Validation of the AUDIT-C in adults seeking help with their drinking online

Abstract

BackgroundThe abbreviated Alcohol Use Disorder Identification Test for Consumption (AUDIT-C) is rapidly becoming the alcohol screening tool of choice for busy practitioners in clinical settings and by researchers keen to limit assessment burden and reactivity. Cut-off scores for detecting drinking above recommended limits vary by population, setting, country and potentially format. This validation study aimed to determine AUDIT-C thresholds that indicated risky drinking among a population of people seeking help over the Internet.MethodThe data in this study were collected in the pilot phase of the Down Your Drink trial, which recruited people seeking help over the Internet and randomised them to a web-based intervention or an information-only website. Sensitivity, specificity, and positive and negative likelihood ratios were calculated for AUDIT-C scores, relative to weekly consumption that indicated drinking above limits and higher risk drinking. Receiver-operating characteristic (ROC) curves were created to assess the performance of different cut-off scores on the AUDIT-C for men and women. Past week alcohol consumption was used as the reference-standard and was collected via the TOT-AL, a validated online measure of past week drinking.ResultsAUDIT-C scores were obtained from 3720 adults (2053 female and 1667 male) searching the internet for help with drinking, mostly from the UK. The area under the ROC curve for risky drinking was 0.84 (95% CI 0.80, 0.87) (female) and 0.80 (95% CI 0.76, 0.84) (male). AUDIT-C cut-off scores for detecting risky drinking that maximise the sum of sensitivity and specificity were ≥8 for women and ≥8 for men; whereas those identifying the highest proportion of correctly classified individuals were ≥4 for women and ≥5 for men. AUDIT-C cut-off scores for detecting higher risk drinking were also calculated.ConclusionsAUDIT-C cut-off scores for identifying alcohol consumption above weekly limits in this largely UK based study population were substantially higher than those reported in other validation studies. Researchers and practitioners should select AUDIT-C cut-off scores according to the purpose of identifying risky drinkers and hence the relative importance of sensitivity and/or specificity.

Electronic Health Record-Based Screening for Substance Abuse

“…For example, the abbreviated Alcohol Use Disorder Identification Test for Consumption (AUDIT-C) reports AROC of 0.84 for females and 0.80 for males. 58 Physicians asking their patients about substance use had AROC of 0.74. 59 Efforts to predict risk of over dose/suicide from EHRs had AROC higher than 0.80, 60 suggesting that the performance of predictive model in this study is reasonable and at levels that are comparable with other clinical screening efforts.…”

What does it mean when people say that they have received expressions of concern about their drinking or advice to cut down on the AUDIT scale?

“…The AUDIT-Consumption subscale (AUDIT-C; consists of the three items assessing quantity of alcohol intake) was calculated [ 13 ]. The AUDIT-C has been validated for online use [ 14 ]. The AUDIT-C was then categorized into low risk drinking, at risk drinking, and high risk drinking (respective scoring for Males: 1-3, 4-8, 9-12; Females: 1-2, 3-7, 8-12) and comparisons on the variables of interest were made between risk drinking categories.…”

Smartphone-based secondary prevention intervention for university students with unhealthy alcohol use identified by screening: study protocol of a parallel group randomized controlled trial

“…Participants (n = 1696) will be recruited among registered students at four higher education institutions in the French part of Switzerland. Eligible students will have to be 18 years of age or older, screen positive for unhealthy alcohol use (defined as Alcohol Screening Tool Audit (AUDIT)-C score ≥ 4 in men and ≥ 3 in women) [10,11,32], own a smartphone, and be willing to complete follow-up assessments. There will be no exclusion criteria except for participation in the qualitative part of the study (semi-structured interviews).…”

“…The screening will be anonymous and no personal data will be recorded at this point. The questionnaire will include the AUDIT-C, a validated screening questionnaire (including the online version) on unhealthy alcohol use, with differing cut-off scores by gender [10,32].…”