Meta-analysis: Are 3 Questions Enough to Detect Unhealthy Alcohol Use?

16 December 2008 | Volume 149 Issue 12 | Pages 879-888

Background: Both the 10-item Alcohol Use Disorders Identification Test (AUDIT) and its abbreviated 3-item version (Alcohol Use Disorders Identification Test–Consumption [AUDIT-C]) are considered to detect unhealthy alcohol use accurately.

Purpose: To examine whether the AUDIT-C is as accurate as the full AUDIT for detecting unhealthy alcohol use in adults.

Data Sources: MEDLINE, EMBASE, CINAHL, Web of Science, PsycINFO, and BIOSIS Previews from 1998 to July 2008.

Study Selection: Three independent reviewers selected studies that administered both the AUDIT and the AUDIT-C, applied a valid reference standard, avoided verification and incorporation bias, and reported relevant data. No language restrictions were applied.

Data Extraction: Two reviewers extracted study characteristics and outcome data, which were cross-checked by a third reviewer. One reviewer assessed methodological quality with a standardized checklist.

Data Synthesis: Fourteen studies were found. Most involved primary care patients in Europe and the United States. Sample sizes ranged between 112 and 13 438 patients, and sex and age distributions varied considerably. No statistically significant differences were found between the overall accuracy of the AUDIT and the AUDIT-C for detecting risky drinking, alcohol use disorders, or unhealthy alcohol use in primary care. Hierarchical summary receiver-operating characteristic curve analysis yielded pooled positive likelihood ratios of 6.62 for the AUDIT and 2.99 for the AUDIT-C, respectively, for detecting risky drinking; 4.03 and 3.82, respectively, for detecting any alcohol use disorder; and 4.82 and 3.91, respectively, for detecting risky drinking or any alcohol use disorder. Findings from a few studies on general population samples and inpatients suggested but did not prove that the AUDIT might be better than the AUDIT-C for identifying severe conditions, such as alcohol dependence.

Limitation: Studies used different reference standards and had heterogeneous findings.

Conclusion: Available evidence is inconclusive but suggests that the full AUDIT may be superior to the AUDIT-C for identifying unhealthy alcohol use in adults in some settings.

Editors' Notes Context Does a 3- or a 10-item questionnaire (Alcohol Use Disorders Identification Test–Consumption [AUDIT-C] or Alcohol Use Disorders Identification Test [AUDIT]) better identify unhealthy alcohol use in adults? Contribution This meta-analysis found 14 studies that directly compared the accuracy of the AUDIT-C with that of the AUDIT. The studies, conducted mainly in primary care settings, used different reference standards and had heterogeneous findings. Some pooled analyses suggested that primary care patients with a positive AUDIT screening result were more likely than those with a positive AUDIT-C screening result to be engaging in risky drinking. Implication This body of evidence suggests, but does not prove, that the AUDIT may be better than the AUDIT-C in some settings for identifying unhealthy alcohol use in adults. —The Editors

 

Author and Article Information

From the University Medical Center Freiburg, Freiburg, and University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Acknowledgment: The authors thank Sarah Mannion for copyediting the manuscript.

Grant Support: In part by a research grant (01EB0111) from the German Federal Ministry of Education and Research.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Levente Kriston, MA, Section Clinical Epidemiology and Health Services Research, Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Hauptstrasse 5, D-79104, Freiburg, Germany; e-mail, levente.kriston{at}uniklinik-freiburg.de.

Current Author Addresses: Mr. Kriston, Mr. Hölzel, Ms. Weiser, and Dr. Berner: Section Clinical Epidemiology and Health Services Research, Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Hauptstrasse 5, D-79104, Freiburg, Germany.

Dr. Härter: Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20246, Hamburg, Germany.

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