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Evidence summaries

Opportunistic Screening for Alcohol Use Disorders in Primary Care

The alcohol use disorders identification test (AUDIT) questionnaire is effective and better and more cost effective diagnostic tool than the traditional blood tests for routine screening for alcohol use disorders in primary care. Level of evidence: "A"

A meta-analysis 5 included 135 discrete validation studies. Summary estimates indicated that the screening instruments performed well : area under the curve (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. AUDIT or AUDIT-C (the first three questions of AUDIT) were recommended.

A cross-sectional study 4 investigated w hether the AUDIT score is useful for predicting hazardous drinking and whether the AUDIT score was more useful than pre-existing laboratory tests. 334 outpatients who consulted internal medicine department in Japan completed self-reported questionnaires and underwent a diagnostic interview, physical examination, and laboratory testing. 40 (23 %) male patients reported daily alcohol consumption HASH(0x2fcfe80) 40 g, and 16 (10 %) female patients reported consumption HASH(0x2fcfe80) 20 g. The optimal cutoff values of hazardous drinking were calculated using a 10-fold cross validation, resulting in an optimal AUDIT score cutoff of 8.2, with a sensitivity of 95.5 %, specificity of 87.0 %, false positive rate of 13.0 %, false negative rate of 4.5 %, and area under the receiver operating characteristic curve of 0.97. Multivariate analysis revealed that the most popular short version of the AUDIT consisting solely of its 3 consumption items (AUDIT-C) and patient sex were significantly associated with hazardous drinking. The aspartate transaminase (AST)/alanine transaminase (ALT) ratio and mean corpuscular volume (MCV) were weakly significant.

A cross-sectional data 6 of health surveys from 5 401 university students in the Netherlands were used. 20 % of students were hazardous and harmful drinkers. The area under the ROC (receiver operating characteristic) curve was 0.922 (95% CI 0.914 to 0.930). At an AUDIT-C cutoff score of HASH(0x2fcfe80)7, sensitivity and specificity were both >80%, while other cutoffs showed less balanced results. A cutoff of HASH(0x2fcfe80)8 performed better among males, but for other subgroups HASH(0x2fcfe80)7 was most suitable.

In a comparative study 1 194 male primary care attendees completed an AUDIT questionnaire. A correlation was observed between alcohol consumption and score on the AUDIT (Pearson's correlation coefficient r = 0.74) and measures of gamma-glutamyltransferase (GGT) (r = 0.20) and per cent carbohydrate deficient transferring (CDT) (r = 0.36) but not aspartate aminotransferase (r = 0.08) or erythrocyte mean cell volume (r = 0.02). The AUDIT exhibited higher sensitivity, specificity, and positive predictive value than all of the biochemical markers for hazardous consumption (69%, 98%, and 95%), weekly binge consumption (75%, 90%, and 71%), monthly binge consumption (66%, 97%, and 91%), and alcohol dependence (84%, 83%, and 41%). The questionnaire was also more cost efficient, with a lower cost per true positive for all consumption outcomes.

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    References

    • Coulton S, Drummond C, James D, Godfrey C, Bland JM, Parrott S, Peters T, Stepwice Research Team. Opportunistic screening for alcohol use disorders in primary care: comparative study. BMJ 2006 Mar 4;332(7540):511-7. [PubMed]
    • Fujii H, Nishimoto N, Yamaguchi S et al. The Alcohol Use Disorders Identification Test for Consumption (AUDIT-C) is more useful than pre-existing laboratory tests for predicting hazardous drinking: a cross-sectional study. BMCPublic Health 2016;(16):379. [PubMed]
    • Toner P, Böhnke JR, Andersen P et al. Alcohol screening and assessment measures for young people: A systematic review and meta-analysis of validation studies. Drug Alcohol Depend 2019;202():39-49. [PubMed]
    • Verhoog S, Dopmeijer JM, de Jonge JM et al. The Use of the Alcohol Use Disorders Identification Test - Consumption as an Indicator of Hazardous Alcohol Use among University Students. Eur Addict Res 2020;26(1):1-9. [PubMed]

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