AUDIT and AUDIT-C as screening instruments for alcohol problem use in adolescents.

BACKGROUND The Alcohol Use Disorders Identification Test (AUDIT) is commonly used in adults to screen for harmful alcohol consumption but few studies exist on its use among adolescents. Our aim was to validate the AUDIT and its derivative consumption questionnaire (AUDIT-C) as screening instruments for the detection of problem use of alcohol in adolescents. METHODS 621 adolescents (age-range, 12-19 years) were drawn from clinical and population samples who completed the AUDIT questionnaire. Psychiatric diagnoses were assessed using K-SADS-PL. A rating based on the K-SADS-PL was used to assess alcohol use habits, alcohol use disorders, screening and symptom criteria questions. Screening performance of the AUDIT and AUDIT-C sum scores and Receiver Operating Characteristic (ROC) curves were calculated. The diagnostic odds ratios (dOR) were calculated to express the overall discrimination between cut-offs. RESULTS Comparisons of ROC between the AUDIT and AUDIT-C pairs indicated a slightly better test performance by AUDIT for the whole sample and in a proportion of the subsamples. Optimal cut-off value for the AUDIT was ≥5 (sensitivity 0.931, specificity 0.772, dOR 45.22; 95% CI: 24.72-83.57) for detecting alcohol problem use. The corresponding optimal cut-off value for the AUDIT-C was ≥3 in detecting alcohol problem use (sensitivity 0.952, specificity 0.663, dOR 39.31; 95% CI: 19.46-78.97). Agreement between the AUDIT and AUDIT-C using these cut-off scores was high at 91.9%. CONCLUSIONS Our results for the cut-off scores for the early detection of alcohol problem use in adolescents are ≥5 for AUDIT, and ≥3 for AUDIT-C.

[1]  P. Jern,et al.  Factor structure of the Alcohol Use Disorders Identification Test (AUDIT) for men and women in different age groups. , 2008, Journal of studies on alcohol and drugs.

[2]  Li-Tzy Wu,et al.  Screening instruments for substance use and brief interventions targeting adolescents in primary care: a literature review. , 2013, Addictive behaviors.

[3]  J. Donovan,et al.  Brief screens for detecting alcohol use disorder among 18-20 year old young adults in emergency departments: Comparing AUDIT-C, CRAFFT, RAPS4-QF, FAST, RUFT-Cut, and DSM-IV 2-Item Scale. , 2009, Addictive behaviors.

[4]  P. Monti,et al.  Screening adolescents for problem drinking: performance of brief screens against DSM-IV alcohol diagnoses. , 2000, Journal of studies on alcohol.

[5]  Robert L. Cook,et al.  Alcohol screening in young persons attending a sexually transmitted disease clinic , 2007, Journal of General Internal Medicine.

[6]  A. Tuulio-Henriksson,et al.  Current comorbidity among consecutive adolescent psychiatric outpatients with DSM-IV mood disorders , 2006, European Child & Adolescent Psychiatry.

[7]  John P. Allen,et al.  The alcohol use disorders identification test: an update of research findings. , 2007, Alcoholism, clinical and experimental research.

[8]  Douglas G. Altman,et al.  Practical statistics for medical research , 1990 .

[9]  Nancy P Barnett,et al.  Alcohol use disorders identification test: factor structure in an adolescent emergency department sample. , 2002, Alcoholism, clinical and experimental research.

[10]  M. Roelants,et al.  The value of CAGE, CUGE, and AUDIT in screening for alcohol abuse and dependence among college freshmen. , 2000, Alcoholism, clinical and experimental research.

[11]  John P. Allen,et al.  The Alcohol Use Disorders Identification Test (AUDIT): a review of recent research. , 2002, Alcoholism, clinical and experimental research.

[12]  R. Hingson,et al.  Age of Drinking Onset, Alcohol Use Disorders, Frequent Heavy Drinking, and Unintentionally Injuring Oneself and Others After Drinking , 2009, Pediatrics.

[13]  Li Danling,et al.  Weighted Youden index and its two-independent-sample comparison based on weighted sensitivity and specificity. , 2013 .

[14]  John R. Knight,et al.  Putting the Screen in Screening: Technology-Based Alcohol Screening and Brief Interventions in Medical Settings. , 2014 .

[15]  J. Nevalainen,et al.  Alcohol policy changes and trends in adolescent drinking in Finland from 1981 to 2011. , 2013, Alcohol and alcoholism.

[16]  T. O’Hare,et al.  Validating the Alcohol Use Disorder Identification Test with college first-offenders. , 1999, Journal of substance abuse treatment.

[17]  Levente Kriston,et al.  Meta-analysis: Are 3 Questions Enough to Detect Unhealthy Alcohol Use? , 2008, Annals of Internal Medicine.

[18]  K. Winters,et al.  Likelihood of developing an alcohol and cannabis use disorder during youth: association with recent use and age. , 2008, Drug and alcohol dependence.

[19]  J. Suvisaari,et al.  DSM-IV mood-, anxiety- and alcohol use disorders and their comorbidity in the Finnish general population , 2005, Social Psychiatry and Psychiatric Epidemiology.

[20]  G. Bischof,et al.  Screening Questionnaires for Problem Drinking in Adolescents: Performance of AUDIT, AUDIT-C, CRAFFT and POSIT , 2012, European Addiction Research.

[21]  J. Donovan,et al.  A comparison of alcohol screening instruments among under-aged drinkers treated in emergency departments. , 2002, Alcohol and alcoholism.

[22]  Janet B W Williams,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[23]  P. Kokotailo.  Alcohol Use by Youth and Adolescents: A Pediatric Concern , 2010, Pediatrics.

[24]  Kelly S. DeMartini,et al.  Optimizing the use of the AUDIT for alcohol screening in college students. , 2012, Psychological assessment.

[25]  P. Ambrosini.  Historical development and present status of the schedule for affective disorders and schizophrenia for school-age children (K-SADS). , 2000, Journal of the American Academy of Child and Adolescent Psychiatry.

[26]  A. Beekman,et al.  The performance of the Alcohol Use Disorder Identification Test (AUDIT) in detecting alcohol abuse and dependence in a population of depressed or anxious persons. , 2010, Journal of affective disorders.

[27]  María-Teresa Cortés-Tomás,et al.  Different versions of the Alcohol Use Disorders Identification Test (AUDIT) as screening instruments for underage binge drinking. , 2016, Drug and alcohol dependence.

[28]  Ronald Gangnon,et al.  Validity of the alcohol use disorders identification test in college students. , 2004, Alcoholism, clinical and experimental research.

[29]  D. Simkin,et al.  Alcohol use and abuse: a pediatric concern. , 2001, Pediatrics.

[30]  D. Kivlahan,et al.  The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. , 1998, Archives of internal medicine.

[31]  J. Kaprio,et al.  Early-onset depressive disorders predict the use of addictive substances in adolescence: a prospective study of adolescent Finnish twins. , 2008, Addiction.

[32]  J. Jung,et al.  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 , 2013, Korean journal of family medicine.

[33]  W. Youden,et al.  Index for rating diagnostic tests , 1950, Cancer.

[34]  J. Mccambridge,et al.  Comparative psychometric study of a range of hazardous drinking measures administered online in a youth population. , 2008, Drug and alcohol dependence.

[35]  Claire Wang,et al.  The neurocognitive effects of alcohol on adolescents and college students. , 2005, Preventive medicine.

[36]  María Elena Alvarado,et al.  The Alcohol Use Disorders Identification Test (AUDIT) as a screening instrument for adolescents. , 2009, Drug and Alcohol Dependence.

[37]  Equivalence of the statistics for replicability and area under the ROC curve. , 2009, The British journal of mathematical and statistical psychology.

[38]  Timothy C Irwin,et al.  A principled approach to setting optimal diagnostic thresholds: where ROC and indifference curves meet. , 2011, European journal of internal medicine.

[39]  R. Cook,et al.  Alcohol use disorders among emergency department-treated older adolescents: a new brief screen (RUFT-Cut) using the AUDIT, CAGE, CRAFFT, and RAPS-QF. , 2004, Alcoholism, clinical and experimental research.

[40]  J. Mccambridge,et al.  Short forms of the AUDIT in a Web-based study of young drinkers. , 2009, Drug and alcohol review.

[41]  Niels Smits,et al.  A note on Youden's J and its cost ratio , 2010, BMC medical research methodology.

[42]  H. Thomas,et al.  Accuracy of Alcohol Use Disorders Identification Test for detecting problem drinking in 18-35 year-olds in England: method comparison study. , 2015, Alcohol and alcoholism.

[43]  D. Kivlahan,et al.  The factor structure of the Alcohol Use Disorders Identification Test (AUDIT). , 2007, Journal of studies on alcohol and drugs.

[44]  B. Grant,et al.  The AUDIT-C: screening for alcohol use disorders and risk drinking in the presence of other psychiatric disorders. , 2005, Comprehensive psychiatry.

[45]  E. Kaner,et al.  Alcohol Screening and Brief Intervention for Adolescents: The How, What and Where of Reducing Alcohol Consumption and Related Harm Among Young People , 2013, Alcohol and alcoholism.

[46]  A. Masten,et al.  Underage Drinking: A Developmental Framework , 2008, Pediatrics.

[47]  E. Costello,et al.  Pubertal maturation and the development of alcohol use and abuse. , 2007, Drug and alcohol dependence.

[48]  N. Ryan,et al.  Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): initial reliability and validity data. , 1997, Journal of the American Academy of Child and Adolescent Psychiatry.

[49]  John R Knight,et al.  Validity of brief alcohol screening tests among adolescents: a comparison of the AUDIT, POSIT, CAGE, and CRAFFT. , 2003, Alcoholism, clinical and experimental research.

[50]  E. DeLong,et al.  Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. , 1988, Biometrics.

[51]  J. Hallak,et al.  Is the full version of the AUDIT really necessary? Study of the validity and internal construct of its abbreviated versions. , 2010, Alcoholism, clinical and experimental research.

[52]  B. Grant,et al.  Age at first drink and the first incidence of adult-onset DSM-IV alcohol use disorders. , 2008, Alcoholism, clinical and experimental research.

[53]  Ping-yan Chen,et al.  Weighted Youden index and its two-independent-sample comparison based on weighted sensitivity and specificity. , 2013, Chinese medical journal.

[54]  A. Adewuya.  Validation of the alcohol use disorders identification test (audit) as a screening tool for alcohol-related problems among Nigerian university students. , 2005, Alcohol and alcoholism.

[55]  O. Aasland,et al.  Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption--II. , 1993, Addiction.

[56]  B. Reiser,et al.  Estimation of the area under the ROC curve , 2002, Statistics in medicine.

[57]  Hannu Alho,et al.  AUDIT and its abbreviated versions in detecting heavy and binge drinking in a general population survey. , 2009, Drug and alcohol dependence.

[58]  R. Richards-Kortum,et al.  A comparison of C/B ratios from studies using receiver operating characteristic curve analysis. , 1999, Journal of clinical epidemiology.

[59]  W. Compton,et al.  Screening and brief intervention and referral to treatment for drug use in primary care: back to the drawing board. , 2014, JAMA.

[60]  A. Spirito,et al.  Utility of the AUDIT for screening adolescents for problematic alcohol use in the emergency department , 2006, International journal of adolescent medicine and health.

[61]  M. Hellard,et al.  Comparing short versions of the AUDIT in a community-based survey of young people , 2013, BMC Public Health.