While I was validating the AUDIT – a tool widely used to quantify alcohol consumption and related problems – to the Sri Lankan context, although researchers and practitioners all over the world have been using it for decades, I faced many difficulties in translating its first three questions: the quantity-frequency questions.
However, I overcame the challenge. Before explaining the method which could be adapted by anyone in any cultural setting, I again will describe the first three AUDIT questions and the challenges of using it.
Keep in mind that these questions refer to the past 12 months from the date of the interview.
How often do you have a drink containing alcohol?
(1) less than monthly
(2) 2-4 times a month
(3) 2-3 times a week
(4) 4 or more times a week
Any respondent might answer the above question relatively easily if they can recall their past 12 months prior to the interview date. Both interviewers and respondents will face a big problem when dealing with the following two questions since both should know what a “drink” is.
How many “drinks” do you have on a typical day when you are drinking?
(0) 1-2 drinks
(1) 2-3 drinks
(2) 4-6 drinks
(3) 7-9 drinks
(4) 10 or more drinks
How often do you have 6 or more drinks on one occasion?
(1) less than monthly
(4) daily or almost daily
According to the original manual, a “drink” refers to an amount of an alcoholic beverage containing 10 grams of pure ethanol (see page 15 of the manual). This definition varies from country to country: It is 13.6 grams in USA and Canada.
The manual (see page 15 in the link) recommends explaining what a “drink” means to respondents. We first need to prepare visuals of drinks of different alcoholic products since drink sizes vary with its alcohol content: For example, a beer bottle equates a “10-grams drink” since its ethanol content is 5%; in contrast, a whisky shot glass equates a “10-grams of drink” whisky since its ethanol content is 40%. It is more challenging in cultures where informal, home-grown, sometimes illicit products, are commoner.
The problem: Accurately estimating the ethanol amount drank is critical for a proper assessment not only among individuals but in the community also.
However, the ethanol content varies significantly by its type;
- 5% in beer;
- 10% – 12% in wine,
- and 40% in spirits.
If someone consumes two glasses of spirits, it is difficult to estimate the amount of ethanol consumed if we do not know the amount of the beverage consumed. Even if we know the amount, we have to do a simple calculation to determine the amount of ethanol.
The solution: Concept of “standard drink” size.
The concept of the “standard drink size”
In order to address the above challenges, researchers created the “standard drink” concept. In Canadian and US contexts, the standard drink refers to the amount of an alcoholic beverage that contains 13.6 grams (or 0.6 ounces of 100%) of pure ethanol. (However, the World Health Organization defines the standard drink as any alcoholic beverage that contains 10 grams of pure ethanol).
Therefore, “standard drink sizes” of beer, wine and spirits vary depending on its pure ethanol contents – beer equivalent to standard drink is larger than the wine equivalent which is larger than the spirits equivalent.
How Alcohol Use Disorders Identification Test (AUDIT) employs this concept
The AUDIT’s first three questions seek the amounts and frequencies of pure ethanol consumed in the 12 months prior to the interview to quantify the hazardous use of alcohol. It does this by asking questions in terms of the number of standard drinks consumed. You can find the complete tool through this link:https://theupstreamboat.com/?s=standard+drink+size.