Alcohol Use Disorder Identification Test (AUDIT): What Does It Screen? Performance of the AUDIT against Four Different Criteria in a Swedish Population Sample

Abstract

The purpose of this article was to examine the kinds of alcohol use disorder the AUDIT most accurately screens for since the literature is inconsistent in the use of the AUDIT. Sometimes it is viewed as a measure of hazardous or harmful drinking and sometimes as a measure of dependence. The performance of its subsets (consumption items, AUDIT-C; and problem items, AUDIT-P) and of the full AUDIT (AUDIT-10) was tested against four criteria: high-volume drinking, alcohol-related social problems, alcohol-related health problems, and alcohol dependence. A general population sample of 600 Swedish subjects was interviewed during the winter 2000–01. The results document that, at the recommended cutoff score of 8+, the AUDIT-10 performed well against all four criteria, even if less well against the alcohol-related health problems. The AUDIT-C also performed well against all the problem criteria, showing high areas under the ROC curve, even though significantly lower than the full scale. When measuring high-volume drinking, the AUDIT-C outperformed the full instrument. Scoring at least 1 on the AUDIT-P improved sensitivity of the instrument when screening for social problems and dependence and made it a satisfactory measure of health problems. It is suggested that, when using the full AUDIT to screen for problems more severe than high-volume drinking, the criterion of scoring at least 1 on the AUDIT-P should be applied in combination with a cutoff score on the AUDIT-C.

Keywords:

• AUDIT
• validity
• consumption
• alcohol-related problems
• dependency
• alcohol use disorders

Notes

*TWEAK is a five-item questionnaire including following questions: (T): “How many drinks can you hold?” (> = 6 drinks indicate tolerance.) Worried (W): “Have close friends or relatives Worried or complained about your drinking in the past year?” Eye-openers (E): “Do you sometimes take a drink in the morning when you first get up?” Amnesia (A): Stads for blackouts—“Has a friend or family member ever told you about things you said or did while you were drinking that you could not remember?” Cut down (K).

^†This is an underestimation. The mean consumption in the whole sample was 3.5 liters pure alcohol and only 2.4 liters when weighted for the overrepresentation of problem consumers. According to a recent study (Leifman and Trolldal, 2001, the actual mean consumption in Sweden at the time of our interviews was about 8 liters. Thus, there is a considerable underreporting in our sample (as always in alcohol surveys). But assuming that it is not systematic, choosing the top 10% should be a valid measure of high-volume drinking, even if the actual limit of this decile is probably much higher than 9.3 liters.

^‡Thirty percent in our sample; 26% when the data are weighted with respect to the overrepresentation of potential problem drinkers in the sample.