcohol Use Disorders Identification Test (AUDIT) as the gold standard, the Fast Alcohol Screening Test (FAST) was developed for use in busy medical settings. AUDIT questionnaires were completed by 666 patients in two London accident & emergency (A&E) departments. Using a principal components analysis, as well as sensitivity and specificity indices, a two-stage screening test was developed, using four of the AUDIT items. The first stage involved one item that identified >50% of patients as either hazardous or non-hazardous drinkers. The second stage made use of the other three items to categorize the rest. The performance of this four-item questionnaire was then tested across a range of settings. Opportunistic samples of 100 patients completed AUDIT questionnaires in each of the following National Health Service settings: A&E department, fracture clinic, primary health centre and a dental hospital. It was concluded that the four-item FAST questionnaire had good sensitivity and specificity, across a range of settings, when the AUDIT score was used as the gold standard. The FAST questionnaire is quick to administer, since >50% of patients are categorized using just one question. Open Access
Hodgson, R.J., John, B., Abbasi, T., (...), Thom, B., Newcombe, R.G.
FAST screening for alcohol misuse. Addictive Behaviors, Volume 28, Issue 8, October 2003, Pages 1453-1463
2003 English The Fast Alcohol Screening Test (FAST) has been developed from the AUDIT questionnaire [Babor, T. F., de la Fuente, J. R., Saunders, J., Grant, M. (2001). AUDIT: The Alcohol Use Disorders Identification Test: guidelines for use in primary health care. Geneva, Switzerland: World Health Organization] for use in very busy medical settings [Alcohol Alcohol. 37 (2002) 61-66] . One feature of the FAST is its ease and speed of administration, especially since one question identifies over 50% of patients as either alcohol misusers or not. This study further explores the sensitivity and specificity of the FAST across ages, gender, and locations using the AUDIT as the gold standard. Two other quick tests are also compared with the AUDIT and the FAST, namely the Paddington Alcohol Test [J. Accid. Emerg. Med. 5 (1996) 308] and the CAGE [Am. J. Psychiatry 131 (1974) 1121] . All tests were quicker to administer than the AUDIT with the FAST taking just 12 s on average. All tests identified drinkers who would accept a health education booklet (over 70% of those identified) or 5 min of advice (over 40%). The FAST was consistently reliable when sensitivity and specificity were tested against AUDIT as the gold standard.  Via Publisher
Justice, A.C., McGinnis, K.A., Tate, J.P., (...), Gelernter, J., Kranzler, H.R.
Validating Harmful Alcohol Use as a Phenotype for Genetic Discovery Using Phosphatidylethanol and a Polymorphism in ADH1B. Alcoholism: Clinical and Experimental Research, Volume 41, Issue 5, May 2017, Pages 998-1003
2017 English Background: Although alcohol risk is heritable, few genetic risk variants have been identified. Longitudinal electronic health record (EHR) data offer a largely untapped source of phenotypic information for genetic studies, but EHR-derived phenotypes for harmful alcohol exposure have yet to be validated. Using a variant of known effect, we used EHR data to develop and validate a phenotype for harmful alcohol exposure that can be used to identify unknown genetic variants in large samples. Herein, we consider the validity of 3 approaches using the 3-item Alcohol Use Disorders Identification Test consumption measure (AUDIT-C) as a phenotype for harmful alcohol exposure. Methods: First, using longitudinal AUDIT-C data from the Veterans Aging Cohort Biomarker Study Cohort (VACS-BC), we compared 3 metrics of AUDIT-C using correlation coefficients: (i) AUDIT-C closest to blood sampling (closest AUDIT-C), (ii) the highest value (highest AUDIT-C), (iii) and longitudinal trajectories generated using joint trajectory modeling (AUDIT-C trajectory). Second, we compared the associations of the 3 AUDIT-C metrics with phosphatidylethanol (PEth), a direct, quantitative biomarker for alcohol in the overall sample using chi-square tests for trend. Last, in the subsample of African Americans (AAs; n = 1,503), we compared the associations of the 3 AUDIT-C metrics with rs2066702 a common missense (Arg369Cys) polymorphism of the ADH1B gene, which encodes an alcohol dehydrogenase isozyme. Results: The sample (n = 1,851, 94.5% male, 65% HIV+, mean age 52 years) had a median of 7 AUDIT-C scores over a median of 6.1 years. Highest AUDIT-C and AUDIT-C trajectory were correlated r = 0.86. The closest AUDIT-C was obtained a median of 2.26 years after the VACS-BC blood draw. Overall and among AAs, all 3 AUDIT-C metrics were associated with PEth (all p < 0.05), but the gradient was steepest with AUDIT-C trajectory. Among AAs (36% with the protective ADH1B allele), the association of rs2066702 with AUDIT-C trajectory and highest AUDIT-C was statistically significant (p < 0.05), and the gradient was steeper for the AUDIT-C trajectory than for the highest AUDIT-C. The closest AUDIT-C was not statistically significantly associated with rs2066702. Conclusions: EHR data can be used to identify complex phenotypes such as harmful alcohol use. The validity of the phenotype may be enhanced through the use of longitudinal trajectories. Via Publisher
Justice, A.C., Smith, R.V., Tate, J.P., (...), Gelernter, J., Kranzler, H.R.
AUDIT-C and ICD codes as phenotypes for harmful alcohol use: association with ADH1B polymorphisms in two US populations. Addiction, Volume 113, Issue12, December 2018, Pages 2214-2224
2018 English Background and Aims: Longitudinal electronic health record (EHR) data offer a large-scale, untapped source of phenotypical information on harmful alcohol use. Using established, alcohol-associated variants in the gene that encodes the enzyme alcohol dehydrogenase 1B (ADH1B) as criterion standards, we compared the individual and combined validity of three longitudinal EHR-based phenotypes of harmful alcohol use: Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) trajectories; mean age-adjusted AUDIT-C; and diagnoses of alcohol use disorder (AUD). Design: With longitudinal EHR data from the Million Veteran Program (MVP) linked to genetic data, we used two population-specific polymorphisms in ADH1B that are associated strongly with AUD in African Americans (AAs) and European Americans (EAs): rs2066702 (Arg369Cys, AAs) and rs1229984 (Arg48His, EAs) as criterion measures. Setting: United States Department of Veterans Affairs Healthcare System. Participants: A total of 167 721 veterans (57 677 AAs and 110 044 EAs; 92% male, mean age = 63 years) took part in this study. Data were collected from 1 October 2007 to 1 May 2017. Measurements: Using all AUDIT-C scores and AUD diagnostic codes recorded in the EHR, we calculated age-adjusted mean AUDIT-C values, longitudinal statistical trajectories of AUDIT-C scores and ICD-9/10 diagnostic groupings for AUD. Findings: A total of 19 793 AAs (34.3%) had one or two minor alleles at rs2066702 [minor allele frequency (MAF) = 0.190] and 6933 EAs (6.3%) had one or two minor alleles at rs1229984 (MAF = 0.032). In both populations, trajectories and age-adjusted mean AUDIT-C were correlated (r = 0.90) but, when considered separately, highest score (8+ versus 0) of age-adjusted mean AUDIT-C demonstrated a stronger association with the ADH1B variants [adjusted odds ratio (aOR) 0.54 in AAs and 0.37 in AAs] than did the highest trajectory (aOR 0.71 in AAs and 0.53 in EAs); combining AUDIT-C metrics did not improve discrimination. When age-adjusted mean AUDIT-C score and AUD diagnoses were considered together, age-adjusted mean AUDIT-C (8+ versus 0) was associated with lower odds of having the ADH1B minor allele than were AUD diagnostic codes: aOR = 0.59 versus 0.86 in AAs and 0.48 versus 0.68 in EAs. These independent associations combine to yield an even lower aOR of 0.51 for AAs and 0.33 for EAs. Conclusions: The age-adjusted mean AUDIT-C score is associated more strongly with genetic polymorphisms of known risk for alcohol use disorder than are longitudinal trajectories of AUDIT-C or AUD diagnostic codes. AUD diagnostic codes modestly enhance this association. Via Publisher
Kaarne, T., Aalto, M., Kuokkanen, M., Seppä, K.
AUDIT-C, AUDIT-3 and AUDIT-QF in screening risky drinking among Finnish occupational health-care patients. Drug and Alcohol Review, Volume 29, Issue 5, September 2010, Pages 563-567
2010 English 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 IdentificationTest-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. 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.  Via Publisher
Katharine A Bradley, Anna F DeBenedetti, Robert J Volk, Emily C Williams, Danielle Frank, Daniel R Kivlahan.
AUDIT-C as a brief screen for alcohol misuse in primary care. Alcoholism: Clinical and Experimental Research. , 2007, Vol.31(7), p.1208-1217
2007 English Background: 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. Methods: 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. Results: 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 ≥4 in men (sensitivity 0.86, specificity 0.89) and ≥3 in women (sensitivity 0.73, specificity 0.91). Conclusions: The AUDIT‐C was an effective screening test for alcohol misuse in this primary care sample. Optimal screening thresholds for alcohol misuse among men (≥4) and women (≥3) were the same as in previously published VA studies.

Via Publisher
Ketoja, J., Svidkovski, A.-S., Heinälä, P., Seppä, K.
Risky drinking and its detection among medical students. Addictive Behaviors, Volume 38, Issue 5, May 2013, Pages 2115-2118
2013 English The drinking patterns of physicians may affect their own health and how they treat patients with substance use disorders. This is why we wanted to find out risky drinking among medical students. A questionnaire was delivered to all medical students at the University of Tampere and risky alcohol drinking was defined as a minimum score of five for women and six for men in the AUDIT-C alcohol screen (rating 0 to 12). The respondent rate was 94% (n =465). Of the whole sample 33% were risky drinkers, 24% of women and 49% of men. After the first study year the female risky drinkers significantly decreased and men increased their drinking. Significantly more men but not women with moderate alcohol use reduced drinking during the first year of studies compared with risky drinkers of the same gender. The AUDIT-C scored higher in the subgroups of risky drinkers willing to reduce drinking compared with those who did not want to cut down drinking (7.3. and 6.5., p. <0.001). In the male sample the third AUDIT-C sub-question on binge drinking (= AUDIT-3, rating 0 to 4) at a cut-off point of ≥ 2 was nearly as effective as the whole AUDIT-C at a cut-off point of ≥ 6. This was not the case in the female sub-sample. Risky drinking is common among medical students and continues throughout the studies especially among men. AUDIT-3 is a short and reliable screening tool for male but not for female students.  Via Publisher
Kim, J.W., Lee, B.C., Lee, D.Y., (...), Kang, T.-C., Choi, I.-G.
The 5-item Alcohol Use Disorders Identification Test (AUDIT-5): An effective brief screening test for problem drinking, alcohol use disorders and alcohol dependence. Alcohol and Alcoholism, Volume 48, Issue 1, January 2013, Article number ags082, Pages 68-73
2013 English Aims: To identify an optimal brief version of the Alcohol Use Disorders Identification Test (AUDIT) and to evaluate its effectiveness as a screening test for problem drinking (PD), alcohol use disorders (AUD) and alcohol dependence (AD). Methods: A multicenter trial was conducted from March, 2010, to January, 2012, in 101 normal comparison, 203 risky drinking, 92 alcohol abuse and 101 AD men aged below 65 years of age in a Korean population. For the purposes of screening, risky drinking, alcohol abuse and AD were grouped: all the three grouped as PD and the latter two grouped as AUD. Logistic regression analysis was used to determine the items among the 10-item AUDIT that provided information predictive of PD, AUD and AD. Receiver operating characteristic (ROC) curve analysis was performed to investigate the discrimination ability of the brief versions of AUDIT, 10-item AUDIT and Cut-down, Annoyed, Guilt, Eye-opener as a screen for PD, AUD and AD. Areas under the ROC curve were compared between tests according to the method suggested by Hanley and McNeil. Results: The 5-item AUDIT (AUDIT-5: AUDIT items 2, 4, 5, 9 and 10) was obtained by stepwise multiple regression analyses for each screening. AUDIT-5 exhibited an AUD screening accuracy significantly superior to that of the 10-item AUDIT, but other brief versions of AUDIT and CAGE did not. Furthermore, AUDIT-5 had a high PD and AD screening accuracy equivalent to that of the 10-item AUDIT. Conclusion: These results strongly support the usefulness of AUDIT-5 for screening of PD, AUD and AD in clinical settings in Korean male populations. Open Access
Kolšek, M., Poplas Susič, T., Kersnik, J.
Slovenian adaptation of the original AUDIT-C questionnaire. Substance Use and Misuse, Volume 48, Issue 8, June 2013, Pages 581-589
2013 English Background: Alcohol Use Disorders Identification Test Consumption (AUDIT-C) questionnaire as a screening instrument for identification of hazardous and harmful drinkers give some false-positive and negative results. Changes of answers decrease the number of false results. Methods: Changes in second and third questions with theoretical simulation of possible answers' combinations was made; cutoff scores have to be changed. Study with original and adapted AUDIT-C was conducted among 298 students to analyze the differences. Results: Adapted Slovenian version of AUDIT-C gives less false-positive and less false-negative results. Conclusions: Changes of AUDIT-C questionnaire that give less false results means less potential disharmony in doctor-patient relationship, less unnecessary questioning, less time spent inadequately, and also less missed hazardous drinkers.  Via Publisher
Kriston, L., Hölzel, L., Weiser, A.-K., Berner, M.M., Härter, M.
Meta-analysis: Are 3 questions enough to detect unhealthy alcohol use? Annals of Internal Medicine, Volume 149, Issue 12, 16 December 2008, Pages 879-888
2008 English Background: Both the 10-item Alcohol Use Disorders Identification Test (AUDIT) and its abbreviated 3-item version (Alcohol Use Disorders Identification Test-Consumption [AUDIT-C]) are considered to detect unhealthy alcohol use accurately. Purpose: To examine whether the AUDIT-C is as accurate as the full AUDIT for detecting unhealthy alcohol use in adults. Data Sources: MEDLINE, EMBASE, CINAHL, Web of Science, Psyc-INFO, and BIOSIS Previews from 1998 to July 2008. Study Selection: Three independent reviewers selected studies that administered both the AUDIT and the AUDIT-C, applied a valid reference standard, avoided verification and incorporation bias, and reported relevant data. No language restrictions were applied. Conclusion: Available evidence is inconclusive but suggests that the full AUDIT may be superior to the AUDIT-C for identifying unhealthy alcohol use in adults in some settings. Via Publisher
Kwon, U.K., Kim, J.S., Kim, S.S., (...), Yoon, S.-J., Kim, S.G.
Utility of the alcohol consumption questions in the Alcohol Use Disorders Identification Test for screening at-risk drinking and alcohol use disorders among Korean college students. Korean Journal of Family Medicine, Volume 34, Issue 4, 2013, Pages 272-280
2013 English Background: This study evaluated the utility of the Alcohol Use Disorders Identification Test Alcohol Consumption Questions (AUDIT-C) in screening at-risk drinking and alcohol use disorders among Korean college students. Methods: For the 387 students who visited Chungnam National University student health center, drinking state and alcohol use disorders were assessed through diagnostic interviews. In addition, Alcohol Use Disorders Identification Test (AUDIT), AUDIT-C, and cut down, annoyed, guilty, eye-opener (CAGE) were applied. The utility of the questionnaires for the interview results were compared. Results: The areas under the receiver operating characteristic curves (AUROCs) of AUDIT-C for screening at-risk drinking were 0.927 in the male and 0.921 in the female participants. The AUROCs of AUDIT and CAGE were 0.906 and 0.643, respectively, in the male, and 0.898 and 0.657, respectively, in the female participants. The optimal screening scores of at-risk drinking in AUDIT-C were ≥6 in the male and ≥4 in the female participants; and in AUDIT and CAGE, ≥8 and ≥1, respectively, in the male, and ≥5 and ≥1 in the female participants. The AUROCs of AUDIT-C in screening alcohol use disorders were 0.902 in the male and 0.939 in the female participants. In the AUDIT and CAGE, the AUROCs were 0.936 and 0.712, respectively, in the male, and 0.960 and 0.844, respectively, in the female participants. The optimal screening scores of alcohol use disorders in AUDIT-C were ≥7 in the male and ≥6 in the female participants; and in AUDIT and CAGE, ≥10 and ≥1, respectively, in the male, and ≥8 and ≥1 in the female participants. Conclusion: AUDIT-C is considered useful in screening at-risk drinking and alcohol use disorders among college students. Open Access
Lee, K.W., Choi, Y.H., Lee, J.H.
Cut-off points for screening at-risk drinking by AUDIT-C Korean version at emergency department. Turkish Journal of Emergency Medicine, Volume 18, Issue 2, June 2018, Pages 57-61
2018 English Purpose: To reduce problems caused by alcohol drinking, it is necessary to identify those with ‘at-risk drinking’ behavior to maximize therapeutic access or intervention. To this end, we sought to determine the cut-off point for screening of at-risk drinking by the Korean version of the AUDIT-C (Alcohol Use Disorder Identification Test-Consumption). Materials and methods: We obtained data from the scientific research project of “the supervision of the Korea Center for Disease Control and Prevention (KCDCP)” in 2010. Injured patients over an 18-year-of age who visited an emergency department of an academic tertiary hospital from May to September 2010 were recruited to perform the AUDIT. The total number of patients who underwent the screening test was 640, 12.7% of the entire patients studied. Among them, 375 patients (58.4%) were men, and 265 patients (41.4%) were women. At-risk drinking was diagnosed based on the AUDIT total score and the cut-off points of the AUDIT-C were determined. Results: Cut-off points were 5 for men [Area Under the Receiver Operation Characteristic (AUROC) 0.956], 4 for women (AUROC 0.966), and 4 in elders >65-year-of age (AUROC 0.972). Conclusion: This study is the first research about the cut-off points of Korean version of AUDIT-C for patients including women and elders to screen for at-risk drinking in South Korea. AUDIT-C is a useful and accurate tool to screen patients for at-risk drinking. Open Access
Levola, J., Aalto, M.
Screening for At-Risk Drinking in a Population Reporting Symptoms of Depression: A Validation of the AUDIT, AUDIT-C, and AUDIT-3. Alcoholism: Clinical and Experimental Research, Volume 39, Issue 7, 1 July 2015, Pages 1186-1192
2015 English Background: Excessive alcohol use is common in patients presenting with symptoms of depression. The aim of this study was to evaluate how the Alcohol Use DisordersIdentification Test (AUDIT) and its most commonly used abbreviated versions perform in detecting at-risk drinking among subjects reporting symptoms of depression. Results: At-risk drinking was common. The AUDIT and AUDIT-C performed quite consistently. Optimal cutoffs for men were ≥9 for the AUDIT and ≥6 for AUDIT-C. The optimal cut-offs for women with mild symptoms of depression were ≥5 for the AUDIT and ≥4 for AUDIT-C. Optimal cutoffs could not be determined for women with moderate symptoms of depression (specificity <0.75). A nearly optimal cutoff for women was ≥5 for the AUDIT. The AUDIT-3 failed to perform in women, but in men, a good level of sensitivity and specificity was reached at a cutoff of ≥2. With standard threshold values, the biochemical markers demonstrated very low sensitivity (9 to 28%), but excellent specificity (83 to 98%). Conclusions: Screening for at-risk drinking among patients presenting with symptoms of depression using the full AUDIT is recommended, although the AUDIT-C performed almost equally well. Cut-offs should be adjusted according to gender, but not according to the severity of depressive symptoms. The AUDIT and its abbreviations were superior to biochemical markers. Via Publisher
Mcginnis, K.A., Justice, A.C., Kraemer, K.L., (...), Bryant, K.J., Fiellin, D.A.
Comparing Alcohol Screening Measures Among HIV-Infected and -Uninfected Men. Alcoholism: Clinical and Experimental Research, Volume 37, Issue 3, March 2013, Pages 435-442
2013 English Background: Brief measures of unhealthy alcohol use have not been well validated among people with HIV. We compared the Alcohol Use Disorders Identification Test (AUDIT) to reference standards for unhealthy alcohol use based on 30-day Timeline Follow Back (TLFB) and Composite International Diagnostic Interview-Substance Abuse Module (CIDI-SAM), among 837 male HIV-infected and -uninfected patients in the Veterans Aging Cohort Study. Methods: Three reference standards were (i) Risky drinking-based on TLFB >14 drinks over 7 consecutive days or >4 drinks on 1 day; (ii) Alcohol dependence-based on a CIDI-SAM diagnosis; and (iii) Unhealthy alcohol use-risky drinking or a CIDI-SAM diagnosis of abuse or dependence. Various cutoffs for the AUDIT, AUDIT-C, and heavy episodic drinking were compared with the reference standards. Conclusions: For identifying risky drinking, alcohol dependence, and unhealthy alcohol use, AUDIT-C performs as well as AUDITand similarly in HIV-infected and -uninfected patients. Cutoffs should be based on the importance of specific operating characteristics for the intended research or clinical use. Incorporating heavy episodic drinking increased sensitivity for detecting alcohol dependence and unhealthy alcohol use Via Publisher
McGinnis, K.A., Tate, J.P., Williams, E.C., (...), Fiellin, D.A., Justice, A.C.
Comparison of AUDIT-C collected via electronic medical record and self-administered research survey in HIV infected and uninfected patients. Drug and Alcohol Dependence, Volume 168, 1 November 2016, Pages 196-202
2016 English Background: Using electronic medical record (EMR) data for clinical decisions, quality improvement, and research is common. While unhealthy alcohol use is particularly risky among HIV infected individuals (HIV+), the validity of EMR data for identifying unhealthy alcohol use among HIV+ is unclear. Among HIV+ and uninfected, we: (1) assess agreement of EMR and research AUDIT-C at validated cutoffs for unhealthy alcohol use; (2) explore EMR cutoffs that maximize agreement; and (3) assess subpopulation variation in agreement. Methods: Using data from the Veterans Aging Cohort Study (VACS), EMR AUDIT-C cutoffs of 2+, 3+, and 4+ for men (2+ and 3+ for women) were compared to research AUDIT-C 4+ for men (3+ for women). Agreement was compared by demographics, HIV, hepatitis C infection, and alcohol related diagnosis. Results: Among 1082 HIV+ and 1160 uninfected men, 14% and 22% had an EMR and research AUDIT-C 4+, respectively. Among 32 HIV+ and 115 uninfected women, 9% and 14% had an EMR and research AUDIT-C 3+. For men, EMR agreement with the research AUDIT-C 4+ was highest at a cutoff of 3+ (kappa = 0.49). For women, EMR agreement with AUDIT-C 3+ was highest at a cutoff of 2+ (kappa = 0.46). Moderate agreement was consistent across subgroups. Conclusions: EMR AUDIT-C underestimates unhealthy alcohol use compared to research AUDIT-C in both HIV+ and uninfected individuals. Methods for improving quality of clinical screening may be in need of investigation. Researchers and clinicians may consider alternative EMR cutoffs that maximize agreement given limitations of clinical screening. Via Publisher
Meneses-Gaya, C., Crippa, J.A.S., Zuardi, A.W., (...), Souza, R.M., Martn-Santos, R.
The fast alcohol screening test (FAST) is as good as the AUDIT to screen alcohol use disorders. Substance Use and Misuse, Volume 45, Issue 10, June 2010, Pages 1542-1557
2010 Portuguese/English This study was aimed at assessing the psychometric qualities of the fast alcohol screening test (FAST), and at comparing these qualities to those of the alcohol use disorders identification test (AUDIT) in three samples of Brazilian adults: (i) subjects attended at an emergency department (530); (ii) patients from a psychosocial care center (40); and (iii) university students (429). The structured clinical interview for diagnosis (SCID)-IV was used as gold standard. The FAST demonstrated high test-retest and interrater reliability coefficients, as well as high predictive and concurrent validity values. The results attest the validity and reliability of the Brazilian version of the FAST for the screening of indicators of alcohol abuse and dependence.  Via Publisher
Meneses-Gaya, C., Zuardi, A.W., Loureiro, S.R., (...), Souza, R.M., Crippa, J.A.S.
Is the full version of the AUDIT really necessary? Study of the validity and internal construct of its abbreviated versions. Alcoholism: Clinical and Experimental Research, Volume 34, Issue 8, August 2010, Pages 1417-1424
2010 English Background: This study was aimed at assessing the psychometric qualities of the abbreviated versions of the Alcohol Use Disorders Identification Test (AUDIT‐3, AUDIT‐4, AUDIT‐C, AUDIT‐PC, AUDIT‐QF, FAST, and Five‐Shot) and at comparing them to the 10‐item AUDIT and the CAGE in 2 samples of Brazilian adults. Methods: The validity and internal consistency of the scales were assessed in a sample of 530 subjects attended at an emergency department and at a Psychosocial Care Center for Alcohol and Drugs. The Structured Clinical Interview for DSM‐IV was used as the diagnostic comparative measure for the predictive validity assessment. The concurrent validity between the scales was analyzed by means of Pearson’s correlation coefficient. Results: The assessment of the predictive validity of the abbreviated versions showed high sensitivity (of 0.78 to 0.96) and specificity (of 0.74 to 0.94) indices, with areas under the curve as elevated as those of the AUDIT (0.89 and 0.92 to screen for abuse and 0.93 and 0.95 in the screening of dependence). The CAGE presented lower indices: 0.81 for abuse and 0.87 for dependence. The analysis of the internal consistency of the AUDIT and its versions exhibited Cronbach’s alpha coefficients between 0.83 and 0.94, while the coefficient for the CAGE was 0.78. Significant correlations were found between the 10‐item AUDIT and its versions, ranging from 0.91 to 0.99. Again, the results for the CAGE were satisfactory (0.77), although inferior to the other instruments. Conclusions: The results obtained in this study confirm the validity of the abbreviated versions of the AUDIT for the screening of alcohol use disorders and show that their psychometric properties are as satisfactory as those of the 10‐item AUDIT and the CAGE. Via Publisher
Morojele, N.K., Nkosi, S., Kekwaletswe, C.T., (...), Myers, B., Parry, C.D.H.
Utility of brief versions of the Alcohol Use Disorders Identification Test (AUDIT) to identify excessive drinking among patients in HIV care in South Africa. Journal of Studies on Alcohol and Drugs, Volume 78, Issue 1, January 2017, Pages 88-96
2017 English Objective: In sub-Saharan Africa, large proportions of patients who are on antiretroviral therapy (ART) engage in excessive alcohol use, which may lead to adverse health consequences and may go undetected. Consequently, health care workers need brief screening tools to be able to routinely identify and manage excessive alcohol use among their patients. Various brief versions of the valid and reliable 10-item Alcohol Use Disorders Identification Test (AUDIT) (i.e., the AUDIT-C, AUDIT-3, AUDIT-QF, AUDIT-PC, AUDIT-4, and m-FAST) may potentially replace the full AUDIT in busy HIV care settings. This study aims to assess the utility of these six brief versions of the AUDIT relative to the full AUDIT for identifying excessive alcohol use among patients in HIV care settings in South Africa. Method: Participants were 188 (95 women) patients from three ART clinics within district hospitals in the City of Tshwane Metropolitan Municipality who reported past- 12-month alcohol use. Performance of each brief AUDIT measure for identifying excessive alcohol use was evaluated against that of the full AUDIT (with a cutoff score of ≥6 for women and ≥8 for men) as the gold standard. We used receiver-operating characteristic (ROC) analysis. Results: Most brief AUDIT measures had an area under the receiver operating curve (AUROC) above. 90 when compared with the full AUDIT (five of six for women and three of six for men). The AUDIT-PC, AUDIT-4, and m-FAST had the highest AUROCs, whereas the three brief measures comprising only consumption items had low specificities at the most optimal cutoff levels. Conclusions: Various brief versions of the AUDIT may be appropriate substitutes for the full AUDIT for screening for excessive alcohol use in HIV clinics in sub-Saharan Africa. Via Publisher
Neumann, T., Linnen, H., Kip, M., (...), Mutzke, S., Spies, C.
Does the Alcohol Use Disorders Identification Test-Consumption identify the same patient population as the full 10-item Alcohol Use Disorders Identification Test? Journal of Substance Abuse Treatment, Volume 43, Issue 1, July 2012, Pages 80-85
2012 English The aim of this study was to evaluate whether a computer-based 3-item version (Alcohol Use Disorders Identification Test-Consumption [AUDIT-C]) of the Alcohol Use Disorders Identification Test (AUDIT) identifies alcohol use disorder (AUD) in the same patients as the full 10-item version in 809 women and 747 men in an anesthesiology preoperative assessment clinic. According to cutoffs used (AUDIT: 5-8 points, AUDIT-C: 4-6 points), rate of disagreement (AUDIT-positive and AUDIT-C-negative or vice versa) ranged between 4% and 31% (men) and between 4% and 19% (women). In male patients, 15% were positive for both the AUDIT (≥8 points) and the AUDIT-C (≥6 points), 7% were positive for AUDIT-C only, and 4% were positive for AUDIT only. In female patients, using cutoffs of 5 more points (AUDIT) and 4 or more points (AUDIT-C), 16% were positive for both versions, 9% were positive for AUDIT-C only, and 2% were positive for AUDIT only. The AUDIT and AUDIT-C seem to identify AUD in differing patients.  Via Publisher
Noble, N., Paul, C., Conigrave, K., (...), Carey, M., McElduff, P.
Does a retrospective seven-day alcohol diary reflect usual alcohol intake for a predominantly disadvantaged Australian aboriginal population. Substance Use and Misuse, Volume 50, Issue 3, 23 February 2015, Pages 308-319
2015 English Background: Alcohol disproportionately affects socially disadvantaged groups including Aboriginal and Torres Strait Islander Australians. Methods to assess alcohol intake for disadvantaged communities need to be able to capture variable or episodic drinking. The ability of a seven-day diary to capture typical consumption for a predominantly Aboriginal sample has not been assessed. Objective: One aim of this paper was to examine agreement between a seven-day retrospective diary and 'usual' drinking assessed by a modified version of the Alcohol Use Disorders Identification Test question 3 (AUDIT-3m; two questions). Other aims were to describe drinking patterns as reported in the seven-day diary. Method: In 2012, consecutive adults attending an Aboriginal Community Controlled Health Service completed a cross-sectional health risk survey on a touch screen laptop (n = 188). Alcohol consumption questions included the retrospective diary and AUDIT-3m. Agreement was assessed using weighted kappa analysis. Results: There was good agreement between the two measures of consumption; however, the AUDIT-3m questions identified more current drinkers. Respondents who were drinkers (54%) tended to consume large amounts per drinking occasion: almost half (46%) of diary completers reported nine or more standard drinks on at least one occasion in the last week. Conclusions: The seven-day diary did not adequately capture variability in alcohol consumption common among this sample. Although the AUDIT-3m appeared acceptable, alternative approaches to assess usual or risky alcohol consumption, such as asking about specific drinking occasions, or allowing participants to respond in non-standard drink sizes, also need to be considered for indigenous and other disadvantaged communities. Via Publisher
Reed Jr., D.N., Saxe, A., Montanez, M., (...), Barber, K., Wolf, B.
Use of a single question to screen trauma patients for alcohol dependence. Journal of Trauma - Injury, Infection and Critical Care, Volume 59, Issue 3, September 2005, Pages 619-623
2005 English Background: Alcohol-dependent trauma patients are known to be at future risk for both recidivism and mortality. Psychological tools exist to screen for alcohol-dependent disorders, and among patients with alcohol-dependent disorders, a brief intervention has been shown to modify behavior. However, the training involved and time required to administer these tools may decrease their utility. We explored the possibility that yet simpler screening tools could be used. Methods: A prospective consecutive study was designed whereby all adult patients admitted to the trauma service were asked to participate in the study. If consent was obtained, one trained member of the research team would apply a standard alcohol-misuse screening tool (i.e., the Alcohol Use Disorders Identification Test [AUDIT]). One hundred forty-nine patients met criteria and agreed to participate. Fully completed questionnaires were then subjected to statistical analysis. Results: Among the 149 participating patients, 36% were women and 64% were men, and 146 had blood alcohol levels (BALs) drawn. Those 146 patients form the basis of this report. Fifty-seven of the 146 (39%) patients had positive BALs and, among them, 74% of men and 54% of women recorded screening results consistent with harmful or dependent drinking. Among those with negative blood alcohol levels, 8% of women and 13% of men had scores consistent with harmful or dependent drinking by the AUDIT score. In both groups of patients, a cutoff of three or more drinks per day as a response to question 2 on the AUDIT (i.e., "On a typical day when you are drinking, how many drinks do you have?") correlated strongly with scores on the entire screening tool (AUDIT) in identifying those at risk for alcohol misuse. Conclusion: It may be reasonable to substitute a single question for the entire AUDIT screening instrument to screen for those at risk for alcohol misuse. If so, this single question could easily be incorporated into the history taken among patients admitted to a trauma service. Confirmation with a larger study is recommended.  Via Publisher
Rodríguez-Martos, A., Santamariña, E.
Does the short form of the Alcohol Use Disorders Identification Test (AUDIT-C) work at a trauma emergency department? Substance Use and Misuse, Volume 42, Issue 6, May 2007, Pages 923-932
2007 English The accuracy of the consumption items of AUDIT (AUDIT-C) was analyzed, using the full AUDIT score as gold standard, in 120 traffic casualties (78% men and 22% women), median age 27 years (IQR = [22-34]), entering an urban emergency room between 2001 and 2003, with (67%) and without (33%) a positive blood alcohol level (≥0.2 g/L). Sensitivity, specificity, predictive value, overall accuracy, and receiver operating characteristics of AUDIT-C were measured. Diagnostic accuracy was 0.79, using cutoff indices of ≥5 for males and ≥4 for females. AUDIT-C may be useful in emergency departments for a stepwise screening. Further validation of this test with larger samples and different settings is warranted. Via Publisher
Seale, J.P., Boltri, J.M., Shellenberger, S., (...), Okosun, I., Sumner, H.
Primary care validation of a single screening question for drinkers. Journal of Studies on Alcohol, Volume 67, Issue 5, September 2006, Pages 778-784
2006 English Objective: The aim of this study was to conduct a primary care validation study of a single screening question for alcohol misuse ("When was the last time you had more than X drinks in 1 day?," where X was four for women and X was five for men), which was previously validated in a study conducted in emergency departments. Method: This cross-sectional study was accomplished by interviewing 625 male and female adult drinkers who presented to five southeastern primary care practices. Patients answered the single question (coded as within 3 months, within 12 months, ever, or never), Alcohol Use Disorders Identification Test (AUDIT), and AUDIT consumption questions (AUDIT-C). Results: Among 625 drinkers interviewed, 25.6% were at-risk drinkers, 21.7% had a current alcohol-use disorder, and 35.2% had either or both conditions. Considering "within the last 3 months" as positive, the sensitivity of the single question was 80% and the specificity was 74%. Chi-square analyses revealed similar sensitivity across ethnic and gender groups; however, specifici ty was higher in women and whites (p = .0187 and .0421, respectively). Considering "within the last 12 months" as positive increased the question's sensitivity, especially for those with alcohol-use disorders. The area under the receiver operating characteristic curve of the single alcohol screening question (0.79) was slightly lower than for the AUDIT and AUDIT-C, but sensitivity and specificity were similar. Conclusions: A single question about the last episode of heavy drinking is a sensitive, time-efficient screening instrument that shows promise for increasing alcohol screening in primary care practices. Via Publisher
Seo, Y.R., Kim, J.S., Kim, S.S., (...), Suh, W.Y., Youn, K.
Development of a simple tool for identifying alcohol use disorder in female Korean drinkers from previous questionnaires. Korean Journal of Family Medicine, Volume 37, Issue 1, 2016, Pages 18-24
2016 English Background: This study aimed to develop a simple tool for identifying alcohol use disorders in female Korean drinkers from previous questionnaires. Methods: This research was conducted on 400 women who consumed at least one alcoholic drink during the past month and visited the health promotion center at Chungnam National University Hospital between June 2013 to May 2014. Drinking habits and alcohol use disorders were assessed by structured interviews using the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition diagnostic criteria. The subjects were also asked to answer the Alcohol Use Disorders Identification Test (AUDIT), AUDIT-Consumption, CAGE (Cut down, Annoyed, Guilty, Eye-opener), TWEAK (Tolerance, Worried, Eye-opener, Amnesia, Kut down), TACE (Tolerance, Annoyed, Cut down, Eye-opener), and NET (Normal drinker, Eye-opener, Tolerance) questionnaires. The area under receiver operating characteristic (AUROC) of each question of the questionnaires on alcohol use disorders was assessed. After combining two questions with the largest AUROC, it was compared to other previous questionnaires. Results: Among the 400 subjects, 58 (14.5%) were identified as having an alcohol use disorder. Two questions with the largest AUROC were question no. 7 in AUDIT, "How often during the last year have you had a feeling of guilt or remorse after drinking?" and question no. 5 in AUDIT, "How often during the past year have you failed to do what was normally expected from you because of drinking?" with an AUROC (95% confidence interval [CI]) of 0.886 (0.850-0.915) and 0.862 (0.824-0.894), respectively. The AUROC (95% CI) of the combination of the two questions was 0.958 (0.934-0.976) with no significant difference as compared to the existing AUDIT with the largest AUROC. Conclusion: The above results suggest that the simple tool consisting of questions no. 5 and no. 7 in AUDIT is useful in identifying alcohol use disorders in Korean female drinkers. Open Access
Seong, J.-H., Lee, C.-H., Do, H.-J., (...), Kweon, K.-J., Cho, D.-Y.
Performance of the AUDIT alcohol consumption questions (AUDIT-C) and AUDIT-K Question 3 alone in screening for problem drinking. Korean Journal of Family Medicine, Volume 30, Issue 9, September 2009, Pages 695-702
2009 Korean Background: In the busy primary care setting, there are several limitations in applying Alcohol Use Disorders Identification Test in Korea (AUDIT-K) to screen problem drinking. Thus, for primary healthcare practice, we evaluated AUDIT-C, which covers questions from 1 to 3 in AUDIT-K, and AUDIT-K Question 3 Alone to present cut points for these two screening questionnaire according to AUDIT-K test scores. Methods: In a university hospital, we surveyed 302 males with a drinking history via self-administered questionnaire including AUDIT-K, from November 2007 to April 2008. On the basis of total score in AUDIT-K, we divided them into four groups: normal, problem drinking, alcohol use disorder, and alcohol dependence. For each alcohol drinking behavior pattern, we drew the receiver operating characteristics (ROC) curves to present cut points for appropriate sensitivity and specificity. In addition, we compared the performance of AUDIT-C and AUDIT-K Question 3 Alone through area under the curve (AUC). Results: For AUDIT-C, we designated the score 8 or more as problem drinking, 9 or more as alcohol use disorder, and 11 or more as dependence. The results of sensitivity/specificity for each group were 82%/76%, 76%/79%, 80%/86%, respectively, which were suitable for screening. For AUDIT-K Question 3 Alone, we defined the score 3 or more as problem drinking or alcohol use disorder and the score 4 as dependence. The results of sensitivity/specificity for each group were 79%/80%, 84%/67%, 85%/77%, which were appropriate for screening. For every drinking behavior group, AUDIT-C was superior to AUDIT-K Question 3 Alone in screening performance (problem drinking: 0.88 vs. respectively 0.85, alcohol use disorder: 0.86 vs. 0.82, alcohol dependence: 0.88 vs. 0.81) Conclusion: We confirmed that both AUDIT-C and AUDIT-K Question 3 Alone, which are more convenient and have fewer time con-straints than AUDIT-K, are reasonable screening methods for problem drinking. Thus, we recommend further drinking assessment and proper intervention for male drinkers who have scores 8 or more in AUDIT-C or 3 or more in AUDIT-K Question 3 Alone. Open Access
Seth, P., Glenshaw, M., Sabatier, J.H.F., (...), DeLuca, N., Bock, N.
AUDIT, AUDIT-C, and AUDIT-3: Drinking patterns and screening for harmful, hazardous and dependent drinking in Katutura, Namibia. PLoS ONE, Volume 10, Issue 3, 23 March 2015, Article number e0120850
2015 English Objectives: To describe alcohol drinking patterns among participants in Katutura, Namibia, and to evaluate brief versions of the AUDIT against the full AUDIT to determine their effectiveness in detecting harmful drinking. Methods: A cross-sectional survey was conducted in four constituencies and 639 participants, 18 years or older, completed a sociodemographic survey and the AUDIT. The effectiveness of the AUDIT-C (first three questions) and the AUDIT-3 (third question) was compared to the full AUDIT. Results: Approximately 40%were identified as harmful, hazardous or likely dependent drinkers, with men having a higher likelihood than women (57.2%vs. 31.0%, p<.0001). Approximately 32% reported making and/or selling alcohol from home. The AUDIT-C performed best at a cutoff- 3, better in men (sensitivity: 99.3%, specificity: 77.8%) than women (sensitivity: 91.7%, specificity: 77.4%). The AUDIT-3 performed poorly (maximum sensitivity: < 90%, maximum specificity: <51%). According to AUROC, the AUDIT-C performed better than the AUDIT-3. Conclusions: A large proportion of participants met criteria for alcohol misuse, indicating a need for screening and referral for further evaluation and intervention. The AUDIT-C was almost as effective as the full AUDIT and may be easier to implement in clinical settings as a routine screening tool in resource-limited settings because of its brevity. Open Access
So, K., Sung, E. A
Validation study of the brief Alcohol Use Disorder Identification Test (AUDIT): A brief screening tool derived from the AUDIT. Korean Journal of Family Medicine, Volume 34, Issue 1, January 2013, Pages 11-18
2013 English Background: The prevalence of alcohol use disorder (AUD) is very high in Korea. To identify AUD in the busy practice setting, brevity of screening tools is very important. We derived the brief Alcohol Use DisordersIdentification Test (AUDIT) and evaluated its performance as a brief screening test. Methods: One hundred male drinkers from Kangbuk Samsung Hospital primary care outpatient clinic and psychiatric ward for alcoholism treatment completed questionnaires including the AUDIT, cut down, annoyed, guilty, eye-opener (CAGE), and National Alcoholism Screening Test (NAST) from April to July, 2007. AUD (alcohol abuse and dependence), defined by a physician in accordance with Diagnostic and Statistical Manual of Mental Disorders-IV, was used as a diagnostic criteria. To derive the brief AUDIT, factor analysis was performed using the principal component extraction method with a varimax rotated solution. Receiver operating characteristic (ROC) curve analysis was performed to investigate the discrimination ability of the brief AUDIT. Areas under the ROC curve were compared performance of screening questionnaires with 95% confidence intervals. Results: The derived brief AUDIT consists of 4 items: frequency of heavy drinking (item 3), impaired control over drinking (item 4), increased salience of drinking (item 5), and alcohol-related injury (item 9). Brief AUDIT exhibited an AUD screening accuracy better than CAGE, and equally to that of NAST. Areas under the ROC curves were 0.87 (0.80-0.94), 0.76 (0.66-0.85), and 0.81 (0.73-0.90) for the brief AUDIT, CAGE, and NAST for AUD, and 0.97 (0.95-0.99), 0.93 (0.88-0.98) and 0.93 (0.88-0.98) for alcohol dependence. Conclusion: The new brief AUDIT seems to be effective in detecting male AUD in the primary care setting in Korea. Further evaluation for women and different age groups is needed.  Open Access
Tomás, M.T.C., Costa, J.A.G., Motos-Sellés, P., Beitia, M.D.S., Mahía, F.C.
The utility of the Alcohol Use Disorders Identification Test (AUDIT) for the analysis of binge drinking in university students | [Utilidad del alcohol use disorders identification test (AUDIT) en el análisis del binge drinking en estudiantes universitarios]. Psicothema, Volume 29, Issue 2, 2017, Pages 229-235
2017 English Background: The increasingly precise conceptualization of Binge Drinking (BD), along with the rising incidence of this pattern of intake amongst young people, make it necessary to review the usefulness of instruments used to detect it. Little evidence exists regarding effectiveness of the AUDIT, AUDIT-C and AUDIT-3 in the detection of BD. This study evaluates their utility in a sample of university students, revealing the most appropriate cut-off points for each sex. Methods: All students self-administered the AUDIT and completed a self-report of their alcohol consumption. A Two-step cluster analysis differentiated 5 groups of BD in terms of: the quantity consumed, the frequency of BD over the past six months and gender. A ROC curve adjusted cut-off points for each case. Results: 862 university students (18-19 years-old/59.5% female), 424 (49.2%) from Valencia and 438 (50.8%) from Madrid, had cut-off points of 4 in AUDIT and 3 in AUDIT-C as a better fit. In all cases, the best classifier was AUDIT-C. Neither version properly classifies students with varying degrees of BD. Conclusions: All versions differentiate BD from non-BD, but none are able to differentiate between types of BD. Open Access
Tvaryanas, A.P., Maupin, G.M., White, E.D., Schroeder, V.M., Mahaney, H.J.
The performance of the AUDIT-C and the examination of risks associated with postdeployment alcohol misuse in air force medical service personnel. Military Psychology, Volume 29, Issue 4, July 2017, Pages 327-335
2017 English This study assessed the performance of the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) in diagnosing a postdeployment alcohol disorder in a cohort of Air Force Medical Services personnel (N = 13,353). The prevalence of alcohol disorders in this population of previously deployed military healthcare personnel was 1.26% based on medical record data. Assessing the AUDIT-C as a screening tool, the following characteristics were found: sensitivity was 23.81%, specificity was 91.48%, positive predictive value was 3.44%, and negative predictive value was 98.95%. The positive and negative likelihood ratios were 2.80 and 0.83, respectively. Classification accuracy of the AUDIT-C was improved by accounting for officer status and female gender. The area under the receiver operating characteristic curve was 0.69 for the multivariable model, indicating poor to fair classification accuracy. However, this model was significantly improved over the univariate model. Thus, taking rank and gender into account when conducting screening may improve the utility of the AUDIT-C. Via Publisher
Vitesnikova, J., Dinh, M., Leonard, E., Boufous, S., Conigrave, K.
Use of AUDIT-C as a tool to identify hazardous alcohol consumption in admitted trauma patients. Injury, Volume 45, Issue 9, September 2014, Pages 1440-1444
2014 English Introduction: Alcohol use is an important contributor to injuries. Simple bedside tools to identify trauma patients with potentially harmful drinking may assist in brief intervention efforts in clinical practice. The objective of the study was to determine and compare the accuracy of alcohol use disorders identification test (AUDIT) and an abbreviated version of this test, in the detection of hazardous drinking. Methods: A cross-sectional study of a convenience sample of admitted trauma patients at a single Australian major trauma centre. Eligible patients completed the AUDIT. AUDIT survey responses were scored in two ways, using the full form scale and secondly an abbreviated (AUDIT C) scale which uses only the first 3 questions. AUDIT and AUDIT-C scores were then evaluated with respect to the primary study measure; the detection of hazardous alcohol consumption based on a full alcohol consumption history. Sensitivities for each relevant score were calculated and receiver operator characteristic (ROC) curve analysis was used to determine test accuracy. Results: During the study period, 523 trauma admissions were identified and of these 146 (28%) were screened. The optimum cut off scores for AUDIT and AUDIT-C were 8 and 5 respectively corresponding to sensitivities of 88% and 91% and both tests had excellent overall accuracy for the detection of hazardous alcohol consumption. There was no significant difference between AUDIT-C and AUDIT performance (p = 0.395) (AUDIT-C AUROC 0.96 95%CI 0.93, 0.99). Conclusion: AUDIT-C appears to be a potentially useful screening tool for use trauma centres, but that further research with larger samples is required. Via Publisher
Wade, D., Varker, T., Forbes, D., O'Donnell, M.
The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) in the Assessment of Alcohol Use Disorders Among Acute Injury Patients. Alcoholism: Clinical and Experimental Research, Volume 38, Issue 1, January 2014, Pages 294-299
2014 English Background: The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) is a brief alcohol screening test and a candidate for inclusion in recommended screening and brief intervention protocols for acute injury patients. The objective of the current study was to examine the performance of the AUDIT-C to risk stratify injury patients with regard to their probability of having an alcohol use disorder. Methods: Participants (n = 1,004) were from a multisite Australian acute injury study. Stratum-specific likelihood ratio (SSLR) analysis was used to examine the performance of previously recommended AUDIT-C risk zones based on a dichotomous cut-point (0 to 3, 4 to 12) and risk zones derived from SSLR analysis to estimate the probability of a current alcohol use disorder. Results: Almost a quarter (23%) of patients met criteria for a current alcohol use disorder. SSLR analysis identified multiple AUDIT-C risk zones (0 to 3, 4 to 5, 6, 7 to 8, 9 to 12) with a wide range of posttest probabilities of alcohol use disorder, from 5 to 68%. The area under receiver operating characteristic curve (AUROC) score was 0.82 for the derived AUDIT-C zones and 0.70 for the recommended AUDIT-C zones. A comparison between AUROCs revealed that overall the derived zones performed significantly better than the recommended zones in being able to discriminate between patients with and without alcohol use disorder. Conclusions: The findings of SSLR analysis can be used to improve estimates of the probability of alcohol use disorder in acute injury patients based on AUDIT-C scores. In turn, this information can inform clinical interventions and the development of screening and intervention protocols in a range of settings. Via Publisher
Yip, B.H.K., Chung, R.Y., Chung, V.C.H., (...), Wong, S.Y.S., Griffiths, S.M.
Is Alcohol Use Disorder Identification Test (AUDIT) or its shorter versions more useful to identify risky drinkers in a Chinese population? A diagnostic study. PLoS ONE, Volume 10, Issue 3, 1 March 2015, Article number 0117721
2015 English Objective: To examine the diagnostic performance of shorter versions of Alcohol Use Disorder Identification Test (AUDIT), including Alcohol Consumption (AUDIT-C), in identifying risky drinkers in primary care settings using conventional performance measures, supplemented by decision curve analysis and reclassification table. Study design and Setting A cross-sectional study of adult males in general outpatient clinics in Hong Kong. The study included only patients who reported at least sometimes drinking alcoholic beverages. Timeline follow back alcohol consumption assessment method was used as the reference standard. A Chinese translated and validated 10-item AUDIT (Ch-AUDIT) was used as a screening tool of risky drinking. Results: Of the participants, 21.7% were classified as risky drinkers. AUDIT-C has the best overall performance among the shorter versions of Ch-AUDIT. The AUC of AUDIT-C was comparable to Ch-AUDIT (0.898 vs 0.901, p-value = 0.959). Decision curve analysis revealed that when the threshold probability ranged from 15-30%, the AUDIT-C had a higher net-benefit than all other screens. AUDIT-C improved the reclassification of risky drinking when compared to Ch- AUDIT (net reclassification improvement = 0.167). The optimal cut-off of AUDIT-C was at ≥5. Conclusion: Given the rising levels of alcohol consumption in the Chinese regions, this Chinese translated 3-item instrument provides convenient and time-efficient risky drinking screening and may become an increasingly useful tool. Open Access