The Alcohol Use Disorders Identification Test (AUDIT) as a screening instrument for adolescents

doi:10.1016/j.drugalcdep.2009.01.017

Drug and Alcohol Dependence

Volume 103, Issue 3, 1 August 2009, Pages 155-158

https://doi.org/10.1016/j.drugalcdep.2009.01.017 Get rights and content

Abstract

Background

The Alcohol Use Disorders Identification Test (AUDIT) is an international screening instrument extensively employed in adult target groups. However, there is scarce information on screening with the AUDIT in adolescent populations. The purpose of this study was to determine the cut-off point for hazardous, harmful, and dependent alcohol use through the validation of the AUDIT in a Chilean adolescent sample.

Methods

The original English version of the AUDIT was translated into Spanish, using the procedure recommended by the World Health Organization. The text was then back-translated and sent to one of the original authors (Thomas Babor), who approved the translation. Students attending public schools in Santiago, Chile, self-administered the AUDIT, and those older than 15 years completed the Composite International Diagnostic Interview-Substance Abuse Module (CIDI-SAM), which served as a gold standard. Between 1 and 4 weeks after the CIDI-SAM, participants answered a second AUDIT.

Results

A total of 42 female and 53 male adolescents (mean age: 15.9 [SD = 1.2]) completed the AUDIT, with a mean score of 4.3. Reliability according to Cronbach's alpha was 0.83. Test–retest correlation was also satisfactory (intra-class correlation 0.81 [95% CI 0.73–0.87]). Analysis of the receiver operating characteristic (ROC) curve yielded cut-off points for hazardous, harmful, and dependent alcohol use of 3, 5, and 7 points, respectively.

Conclusions

The Chilean version of the AUDIT is a valid and reliable tool for identifying adolescents with hazardous, harmful, and dependent alcohol use. The suggested cut-off points make screening with the AUDIT more accurate for adolescent populations.

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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Les urgences sont des lieux pertinents pour dépister les CPS chez les jeunes, mais le niveau de consultation après orientation reste très faible. Offrir un dépistage systématique lors d’une visite aux urgences pourrait permettre une identification et une prise en charge plus appropriées des jeunes présentant une CPS.
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Citation 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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Heterogeneity was still very high - I² = 98. A total of n = 20 reports (Chung et al., 2002; Edelen et al., 2009; Ferreira et al., 2014; Fleming et al., 1991; Hurlbut and Sher, 1992; Kahler et al., 2008, 2005; Kelly et al., 2009, 2004; Kelly et al., 2002; Kokotailo et al., 2004; López-Núñez et al., 2012; McGee and Kypri, 2004; O’Hare and Sherrer, 1999; Read et al., 2007; Rumpf et al., 2013; Santis et al., 2009; Thomas and McCambridge, 2008; Verster et al., 2009; West and Graham, 2001) provided reliability estimates for 26 instruments. In these studies, data were gathered on 12,760 participants.
There is a strong rationale for clinicians to identify risky drinking among young people given the harms caused by alcohol. This systematic review evaluates the quality of evidence in the validation literature on alcohol screening and assessment measures for young people under 25.
Six electronic databases (MEDLINE; EMBASE; PsycINFO; SSCI; HMIC; ADAI) were searched in May 2016 for published and grey literature. Full-text reports published in English since 1980 were included if they aimed to validate an alcohol screening or assessment measure in comparison with a previously validated alcohol measure. Risk of bias was assessed in studies surpassing a priori quality thresholds for predictive validity, internal and test-retest reliability using COSMIN and QUADAS-2.
Thirty nine reports comprising 135 discrete validation studies were included. Summary estimates indicated that the screening instruments performed well - AUC 0.91 (95% CI: 0.88 to 0.93); sensitivity 0.98 (0.95 to 0.99); specificity 0.78 (0.74 to 0.82). Noting a paucity of validation evidence for existing assessment instruments, aggregated reliability estimates suggest a reliability of 0.81 (0.78 to 0.83) adjusted for 10 items. Risk of bias was high for both types of studies.
The volume and quality of available evidence are superior for screening measures. It is recommended that clinicians use alcohol frequency or quantity items if asking a single question. If there is an opportunity to ask more questions either the 3-item AUDIT-C or the 10-item AUDIT are recommended. There is a need to develop new instruments to assess young people’s alcohol-related problems.
Alcohol use in adolescents and its association with sensation seeking and impulsivity: A survey in the city of Sfax, Tunisia
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Les conduites de consommation de substances psychoactives, notamment celle de l’alcool, suscitent un intérêt médiatique accru depuis la révolution, en Tunisie. En fait, la Tunisie dispose de peu d’études épidémiologiques sur ce sujet ; ce qui ne permet pas d’avoir une idée claire sur l’ampleur réelle du problème et sur ses différents déterminants.
Evaluer la prévalence de la consommation d’alcool chez les adolescents scolarisés de la région de Sfax, deuxième ville du pays du point de vue démographique, et déterminer ses liens avec les deux dimensions de la personnalité : recherche de sensations et impulsivité.
Il s’agissait d’une étude transversale ayant inclus 317 élèves des établissements publics de la région de Sfax. Les participants ont rempli, après consentement, une fiche de renseignements épidémiologiques, l’échelle « Alcohol Use Disoders Identification Test » (AUDIT), l’échelle d’impulsivité de Barratt (BIS-11) et l’échelle de recherche de sensations (SSS-V).
L’âge moyen des élèves était de 15,79 ± 1,5 ans avec un sex-ratio de 1,07. La prévalence des expérimentateurs (ayant consommé de l’alcool au moins une fois dans leur vie) était de 19,6 %. Celle des consommateurs actuels (ayant consommé de l’alcool plus d’une fois au cours des 12 derniers mois précédant l’enquête) était de 8,8 %. Parmi ces derniers, et selon l’AUDIT, 42,8 % présentaient une dépendance à l’alcool. L’étude des dimensions de la personnalité a montré une association significative entre la consommation actuelle d’alcool et la recherche de sensations (p < 0,001) et en particulier les dimensions de désinhibition, de recherche d’expériences et de susceptibilité à l’ennui (p respectifs <0,001 ; 0,002 et 0,001). L’impulsivité globale, ainsi que l’impulsivité motrice et attentionnelle étaient associées à la consommation actuelle d’alcool (p respectifs : 0,001, 0,005 et 0,015).
Il ressort de notre étude que les dimensions de recherche de sensations et d’impulsivité sont associées à la consommation d’alcool chez les adolescents tunisiens scolarisés. Cette conduite semble assez fréquente et souvent problématique chez eux.
Although the increase of media interest for psychoactive substances use, especially alcohol, among young people, since the revolution, Tunisia has few epidemiological studies on this subject, which does not allow having a clear idea of the importance of the problem and its different determinants.
To assess the prevalence of alcohol consumption among adolescents in the region of Sfax (Tunisia) and to determine its relations to the two personality dimensions: sensation seeking and impulsivity.
This was a cross-sectional study involving 317 middle and high school students in Sfax (Tunisia). We used the Alcohol Use Disorders Identification Test (AUDIT) to assess risky alcohol-consumption, the Barratt Impulsiveness Scale (BIS-11) to assess the degree of impulsivity and the Sensation Seeking Scale (SSS-V) to assess the level of sensation seeking.
The average age of students was 15.79 ± 1.5 years with a sex-ratio of 1.07. The prevalence of experimenters (who had drunk alcohol at least once in their lifetime) was 19.6% while that of current consumers (who had drunk alcohol more than one time during the past 12 months before the survey) was 8.8%. Among those who reported alcohol use during the last year, 42.8% were alcohol-dependent, according to the AUDIT. The analysis of personality dimensions showed a significant association between current alcohol consumption and sensation seeking (P < 0.001) in particular on the dimensions of disinhibition (DIS), experience seeking (ES) and boredom susceptibility (BS) (P respectively: <0.001; 0.002 and 0.001). Total impulsivity and motor and attention impulsivity were associated with current alcohol consumption (respective P: 0.001, 0.005 and 0.015).
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Patterns of healthy lifestyle behaviours in older adults: Findings from the Chilean National Health Survey 2009–2010
2018, Experimental Gerontology
Citation Excerpt :
This was then converted to grams and ≥400 g/day was used as cut-off point for healthy intake (MINSAL, 2010). Based on the data collected by the CNHS, seven lifestyle behaviours were used to derive a healthy lifestyle index score including the following cut-off points: a) consumption of ≥5 portions of fruit and vegetables per day; b) salt intake <8 g/day (WHO, 2015b); c) alcohol intake <8 AUDIT score points (Santis et al., 2009; Saunders et al., 1993); d) self-reported sleeping time between 7 and 9 h/day; e) smoking (being a non-smoker); f) physical activity >600 MET/min/week; and g) sedentary behaviour <4 h per day. Individuals who meet these healthy recommendations were given 1 point for each recommendation met whereas those who did not follow them were assigned 0 points.
The purpose of this study was to investigate healthy lifestyle behaviours across age categories in the older population in Chile. Data from 1390 older adults (≥60 years), in the 2009–2010 Chilean National Health Survey were analyzed. We derived the following age categories: 60–65, 66–70, 71–75, 76–80 and >80 years. The associations between age and compliance with healthy lifestyle behaviours (smoking, sitting time, physical activity, sleep duration and intake of salt, alcohol, fruit and vegetables) were investigated using logistic regression. The probability of meeting the guidelines for alcohol intake (OR trend: 1.35 [95% CI: 1.11; 1.64], p = 0.001) and smoking (OR trend: 1.23 [95% CI: 1.13; 1.33], p < 0.0001) increased with age, whereas spending <4 h per day sitting time or engaging in at least 150 min of physical activity per week or sleep on average between 7 and 9 h per day were less likely to be met with increasing age (OR trend: 0.77 [95% CI: 0.71; 0.83], p < 0.000; OR trend: 0.73 [95% CI: 0.67; 0.79], p < 0.0001, and OR trend: 0.89 [95% CI: 0.82; 0.96], p = 0.002, respectively). No significant trend across age categories was observed for fruit and vegetables, and salt intake. The probability of meeting at least 3 out of 7 healthy lifestyle behaviours across the age categories was also lower in older age categories compared to those aged 60 to 65 years. Overall, in older adults the probability of having the healthy lifestyle behaviours of physical activity, sitting time and sleeping behaviours was low but not for smoking or alcohol consumption. With an increasingly ageing population, these findings could inform stakeholders on which lifestyle behaviours could be targeted in the older adults and therefore which interventions should take place to promote healthy ageing.

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Short communicationThe Alcohol Use Disorders Identification Test (AUDIT) as a screening instrument for adolescents

Abstract

Background

Methods

Results

Conclusions

Introduction

Section snippets

Methods

Results

Discussion

Role of funding source

Contributors

Conflict of interest

Acknowledgements

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Int. J. Forecast.

Curr. Opin. Neurobiol.

The value of CAGE, CUGE and AUDIT in screening for alcohol abuse and dependence among college freshmen

Alcohol Clin. Exp. Res.

Screening adolescents for problem drinking and performance of brief screens against DSM-IV alcohol diagnoses

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Alcohol Alcohol.

Exploring the effects of age of alcohol use initiation and psychosocial risk factors on subsequent alcohol misuse

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JAMA

Short communication
The Alcohol Use Disorders Identification Test (AUDIT) as a screening instrument for adolescents