Is the 3-Item AUDIT-C as Accurate as the Full 10-Item AUDIT in Detecting Unhealthy Alcohol Use?
Although the 10-item Alcohol Use Disorders Identification Test (AUDIT) and its first 3 items, the AUDIT-C (for “consumption”), are recommended screening tests for unhealthy alcohol use, their comparative accuracy is not clear. To address this question, researchers conducted a meta-analysis of published studies that directly compared the AUDIT with the AUDIT-C. Fourteen studies were selected by independent reviewers according to defined inclusion and quality criteria.
- Overall accuracy of the AUDIT and AUDIT-C did not differ in detecting risky drinking,* alcohol use disorders,** and unhealthy alcohol use† among primary care patients.
- Pooled estimates of the positive likelihood ratio (how many times more likely the condition is in someone with a positive versus a negative result) were higher for the AUDIT than for the AUDIT-C for risky drinking (6.6 versus 3.0), alcohol use disorders (4.0 versus 3.8), and unhealthy alcohol use (4.8 versus 3.9).
- Positive predictive values (the chance someone with a positive test has the condition) for risky drinking over a prevalence range of 5–50% were higher for the AUDIT than for the AUDIT-C. But both positive and negative predictive values (the chance someone with a negative test doesn’t have the condition) for alcohol use disorders and unhealthy alcohol use were similar for the 2 instruments over the same prevalence range.
- Results did not vary by age and gender.
*defined as alcohol consumption above a recommended level or heavy episodic drinking in the past 12 months.
**defined as harmful drinking, alcohol abuse, or alcohol dependence.
†defined as risky drinking or any alcohol use disorder.
Comments:
This well-done meta-analysis indicates the AUDIT and AUDIT-C have similar overall accuracy for detecting unhealthy alcohol use. Interestingly, the area where the AUDIT seemed to have a small advantage was in detecting risky drinking, which is dependent on the 3 consumption questions common to both instruments. Clinicians should be encouraged to use whichever of the 2 instruments they can practically and consistently integrate into their clinical practice. The AUDIT-C has the advantage of being short and potentially cost-saving. The AUDIT has the ad-vantage of inclusion of items on alcohol adverse consequences that can be used as a starting point for further assessment and counseling.
Kevin L. Kraemer, MD, MSc
Reference:
Kriston L, Hölzel L, Weiser AK, et al. Meta-analysis: are 3 questions enough to detect unhealthy alcohol use? Ann Intern Med. 2008;149(12):879–888.