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Redalyc.Alcohol Use Disorders Identification Test (AUDIT): an Updated Systematic Review of Psychometric Properties Psychology & Neuroscience ISSN: 1984-3054 [email protected] Pontifícia Universidade Católica do Rio de Janeiro Brasil Meneses-Gaya, Carolina de; Waldo Zuardi, Antonio; Loureiro, Sonia Regina; Crippa, José Alexandre S. Alcohol Use Disorders Identification Test (AUDIT): An updated systematic review of psychometric properties Psychology & Neuroscience, vol. 2, núm. 1, enero-junio, 2009, pp. 83-97 Pontifícia Universidade Católica do Rio de Janeiro Rio de Janeiro, Brasil Available in: http://www.redalyc.org/articulo.oa?id=207014860012 How to cite Complete issue Scientific Information System More information about this article Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Journal's homepage in redalyc.org Non-profit academic project, developed under the open access initiative PSYCHOLOGY Psychology & Neuroscience, 2009, 2, 1, 83 - 97 NEUROSCIENCE DOI: 10.3922/j.psns.2009.1.12 Alcohol Use Disorders Identification Test (AUDIT): An updated systematic review of psychometric properties Carolina de Meneses-Gaya, Antonio Waldo Zuardi, Sonia Regina Loureiro and José Alexandre S. Crippa University of São Paulo, Ribeirão Preto, São Paulo, Brazil and INCT Translational Medicine, Brazil Abstract The Alcohol Use Disorders Identification Test (AUDIT) is an instrument used to screen for alcohol-related problems. It has been increasingly used in many different countries in both the original English-language version and its many translated versions. Because of the need for screening instruments of faster administration, shortened versions of the AUDIT have also been developed. This study was aimed at expanding the work by Berner and colleagues (2007) in an attempt to answer some remaining questions as well as to identify and evaluate studies on the validation of modified versions of the AUDIT, which have not been previously analyzed. In order to do so, we identified indexed articles published between 2002 and 2009 related to the psychometric qualities of the AUDIT by matching the keywords: alcohol, Alcohol Use Disorders Identification Test, and AUDIT. We found 47 articles that evaluated the AUDIT in different countries and in diverse health and community contexts, involving adolescent, adult, and elderly samples. The studies confirmed the validity and efficiency of the AUDIT in the identification of harmful use, abuse, and dependence of alcohol, both in the original version and in modified ones. The possibility of using brief and efficient versions is of great value, since certain health contexts demand faster assessment. The results also showed that the reduced versions have satisfactory psychometric qualities, sometimes with sensitivity values higher than those of the AUDIT itself. The studies analyzed confirm the efficiency of the AUDIT both in its original, reduced, and language-adapted versions in different contexts and cultures. Keywords: alcohol, Alcohol Use Disorders Identification Test,AUDIT. Received 4 November 2008; received in revised form 20 April 2009; accepted 22 June 2009. Available online 29 June 2009 Introduction These instruments also allow for comparisons between similar assessment results and minimize the influence Hazardous alcohol consumption is a major contributor of subjective factors on data collection and recording. to risky behaviors and adverse health outcomes; hence, the Appropriate screening instruments are quick and easy to detection of Alcohol Use Disorders (AUD) constitutes a administer, score, and interpret, in addition to presenting great challenge for public health planners across countries significant reliability and validity coefficients regarding the (Gómez, Conde, Santana, & Jorrín, 2005) and screening research objectives. instruments for alcohol problems have recently become The Alcohol Use Disorders Identification Test the subject of growing interest. (AUDIT) is a widely used instrument that was developed Screening instruments are highly valuable in that they by the World Health Organization (WHO) for identifying provide accurate, reproducible, relevant measurements. risky or harmful alcohol consumption as well as alcohol In addition, their use offers better information records, dependence and abuse (Babor, La Fuente, Saunders, & especially in health care settings with high labor turnover. Grant, 1992). The 10-item AUDIT includes questions to assess the amount and frequency of alcohol intake (items 1-3), alcohol dependence (questions 4-6) and problems Carolina de Meneses-Gaya, Antonio Waldo Zuardi, Sonia related to alcohol consumption (items 7-10) (Shevlin Regina Loureiro and José Alexandre S. Crippa, Department of & Smith, 2007). Scores range from 0 to 40, and the Neuroscience and Behavior, Faculty of Medicine, University of São generally accepted cut-off point of the scale to identify Paulo, Ribeirão Preto, São Paulo, Brazil and INCT Translational potentially hazardous alcohol intake is 8. It is worthwhile Medicine, Brazil. Correspondence regarding this article should highlighting that numerous studies have validated the be directed to: José Alexandre S. Crippa Departamento de AUDIT, and reached better sensitivity and specificity Neurociências e Ciências do Comportamento; Faculdade de Medicina de Ribeirão Preto; Universidade de São Paulo Hospital values with different cut-off points (Adewuya, 2005; das Clínicas - Terceiro Andar, Av. Bandeirantes, 3900 - Ribeirão Bradley et al., 2003; Dawson, Grant, & Stinson, 2005a; Preto - São Paulo - Brasil - CEP - 14049-900. Phone/fax: (+55)-16- Dybek et al., 2006; Gache et al., 2005; Knight, Sherritt, 6022201/ (+55)-16-6350713. E-mail: [email protected] Harris, Gates, & Chang, 2003; Pal, Jena, & Yadav, 84 Meneses-Gaya et al 2004; Pérula et al., 2005). Similarly, it has recently been translation and validation of modified non-English versions observed that male and female patients require different of the AUDIT, which have not been previously analyzed. cut-off scores (Reinert & Allen, 2002, 2007). Although the AUDIT was originally designed as Method an instrument for use in primary care settings, several recent studies have validated it in other health care and A systematic search of the literature published up community contexts (Lima et al., 2005). The AUDIT has to January 2009 was carried out using the following been translated into several languages for use in various electronic databases: Medline; LILACS, PsycINFO, countries. Literature contains references to translations Science Citation Index Expanded, BIOSIS Previews, in Nigeria (Adewuya, 2005); India (Carey, Carey, & Cumulative Index to Nursing and Allied Health Literature Chandra, 2003; Pal, Jena, & Yadav, 2004); Spain (Gómez (CINAHL), MEDION, Scopus, and SciELO. The et al., 2005; Pérula et al., 2005); Brazil (Lima et al., following search terms were used: “alcohol”, “Alcohol 2005), Switzerland (Bergman & Källmén 2002; Selin, Use Disorders Identification Test”, and “AUDIT”. 2003); China (Chen, Chen, & Cheng, 2004, 2005; Tsai, In the first step, one reviewer assessed the title and Tsai, Chen, & Liu, 2005); Germany (Bischof et al., 2005; abstract of all publications that were retrieved in electronic Dybek et al., 2006; Neumann et al., 2009; Rumpf et al., database searches using the inclusion and exclusion 2003); Vietnam (Giang, Spak, Dzung, & Allebeck, 2005) criteria. We included articles published in English, and France (Gache et al., 2005). Nonetheless, only a small Spanish and Portuguese and in which the psycho¬metric number of studies have addressed the validity, reliability properties of the AUDIT and its abbreviated versions and factorial structure of these non-English versions. This were evaluated. Studies dealing with the clinical and fact can compromise the comparability across studies. epidemiolo¬gical aspects of alcohol problems were In view of the need for screening instruments that excluded, as well as studies on the therapeutic efficacy to are faster to apply, abbreviated versions of the AUDIT treat dependence and articles published before 2002. The have been developed. This was possible thanks to the original articles obtained through this search were then AUDIT’s high internal consistency, which allowed reviewed for additional references. shorter versions to be just as efficient as the full-scale The searches retrieved 807 potentially relevant version. The reduced versions known to date are the publications; 760 publications were excluded and 47 AUDIT-3 – the shortest of all, consisting solely of studies were analyzed. Table 1 lists the sociodemographic the third question of the AUDIT (Bradley et al., 2003; variables of the studies analyzed in this review. Gómez et al., 2005; Wu et al., 2008) -; AUDIT-C, consisting of the first three questions of the full-scale Results (Aertgeerts, Buntinx, Ansoms, & Fevery, 2002; Bradley et al., 2003; Dawson et al., 2005a; Gómez et al., 2005; Characteristics of the AUDIT in specific groups Tsai et al., 2005; Bradley et al., 2007; Bischof et al., The AUDIT was originally developed to be used with 2007; Frank et al., 2008); AUDIT QF, comprising the adult populations. However, AUDIT validation studies have first two questions (Aalto, Tuunanen, Sillanaukee, & also been performed in samples composed of adolescents Seppa, 2006); AUDIT-PC, with questions one, two, and university students (Reinert & Allen, 2002). four, five, and 10 (Aertgeerts et al., 2002; Gómez et Over the last years, two studies that validated and al., 2005; Aalto et al., 2006; Wu et al., 2008); AUDIT compared the AUDIT to other screening instruments,
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