AUDIT-C as a Brief Screen for Alcohol Misuse in Primary Care

Authors

  • Katharine A. Bradley,

    1. Health Services Research & Development, VA Puget Sound Health Care System, Seattle, Washington
    2. Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington
    3. Department of Medicine, University of Washington, Seattle, Washington
    4. Department of Health Services, University of Washington, Seattle, Washington
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  • Anna F. DeBenedetti,

    1. Health Services Research & Development, VA Puget Sound Health Care System, Seattle, Washington
    2. Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington
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  • Robert J. Volk,

    1. Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
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  • Emily C. Williams,

    1. Health Services Research & Development, VA Puget Sound Health Care System, Seattle, Washington
    2. Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington
    3. Department of Medicine, University of Washington, Seattle, Washington
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  • Danielle Frank,

    1. Health Services Research & Development, VA Puget Sound Health Care System, Seattle, Washington
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  • Daniel R. Kivlahan

    1. Health Services Research & Development, VA Puget Sound Health Care System, Seattle, Washington
    2. Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington
    3. Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
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  • The research reported in this article was supported by National Institute on Alcohol Abuse and Alcoholism R21AA14672 and R03AA09496, and a grant from the Bureau of Health Professions, Health Resources and Services Administration (D32-PE16033).

Reprint requests: Katharine A. Bradley, MD, MPH, (152), VA Puget Sound Health Services Research & Development, 1100 Olive Way, Suite 1400, Seattle, WA 98101; Fax: 206-764-2935; E-mail: willi@u.washington.edu

Abstract

Background: The Alcohol Use Disorders Identification Test Consumption (AUDIT-C) questions have been previously validated as a 3-item screen for alcohol misuse and implemented nationwide in Veterans Affairs (VA) outpatient clinics. However, the AUDIT-C's validity and optimal screening threshold(s) in other clinical populations are unknown.

Methods: This cross-sectional validation study compared screening questionnaires with standardized interviews in 392 male and 927 female adult outpatients at an academic family practice clinic from 1993 to 1994. The AUDIT-C, full AUDIT, self-reported risky drinking, AUDIT question #3, and an augmented CAGE questionnaire were compared with an interview primary reference standard of alcohol misuse, defined as a Diagnostic and Statistical Manual, 4th ed. alcohol use disorder and/or drinking above recommended limits in the past year.

Results: Based on interviews with 92% of eligible patients, 128 (33%) men and 177 (19%) women met the criteria for alcohol misuse. Areas under the receiver operating characteristic curves (AUROCs) for the AUDIT-C were 0.94 (0.91, 0.96) and 0.90 (0.87, 0.93) in men and women, respectively (p=0.04). Based on AUROC curves, the AUDIT-C performed as well as the full AUDIT and significantly better than self-reported risky drinking, AUDIT question #3, or the augmented CAGE questionnaire (p-values <0.001). The AUDIT-C screening thresholds that simultaneously maximized sensitivity and specificity were ≥4 in men (sensitivity 0.86, specificity 0.89) and ≥3 in women (sensitivity 0.73, specificity 0.91).

Conclusions: The AUDIT-C was an effective screening test for alcohol misuse in this primary care sample. Optimal screening thresholds for alcohol misuse among men (≥4) and women (≥3) were the same as in previously published VA studies.

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