Quantifying alcohol-related problems with AUDIT

Is it possible to quantify alcohol-related problems?

During the past half a century, researchers have been grappling with this problem. They have developed a plethora of tools to quantify alcohol-related problems depending on how they define it. One such famous tool to date is the A.U.D.I.T.: (Alcohol Use Disorders Identification Test). This 10-item instrument came to us as a result of a multi-center study executed by the World Health Organization (WHO).

I do not discuss how it was developed. Rather, I describe the test.

AUDIT (Alcohol Use Disorders Identification Test)

The AUDIT – the 10-item questionnaire – screens for alcohol-related problems within 10 minutes fairly accurately.

In 2001, the WHO published the tool as a freely available booklet. You can access it through this link: AUDIT test. Thomas Babor, John Higgins-Biddle, John Sanders, and Maristela Monteiro authored the booklet (Figure 1).

What is this instrument?

The instrument consists of 10 questions and each question owns 5 responses with scores ranging from 0 – 4. The respondent should choose one response out of 5 responses. This means after responding to all ten questions, the respondent’s score may be any value between 0 – 40.

All the questions inquire about the respondent’s alcohol consumption and related problems during the past 12 months from the date of the interview.

The interview version of the AUDIT tool

Item domains

The instrument consists of 3 domains: hazardous alcohol use, dependence symptoms, and harmful alcohol use. The first three questions deal with the first domain – hazardous alcohol use while the second three questions probe about dependence symptoms. The last four questions seek information about harmful alcohol use. The box 2 summarises these three domains and its related question items succinctly.

Figure 2:
source: https://apps.who.int/iris/bitstream/handle/10665/67205/WHO_MSD_MSB_01.6a.pdf?sequence=1

Challenges in using the AUDIT instrument

Among several challenges in using this instrument, the most crucial one is assessing the hazardous consumption in terms of the amount of pure ethanol consumed in the 12 months prior to the interview. This is because the percentages of pure ethanol in alcohol beverages vary significantly by the product. For example, beer products contain about 5 percent of pure ethanol while spirits having about 40 percent of pure ethanol. The instrument adopts the standard drink size concept to overcome the challenge.

Author: Prasantha De Silva

A specialist in Community Medicine board-certified in Sri Lanka and a research analyst in Canada

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