Skip to main content

Advertisement

Log in

Effectiveness of the AUDIT-C as a Screening Test for Alcohol Misuse in Three Race/Ethnic Groups

  • Original Article
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Summary

Background

The Alcohol Use Disorders Identification Test—Consumption (AUDIT-C) is a brief validated screen for risky drinking and alcohol abuse and dependence (alcohol misuse). However, the AUDIT-C was validated in predominantly White populations, and its performance in different racial/ethnic groups is unclear.

Objective

To evaluate the validity of the AUDIT-C among primary care patients from the predominant racial/ethnic subgroups within the United States: White, African American, and Hispanic.

Design

Cross-sectional interview validation study.

Participants

1,292 outpatients from an academic family practice clinic in Texas (90% of randomly sampled eligible).

Measurements and Main Results

Race/ethnicity was self-reported. Areas under the receiver operating curve (AuROCs) evaluated overall AUDIT-C performance in the 3 racial/ethnic groups compared to diagnostic interviews for alcohol misuse. AUDIT-C sensitivities and specificities at recommended screening thresholds were compared across racial/ethnic groups. AuROCs were greater than 0.85 in all 3 groups, with no significant differences across racial/ethnic groups in men (P = .43) or women (P = .12). At previously recommended cut points, there were statistically significant differences by race in AUDIT-C sensitivities but not specificities. In women, the sensitivity was higher in Hispanic (85%) than in African-American (67%; P = .03) or White (70%; P = .04) women. In men, the sensitivity was higher in White (95%) than in African-American men (76%; P = .01), with no significant difference from Hispanic men (85%; P = .11).

Conclusions

The overall performance of the AUDIT-C was excellent in all 3 racial/ethnic groups as reflected by high AuROCs. At recommended cut points, there were significant differences in the AUDIT-C’s sensitivity but not in specificity across the 3 racial/ethnic groups.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3
Figure 4

Similar content being viewed by others

References

  1. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004;291(10):1238–45.

    Article  PubMed  Google Scholar 

  2. Saitz R. Clinical practice. Unhealthy alcohol use. N Engl J Med. 2005;352(6):596–607.

    Article  PubMed  CAS  Google Scholar 

  3. Fleming MF, Barry KL, Manwell LB, Johnson K, London R. Brief physician advice for problem alcohol drinkers. A randomized controlled trial in community-based primary care practices. JAMA. 1997;277(13):1039–45.

    Article  PubMed  CAS  Google Scholar 

  4. Wallace P, Cutler S, Haines A. Randomised controlled trial of general practitioner intervention in patients with excessive alcohol consumption. BMJ. 1988;297(6649):663–8.

    Article  PubMed  CAS  Google Scholar 

  5. Whitlock EP, Polen MR, Green CA, Orleans T, Klein J. Behavioral counseling interventions in primary care to reduce risky/harmful alcohol use by adults: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2004;140(7):557–68.

    PubMed  Google Scholar 

  6. Kaner E, Beyer F, Dickinson H, et al. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev. 2007;(2):CD004148.

    Google Scholar 

  7. U.S. Preventive Services Task Force. Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: Recommendation statement. Ann Intern Med. 2004;140:554–6.

    Google Scholar 

  8. Ewing JA. Detecting alcoholism. The CAGE questionnaire. JAMA. 1984;252(14):1905–7.

    Article  PubMed  CAS  Google Scholar 

  9. Bradley KA, DeBenedetti AF, Volk RJ, Williams EC, Frank D, Kivlahan DR. AUDIT-C as a brief screen for alcohol misuse in primary care. Alcohol Clin Exp Res. 2007;31(7):1–10.

    Article  Google Scholar 

  10. Cherpitel CJ, Clark WB. Ethnic differences in performance of screening instruments for identifying harmful drinking and alcohol dependence in the emergency room. Alcohol Clin Exp Res. 1995;19(3):628–34.

    Article  PubMed  CAS  Google Scholar 

  11. Volk RJ, Cantor SB, Steinbauer JR, Cass AR. Item bias in the CAGE screening test for alcohol use disorders. J Gen Intern Med. 1997;12(12):763–9.

    Article  PubMed  CAS  Google Scholar 

  12. Cherpitel CJ. Differences in performance of screening instruments for problem drinking among blacks, whites and Hispanics in an emergency room population. J Stud Alcohol. 1998;59(4):420–6.

    PubMed  CAS  Google Scholar 

  13. Steinbauer JR, Cantor SB, Holzer CE 3rd, Volk RJ. Ethnic and sex bias in primary care screening tests for alcohol use disorders. Ann Intern Med. 1998;129(5):353–62.

    PubMed  CAS  Google Scholar 

  14. Cherpitel CJ. Screening for alcohol problems in the U.S. general population: a comparison of the CAGE and TWEAK by gender, ethnicity, and services utilization. J Stud Alcohol. 1999;60(5):705–11.

    PubMed  CAS  Google Scholar 

  15. Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption—II. Addiction. 1993;88(6):791–804.

    Article  PubMed  CAS  Google Scholar 

  16. National Institute on Alcohol Abuse and Alcoholism, UDoHaHS, National Institute of Health. Helping Patients Who Drink Too Much: A Clinician’s Guide. Baltimore, MD: National Institute of Health; 2005.

    Google Scholar 

  17. Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Arch Intern Med. 1998;158(16):1789–95.

    Article  PubMed  CAS  Google Scholar 

  18. Bradley KA, Bush KR, Epler AJ, et al. Two brief alcohol-screening tests From the Alcohol Use Disorders Identification Test (AUDIT): validation in a female Veterans Affairs patient population. Arch Intern Med. 2003;163(7):821–9.

    Article  PubMed  Google Scholar 

  19. Volk RJ, Steinbauer JR, Cantor SB, Holzer CE 3rd. The Alcohol Use Disorders Identification Test (AUDIT) as a screen for at-risk drinking in primary care patients of different racial/ethnic backgrounds. Addiction. 1997;92(2):197–206.

    Article  PubMed  CAS  Google Scholar 

  20. Chatterji S, Saunders JB, Vrasti R, Grant BF, Hasin D, Mager D. Reliability of the alcohol and drug modules of the Alcohol Use Disorder and Associated Disabilities Interview Schedule—Alcohol/Drug-Revised (AUDADIS-ADR): an international comparison. Drug Alcohol Depend. 1997;47(3):171–85.

    Article  PubMed  CAS  Google Scholar 

  21. Cottler LB, Grant BF, Blaine J, et al. Concordance of DSM-IV alcohol and drug use disorder criteria and diagnoses as measured by AUDADIS-ADR, CIDI and SCAN. Drug Alcohol Depend. 1997;47(3):195–205.

    Article  PubMed  CAS  Google Scholar 

  22. Grant BF, Harford TC, Dawson DA, Chou PS, Pickering RP. The Alcohol Use Disorder and Associated Disabilities Interview schedule (AUDADIS): reliability of alcohol and drug modules in a general population sample. Drug Alcohol Depend. 1995;39(1):37–44.

    Article  PubMed  CAS  Google Scholar 

  23. Ustun B, Compton W, Mager D, et al. WHO study on the reliability and validity of the alcohol and drug use disorder instruments: overview of methods and results. Drug Alcohol Depend. 1997;47(3):161–9.

    Article  PubMed  CAS  Google Scholar 

  24. Fiellin DA, Reid MC, O’Connor PG. Screening for alcohol problems in primary care: a systematic review. Arch Intern Med. 2000;160(13):1977–89.

    Article  PubMed  CAS  Google Scholar 

  25. Rothman KJ. No adjustments are needed for multiple comparisons. Epidemiology. 1990;1(1):43–6.

    Article  PubMed  CAS  Google Scholar 

  26. Perneger TV. What’s wrong with Bonferroni adjustments. BMJ. 1998;316(7139):1236–8.

    PubMed  CAS  Google Scholar 

  27. Feise RJ. Do multiple outcome measures require p-value adjustment? BMC Med Res Method. 2002;2:8.

    Article  Google Scholar 

  28. DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44(3):837–45.

    Article  PubMed  CAS  Google Scholar 

  29. Bischof G, Reinhardt S, Grothues J, et al. Effects of item sequence on the performance of the AUDIT in general practices. Drug Alcohol Depend. 2005;79(3):373–7.

    Article  PubMed  CAS  Google Scholar 

  30. Dawson DA, Grant BF, Stinson FS, Chou PS. Toward the attainment of low-risk drinking goals: a 10-year progress report. Alcohol Clin Exp Res. 2004;28(9):1371–8.

    Article  PubMed  Google Scholar 

  31. Dawson DA, Grant BF, Stinson FS, Zhou Y. Effectiveness of the derived Alcohol Use Disorders Identification Test (AUDIT-C) in screening for alcohol use disorders and risk drinking in the US general population. Alcohol Clin Exp Res. 2005;29(5):844–54.

    Article  PubMed  Google Scholar 

  32. Cherpitel CJ. Comparison of screening instruments for alcohol problems between black and white emergency room patients from two regions of the country. Alcohol Clin Exp Res. 1997;21(8):1391–7.

    PubMed  CAS  Google Scholar 

  33. Cherpitel CJ. Gender, injury status and acculturation differences in performance of screening instruments for alcohol problems among US Hispanic emergency department patients. Drug Alcohol Depend. 1999;53(2):147–57.

    Article  PubMed  CAS  Google Scholar 

  34. Seale JP, Boltri JM, Shellenberger S, et al. Primary care validation of a single screening question for drinkers. J Stud Alcohol. 2006;67(5):778–84.

    PubMed  Google Scholar 

  35. Caetano R. Alcohol use among Hispanic groups in the United States. Am J Drug Alcohol Abuse. 1988;14(3):293–308.

    Article  PubMed  CAS  Google Scholar 

  36. Cherpitel CJ, Bazargan S. Screening for alcohol problems: comparison of the audit, RAPS4 and RAPS4-QF among African American and Hispanic patients in an inner city emergency department. Drug Alcohol Depend. 2003;71(3):275–80.

    Article  PubMed  Google Scholar 

  37. Cherpitel CJ, Borges G. Screening instruments for alcohol problems: a comparison of cut points between Mexican American and Mexican patients in the emergency room. Subst Use Misuse. 2000;35(10):1419–30.

    Article  PubMed  CAS  Google Scholar 

  38. Williams R, Vinson DC. Validation of a single screening question for problem drinking. J Fam Pract. 2001;50(4):307–12.

    PubMed  CAS  Google Scholar 

  39. Bradley KA, McDonell MB, Bush K, Kivlahan DR, Diehr P, Fihn SD. The AUDIT alcohol consumption questions: reliability, validity, and responsiveness to change in older male primary care patients. Alcohol Clin Exp Res. 1998;22(8):1842–9.

    PubMed  CAS  Google Scholar 

  40. Bradley KA, Kivlahan DR, Zhou XH, et al. Using alcohol screening results and treatment history to assess the severity of at-risk drinking in Veterans Affairs primary care patients. Alcohol Clin Exp Res. 2004;28(3):448–55.

    Article  PubMed  Google Scholar 

  41. Au DH, Kivlahan DR, Bryson CL, Blough D, Bradley KA. Alcohol screening scores and risk of hospitalizations for GI conditions in men. Alcohol Clin Exp Res. 2007;31(3):443–51.

    Article  PubMed  Google Scholar 

  42. American Psychiatric Association. American Psychiatric Association. Task Force on DSM-IV.. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. 4Washington, DC: American Psychiatric Association; 2000.

    Google Scholar 

Download references

Acknowledgments

The authors would like to acknowledge Colin Cooke for his thoughtful review of the manuscript.

Sources of Funding

The research reported here was supported by Health Service Research and Development (HSR&D) MD Postdoctoral Fellowship Research TPM 61-028 and the National Institute on Alcohol Abuse and Alcoholism R21AA14672. Dr. Frank is a senior general medicine fellow at the VA Northwest HSR&D Center of Excellence, VA Puget Sound Health Care System, Seattle, WA, USA. Views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs, the University of Washington, or the NIAAA.

Conflict of Interest

The authors have no potential conflicts of interest that pertain to the content of this manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Danielle Frank MD, MPH.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Table 1

Previous Studies Comparing Sensitives/Specificities of the AUDIT, AUDIT-C, and Single-Item Screen Groups (DOC 26.5 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Frank, D., DeBenedetti, A.F., Volk, R.J. et al. Effectiveness of the AUDIT-C as a Screening Test for Alcohol Misuse in Three Race/Ethnic Groups. J GEN INTERN MED 23, 781–787 (2008). https://doi.org/10.1007/s11606-008-0594-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-008-0594-0

Key Words

Navigation