Short communicationThe Alcohol Use Disorders Identification Test (AUDIT) as a screening instrument for adolescents
Introduction
Alcohol consumption by adolescents has shown a marked increase over the last 30 years in the majority of countries (World Health Organization, 1980, World Health Organization, 2001, World Health Organization, 2007). Consumption at early ages and frequent inebriation characterize an emerging pattern of use (Deas et al., 2000, World Health Organization, 2001). Individuals who start to consume alcohol at an early age have a higher risk of the following: future development of alcohol dependency (Grant and Dawson, 1997); unintentional alcohol-related injuries (Hingson et al., 2000); early age of alcohol abuse (Hawkins et al., 1997); illicit drug use (Grunbaum et al., 2004); and tobacco use (Shiffman and Balabanis, 1995). Therefore, children and adolescents who consume alcohol are thought to constitute a risk group (World Health Organization, 2004) that should be actively screened to facilitate early intervention (Jernigan, 2001, World Health Organization, 2007).
The Project on Identification and Management of Alcohol-Related Problems has developed an international screening tool, the Alcohol Use Disorders Identification Test (AUDIT) (Saunders et al., 1993), and evaluated early interventions for groups with high risk alcohol consumption (Babor and Grant, 1992, World Health Organization, 2006). A World Health Organization Expert Committee recently recommended the implementation of screening and brief intervention programs in national and regional health-care systems, to reduce alcohol-related problems (World Health Organization, 2007).
The AUDIT is used as a screening method in primary care and other settings, with various target groups (Babor et al., 2001). Clinical research using the AUDIT has been carried out primarily in developed countries and focused on adult risk groups (Babor et al., 2001). It has been suggested that screening with the AUDIT be expanded to include additional groups at risk of alcohol-related problems, such as adolescents (Babor et al., 2001). For this, the AUDIT should be evaluated with specific regard to its validity and reliability in this group. Given that the AUDIT was designed as a screening tool for international use, its authors have emphasized the need to address its cultural appropriateness and cross-national applicability (Babor et al., 2001).
The Seventh National Study on Drugs in School Population of Chile showed a 38% prevalence of last-month alcohol use (Chilean National Counsel for Narcotics Control, 2008). In the 2006 General Population Survey on Substance Use, 17.7% of adolescents who drank alcohol in the previous month met the criteria of alcohol abuse according to the DSM-IV (Chilean National Counsel for Narcotics Control, 2006). Thus, in Chile there is a large group of adolescents who would benefit from proper screening and intervention.
The available versions of the AUDIT in Spanish (Rubio et al., 1998, Saunders et al., 1993) have linguistic usage that is uncommon in Chile. The purpose of this study was to determine the cut-off points for hazardous, harmful, and dependent alcohol use through the validation of a new Spanish version the AUDIT in a Chilean adolescent sample.
Section snippets
Methods
The study protocol and the Informed Consent Form were approved by the Ethical Committee of University of Chile.
Results
The sample was composed of 42 female and 53 male participants. Their mean age was 15.9 years (95% CI: 15.7–16.2). The mean AUDIT score was 4.4 (95% CI: 3.3–5.5). Internal consistency showed a Cronbach's alpha of 0.83 (95% CI: 0.78–0.82). Test–retest reliability showed an intra-class correlation coefficient of 0.81 (95% CI: 0.73–0.87).
According to the World Health Organization criteria, 34.7% (95% CI: 23.6–45.7%) of the sample reported hazardous drinking. In the CIDI-SAM administration, 27.9%
Discussion
According to this study, the Chilean version of the AUDIT is a reliable and valid tool for identifying adolescents engaged in hazardous, harmful, and dependent alcohol use. Internal consistency, test–retest reliability, sensitivity, and specificity were satisfactory.
Reinert and Allen (2002), after reviewing studies that used the AUDIT, pointed out the scarcity of research done on this test in adolescent populations. Several studies used the cut-off scores recommended for adult populations to
Role of funding source
Funding for this study was provided by FONIS Grant SA05I20078; FONIS had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.
Contributors
Authors Santis, Garmendia, Acuña, Alvarado and Arteaga designed the study and wrote the protocol. Authors Santis and Acuña managed the literature searches and summaries of previous related work. Authors Garmendia and Alvarado undertook the statistical analysis, and authors Santis, Garmendia and Acuña wrote the first draft of the manuscript. All authors contributed to and have approved the final manuscript.
Conflict of interest
All authors declare that they have no conflicts of interest.
Acknowledgements
This project was funded by FONIS (Grant SA05I20078). We would like to thank Professor Thomas Babor for his assistance in the adaptation process of the AUDIT.
We are very grateful to Professor Thomas Babor for his collaboration in the back translation of the Chilean version of the AUDIT.
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2019, Drug and Alcohol DependenceCitation Excerpt :One study from India found that an even higher score of >16 for harmful drinking yielded the highest psychometric results within the study (85.3% sensitivity, 89.4% specificity; Pal et al. (2004)). Dependent drinking was measured with the widest range of cut-off scores (>7 to >24), and all but a cut-off score of >7 (with sensitivity 63.6%, specificity 75%, PPV 46.7%, NPV 85.7%; Santis et al. (2009)) yielded generally high psychometric properties (sensitivity ranged from 81 to 100%, specificity from 28.6 to 94.1%, PPV from 20 to 89.3%, and NPV from 85.7 to 100%). Overall, a wide range of AUDIT cut-off scores performed well across studies.
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