The AUDIT Alcohol Consumption Questions: Reliability, Validity, and Responsiveness to Change in Older Male Primary Care Patients

Authors

  • Katharine A. Bradley,

    Corresponding author
    1. From Health Services Research and Development (K.A.B., M.B.M., K.B., S.D.F.), Center of Excellence for Substance Abuse Treatment and Education (D.R.K.) and the Medical Service (K.A.B., S.D.F.), VA Puget Sound Health Care System (Seattle Division); and the Departments of Medicine (K.A.B., S.D.F.), Psychiatry and Behavioral Sciences (D.R.K., K.B.), Biostatistics (P.D.), and Health Services (K.A.B., S.D.F.), University of Washington, Seattle, Washington.
      Reprint requests: Katharine A. Bradley, M.D., M.P.H., Health Services Research and Development, M.S. 152, VA Puget Sound Health Care System (Seattle Division), 1660 South Columbian Way, Seattle, WA 98108.
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  • Mary B. McDonell,

    1. From Health Services Research and Development (K.A.B., M.B.M., K.B., S.D.F.), Center of Excellence for Substance Abuse Treatment and Education (D.R.K.) and the Medical Service (K.A.B., S.D.F.), VA Puget Sound Health Care System (Seattle Division); and the Departments of Medicine (K.A.B., S.D.F.), Psychiatry and Behavioral Sciences (D.R.K., K.B.), Biostatistics (P.D.), and Health Services (K.A.B., S.D.F.), University of Washington, Seattle, Washington.
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  • Kristen Bush,

    1. From Health Services Research and Development (K.A.B., M.B.M., K.B., S.D.F.), Center of Excellence for Substance Abuse Treatment and Education (D.R.K.) and the Medical Service (K.A.B., S.D.F.), VA Puget Sound Health Care System (Seattle Division); and the Departments of Medicine (K.A.B., S.D.F.), Psychiatry and Behavioral Sciences (D.R.K., K.B.), Biostatistics (P.D.), and Health Services (K.A.B., S.D.F.), University of Washington, Seattle, Washington.
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  • Daniel R. Kivlahan,

    1. From Health Services Research and Development (K.A.B., M.B.M., K.B., S.D.F.), Center of Excellence for Substance Abuse Treatment and Education (D.R.K.) and the Medical Service (K.A.B., S.D.F.), VA Puget Sound Health Care System (Seattle Division); and the Departments of Medicine (K.A.B., S.D.F.), Psychiatry and Behavioral Sciences (D.R.K., K.B.), Biostatistics (P.D.), and Health Services (K.A.B., S.D.F.), University of Washington, Seattle, Washington.
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  • Paula Diehr,

    1. From Health Services Research and Development (K.A.B., M.B.M., K.B., S.D.F.), Center of Excellence for Substance Abuse Treatment and Education (D.R.K.) and the Medical Service (K.A.B., S.D.F.), VA Puget Sound Health Care System (Seattle Division); and the Departments of Medicine (K.A.B., S.D.F.), Psychiatry and Behavioral Sciences (D.R.K., K.B.), Biostatistics (P.D.), and Health Services (K.A.B., S.D.F.), University of Washington, Seattle, Washington.
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  • Stephan D. Fihn

    1. From Health Services Research and Development (K.A.B., M.B.M., K.B., S.D.F.), Center of Excellence for Substance Abuse Treatment and Education (D.R.K.) and the Medical Service (K.A.B., S.D.F.), VA Puget Sound Health Care System (Seattle Division); and the Departments of Medicine (K.A.B., S.D.F.), Psychiatry and Behavioral Sciences (D.R.K., K.B.), Biostatistics (P.D.), and Health Services (K.A.B., S.D.F.), University of Washington, Seattle, Washington.
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  • All authors are affiliated with the Ambulatory Care Quality Improvement Project (ACQUIP). See appendix for complete list of investigators.

  • This research was supported by the Department of Veteran Affairs, Cooperative Studies in Health Services Research #91-007, and Health Services Research and Development, SDR #96-002, Ambulatory Care Quality Improvement Project (ACQUIP); by a grant from the University of Washington Alcohol and Drug Abuse Institute; and by the Health Services Research and Development Field Program and Medicine Service, Seattle Division, VA Puget Sound Health Care System.

Reprint requests: Katharine A. Bradley, M.D., M.P.H., Health Services Research and Development, M.S. 152, VA Puget Sound Health Care System (Seattle Division), 1660 South Columbian Way, Seattle, WA 98108.

Abstract

Objectives: To determine the reliability, validity, and responsiveness to change of AUDIT (Alcohol Use Disorders Identification Test) questions 1 to 3 about alcohol consumption in a primary care setting. Patients: Randomly selected, male general medical patients (n= 441) from three VA Medical Centers, who had 5 or more drinks containing alcohol in the past year and were willing to be interviewed about their health habits. Measures: Three self-administered AUDIT consumption questions were compared with a telephone-administered version of the trilevel World Health Organization interview about alcohol consumption. Results: Of 393 eligible patients, 264 (67%) completed interviews. Test-retest reliability—Correlations between baseline and repeat measures 3 months later for four dimensions of consumption according to the AUDIT, ranged from 0.65 to 0.85, among patients who indicated they had not changed their drinking (Kendall's Tau-b). Criterion validity—Correlations between AUDIT and interview for four dimensions of alcohol consumption ranged from 0.47 to 0.66 (Kendall's Tau-b). Discriminative validity—The AUDIT questions were specific (90 to 93%), but only moderately sensitive (54 to 79%), for corresponding criteria for heavy drinking. Responsiveness to change—The AUDIT consumption questions had a Guyatt responsiveness statistic of 1.04 for detecting a change of 7 drinks/week, suggesting excellent responsiveness to change. Conclusions: AUDIT questions 1 to 3 demonstrate moderate to good validity, but excellent reliability and responsiveness to change. Although they often underestimate heavy alcohol consumption according to interview, they performed adequately to be used as a proxy measure of consumption in a clinical trial of heavy drinkers in this population.

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