Cross-Cultural Evaluation of the Alcohol Relapse Risk Scale in an Australian Inpatient Setting

Alcohol use disorder (AUD) remains a leading cause of preventable disease burden globally, with relapse following inpatient withdrawal a persistent challenge. The Alcohol Relapse Risk Scale (ARRS), developed in Japan, is a validated tool designed to assess relapse risk. This study aimed to evaluate its applicability in an Australian inpatient context.

A cross-sectional study was conducted across two sites within South Western Sydney Local Health District (SWSLHD): the Withdrawal Management Unit and a Hospital Consultation-Liaison Service. A total of 101 patients with AUD completed the ARRS following informed consent. Internal consistency was assessed using Cronbach's α. Predictive validity was analysed using Pearson's correlation, logistic regression and receiver operating characteristic curve analysis.

Participants were predominantly middle-aged males with high daily alcohol intake (~20 standard drinks). The ARRS demonstrated strong overall internal consistency (Cronbach's α = 0.86). The Positive Expectancy subscale recorded the highest scores, particularly beliefs about alcohol alleviating loneliness. The Craving and Availability subscale had the lowest scores, possibly due to stigma or framing. The Negative Emotion subscale showed poor reliability (α = 0.467). Among 64 participants followed up at 4 weeks, relapse was significantly associated with higher scores on the Insight Into Mental Conditions subscale. A cutoff score of 71.5 yielded reasonable sensitivity (0.8) but low specificity (0.42).

The ARRS is a promising tool for assessing relapse risk in Australian inpatient settings. Its multidimensional structure supports its clinical utility, though further validation and cultural adaptation are recommended for broader application.