Cutoffs for Unhealthy Alcohol Use Are Actually Lower than Those Often Suggested
Although many publications suggest a score of ≥8 on the Alcohol Use Disorders Identification Test (AUDIT) as the threshold for detecting unhealthy alcohol use, other have suggested that cutoff may not be sufficiently sensitive. Investigators analyzed data collected by research-assistant (RA) interviews with patients who visited 1 of 5 primary care practices in the southeastern US (N=625). They used the Diagnostic Interview Schedule to diagnose abuse and dependence and the timeline follow-back calendar method to detect at-risk drinking amounts as defined by the National Institute on Alcohol Abuse and Alcoholism. Unhealthy use was defined as drinking at-risk amounts, abuse, or dependence.
- For men, an AUDIT score of ≥8 was only 43% sensitive for unhealthy use (specificity was 94%). A score of ≥5 was 77% sensitive and 76% specific.
- For women, an AUDIT score of ≥7 was only 31% sensitive for unhealthy use (specificity was 98%). A score of ≥3 was 86% sensitive and 74% specific.
- Optimal sensitivity and specificity of the AUDIT-consumption (AUDIT-C) items was similar to that reported previously (scores of ≥4 for men and ≥3 or for women).
- An AUDIT score of ≥15 for men and ≥13 for women was 100% specific for current alcohol dependence.
Comments:These results, which are consistent with other studies in primary care in the US, make a strong case for not using 8 as the AUDIT screening cutoff for unhealthy alcohol use and instead using ≥5 for men and ≥3 for women. The study also provided useful information on how to use the AUDIT as an assessment tool for advising patients who screen positive for dependence. Richard Saitz, MD, MPH
Johnson JA, Lee A, Vinson D, et al. Use of AUDIT-based measures to identify unhealthy alcohol use and alcohol dependence in primary care: a validation study. Alcohol Clin Exp Res. July 26, 2012 [Epub ahead of print]. doi: 10.1111/j.1530-0277.2012.01898.x