Effectiveness of the AUDIT-C as a Screening Test for Alcohol Misuse in Three Race/Ethnic Groups

SummaryBackgroundThe 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.ObjectiveTo 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.DesignCross-sectional interview validation study.Participants1,292 outpatients from an academic family practice clinic in Texas (90% of randomly sampled eligible).Measurements and Main ResultsRace/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).ConclusionsThe 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.

[1]  H. Smeets,et al.  A functional polymorphism of the mu-opioid receptor gene (OPRM1) influences cue-induced craving for alcohol in male heavy drinkers. , 2007, Alcoholism, clinical and experimental research.

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

[3]  K. Barry,et al.  Brief physician advice for problem alcohol drinkers. A randomized controlled trial in community-based primary care practices. , 1997, JAMA.

[4]  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.

[5]  B. Grant,et al.  Toward the attainment of low-risk drinking goals: a 10-year progress report. , 2004, Alcoholism, clinical and experimental research.

[6]  R. Saitz.  Clinical practice. Unhealthy alcohol use. , 2005, The New England journal of medicine.

[7]  C. Cherpitel.  Differences in performance of screening instruments for problem drinking among blacks, whites and Hispanics in an emergency room population. , 1998, Journal of studies on alcohol.

[8]  E Guillibert,et al.  [Detecting alcoholism]. , 1984, Soins; la revue de reference infirmiere.

[9]  C. Cherpitel.  Comparison of screening instruments for alcohol problems between black and white emergency room patients from two regions of the country. , 1997, Alcoholism, clinical and experimental research.

[10]  K. Bush,et al.  Screening for problem drinking , 1998, Journal of general internal medicine.

[11]  A. Haines,et al.  Randomised controlled trial of general practitioner intervention in patients with excessive alcohol consumption. , 1988, BMJ.

[12]  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.

[13]  C. Cherpitel.  Screening for alcohol problems in the U.S. general population: a comparison of the CAGE and TWEAK by gender, ethnicity, and services utilization. , 1999, Journal of studies on alcohol.

[14]  Ncd,et al.  Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: recommendation statement. , 2004, Annals of internal medicine.

[15]  C. Cherpitel.  Gender, injury status and acculturation differences in performance of screening instruments for alcohol problems among US Hispanic emergency department patients. , 1999, Drug and alcohol dependence.

[16]  P. O'Connor,et al.  Screening for alcohol problems in primary care: a systematic review. , 2000, Archives of internal medicine.

[17]  R. Caetano.  Alcohol use among Hispanic groups in the United States. , 1988, The American journal of drug and alcohol abuse.

[18]  Robert J Volk,et al.  AUDIT-C as a brief screen for alcohol misuse in primary care. , 2007, Alcoholism, clinical and experimental research.

[19]  J. Ewing,et al.  Detecting alcoholism. The CAGE questionnaire. , 1984, JAMA.

[20]  G. O. Lignac.  [Actual causes of death]. , 1951, Nederlands tijdschrift voor geneeskunde.

[21]  K J Rothman,et al.  No Adjustments Are Needed for Multiple Comparisons , 1990, Epidemiology.

[22]  T. M. Davis,et al.  Two brief alcohol-screening tests From the Alcohol Use Disorders Identification Test (AUDIT): validation in a female Veterans Affairs patient population. , 2003, Archives of internal medicine.

[23]  R. Fleming.  Behavioral counseling interventions in primary care to reduce risky/harmful alcohol use by adults: a summary of the evidence for the U.S. Preventive Services Task Force , 2010 .

[24]  B. Grant,et al.  The Alcohol Use Disorder and Associated Disabilities Interview schedule (AUDADIS): reliability of alcohol and drug modules in a general population sample. , 1995, Drug and alcohol dependence.

[25]  S. Cantor,et al.  The Alcohol Use Disorders Identification Test (AUDIT) as a screen for at-risk drinking in primary care patients of different racial/ethnic backgrounds. , 1997, Addiction.

[26]  Amee J. Epler,et al.  Using alcohol screening results and treatment history to assess the severity of at-risk drinking in Veterans Affairs primary care patients. , 2004, Alcoholism: Clinical and Experimental Research.

[27]  J. Gerberding,et al.  Actual causes of death in the United States, 2000. , 2004, JAMA.

[28]  F. Fantozzi,et al.  Helping patients who drinks too much. A Clinician’s Guide , 2006 .

[29]  S. Shellenberger,et al.  Primary care validation of a single screening question for drinkers. , 2006, Journal of studies on alcohol.

[30]  N Sartorius,et al.  WHO Study on the reliability and validity of the alcohol and drug use disorder instruments: overview of methods and results. , 1997, Drug and alcohol dependence.

[31]  B. Grant,et al.  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. , 2005, Alcoholism, clinical and experimental research.

[32]  G. Bischof,et al.  Effects of item sequence on the performance of the AUDIT in general practices. , 2005, Drug and alcohol dependence.

[33]  P. Diehr,et al.  The AUDIT alcohol consumption questions: reliability, validity, and responsiveness to change in older male primary care patients. , 1998, Alcoholism, clinical and experimental research.

[34]  C. Cherpitel,et al.  Ethnic differences in performance of screening instruments for identifying harmful drinking and alcohol dependence in the emergency room. , 1995, Alcoholism, clinical and experimental research.

[35]  S. Cantor,et al.  Ethnic and Sex Bias in Primary Care Screening Tests for Alcohol Use Disorders , 1998, Annals of Internal Medicine.

[36]  D. Kivlahan,et al.  Alcohol screening scores and risk of hospitalizations for GI conditions in men. , 2007, Alcoholism, clinical and experimental research.

[37]  S. Cantor,et al.  Item bias in the CAGE screening test for alcohol use disorders , 1997, Journal of General Internal Medicine.

[38]  B. Grant,et al.  Reliability of the alcohol and drug modules of the Alcohol Use Disorder and Associated Disabilities Interview Schedule--Alcohol/Drug-Revised (AUDADIS-ADR): an international comparison. , 1997, Drug and alcohol dependence.

[39]  G. Borges,et al.  Screening Instruments for Alcohol Problems: A Comparison of Cut Points between Mexican American and Mexican Patients in the Emergency Room , 2000, Substance use & misuse.

[40]  Helen Young,et al.  Effectiveness of brief alcohol interventions in primary care populations , 2010 .

[41]  Thomas F. Babor,et al.  Alcohol Use Disorders Identification Test , 1995 .

[42]  C. Cherpitel,et al.  Screening for alcohol problems: comparison of the audit, RAPS4 and RAPS4-QF among African American and Hispanic patients in an inner city emergency department. , 2003, Drug and alcohol dependence.

[43]  McGinnis Jm,et al.  Actual causes of death in the United States. , 1993 .

[44]  M. Polen,et al.  Behavioral Counseling Interventions in Primary Care To Reduce Risky/Harmful Alcohol Use by Adults: A Summary of the Evidence for the U.S. Preventive Services Task Force , 2004, Annals of Internal Medicine.

[45]  D. Vinson,et al.  Validation of a single screening question for problem drinking. , 2001, The Journal of family practice.

[46]  B. Grant,et al.  Concordance of DSM-IV alcohol and drug use disorder criteria and diagnoses as measured by AUDADIS-ADR, CIDI and SCAN. , 1997, Drug and alcohol dependence.

[47]  T. Perneger.  What's wrong with Bonferroni adjustments , 1998, BMJ.

[48]  R. Feise.  Do multiple outcome measures require p-value adjustment? , 2002, BMC medical research methodology.