Accuracy of alcohol use disorders identification test for detecting problem drinking in 18-35 year-olds in England: Method comparison study

Foxcroft, David R.; Smith, Lesley A.; Thomas, Hayley; Howcutt, Sarah

Abstract

Aims: To assess the accuracy of Alcohol Use Disorders Identification Test (AUDIT) scores for problem drinking in males and females aged 18–35 in England. Methods: A method comparison study with 420 primary care patients aged 18–35. Test measures were AUDIT and AUDIT-C. Reference standard measures were (a) Time-Line Follow-Back interview for hazardous drinking; World Mental Health Composite International Diagnostic Interview for (b) DSM-IV alcohol abuse, (c) DSM-IV alcohol dependence, (d) DSM-5 alcohol use disorders. Results: Area under the curve (AUC) was (a) 0.79 (95% CI 0.73–0.85; males) and 0.84 (0.79–0.88; females); (b) 0.62 (0.54–0.72; males) and 0.65 (0.57–0.72; females); (c) 0.77 (0.65–0.87; males) and 0.76 (0.67–0.74; females); (d) 0.70 (0.60–0.78; males) and 0.73 (CI 0.67–0.78; females). Identification of threshold cut-point scores from the AUC was not straightforward. Youden J statistic optimal cut-point scores varied by 4–6 AUDIT scale points for each outcome according to whether sensitivity or specificity were prioritized. Using Bayes' Theorem, the post-test probability of drinking problems changed as AUDIT score increased, according to the slope of the probability curve. Conclusion: The full AUDIT scale showed good or very good accuracy for all outcome measures for males and females, except for alcohol abuse which had sufficient accuracy. In a screening scenario where sensitivity might be prioritized, the optimal cut-point is lower than established AUDIT cut-points of 8+ for men and 6+ for women. Bayes' Theorem to calculate individual probabilities for problem drinking offers an alternative to arbitrary cut-point threshold scores in screening and brief intervention programmes.

Citation

Foxcroft, D. R., Smith, L. A., Thomas, H., & Howcutt, S. (2015). Accuracy of alcohol use disorders identification test for detecting problem drinking in 18-35 year-olds in England: Method comparison study. Alcohol and Alcoholism, 50(2), 244-250. https://doi.org/10.1093/alcalc/agu095

• Journal Article Type: Article
• Acceptance Date: Dec 3, 2014
• Online Publication Date: Dec 22, 2014
• Publication Date: Mar 1, 2015
• Deposit Date: Apr 25, 2019
• Journal: Alcohol and Alcoholism
• Print ISSN: 0735-0414
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 50
• Issue: 2
• Pages: 244-250
• DOI: https://doi.org/10.1093/alcalc/agu095
• Keywords: Alcohol abuse; Alcohol dependence; Area under curve; Mental health; Primary health care; Reference standards; Alcohol use disorders identification test; Diagnostic and statistical manual; Alcohol use disorder; Brief intervention; Outcome measures; Patient interview
• Public URL: https://hull-repository.worktribe.com/output/1647278
• Publisher URL: https://academic.oup.com/alcalc/article/50/2/244/131404