Are short AUDIT screeners effective in identifying unhealthy drinking of varying severity? A prison population study

Whether brief versions of the Alcohol Use Disorder Identification Test (AUDIT) can be used as graded severity measures is largely unknown. We examined the performance of eight such brief screeners in a prison population, and compared their effectiveness in detecting hazardous drinking, harmful drinking, and possible alcohol dependence as classified by the full ten-item AUDIT.

The study sample included pre-prison drinkers who participated in the Norwegian Offender Mental Health and Addiction (NorMA) study (n = 758). We conducted receiver operating characteristic curve (ROC) analyses and estimated the area under the curve (AUROC) to assess the performance of AUDIT-C (three consumption items) and four-item versions that consisted of AUDIT-C and one additional item.

AUDIT-C performed very well in detecting unhealthy drinking of varying severity (AUROCs of 0.933 or 0.935). Four-item versions performed even better. Of these, the well-established AUDIT-4 was superior in identifying harmful drinking (AUROC=0.969) and possible alcohol dependence (AUROC=0.976). For AUDIT-C, the optimal cut-points in terms of the highest combined sensitivity and specificity were ≥ 6 (hazardous drinking), ≥ 8 (harmful drinking) and ≥ 8 or ≥ 9 (possible dependence). The corresponding cut-points on AUDIT-4 were ≥ 6, ≥ 9 and ≥ 10. The highest cut-point whereby all cases of possible dependence were identified was ≥ 6 on AUDIT-C and ≥ 8 on AUDIT-4. At these cut-points, almost all individuals with harmful drinking were also detected.

AUDIT-C and AUDIT-4 were both highly effective in detecting hazardous drinking, harmful drinking and possible alcohol dependence. AUDIT-4 was superior, notably as a graded severity measure.