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Validation in a Female Veterans Affairs Patient Population

Katharine A. Bradley, MD, MPH; Kristen R. Bush, MPH; Amee J. Epler, BA; Dorcas J. Dobie, MD; Tania M. Davis, PhD; Jennifer L. Sporleder, BS; Charles Maynard, PhD; Marcia L. Burman, MD, MPH; Daniel R. Kivlahan, PhD

Arch Intern Med. 2003;163:821-829.

Background  Primary care physicians need a brief alcohol questionnaire that identifies hazardous drinking and alcohol use disorders. The Alcohol Use Disorders Identification Test (AUDIT) questions 1 through 3 (AUDIT-C), and AUDIT question 3 alone are effective alcohol-screening tests in male Veterans Affairs (VA) patients, but have not been validated in women.

Methods  Female VA patients (n = 393) completed self-administered questionnaires, including the 10-item AUDIT and a previously proposed modification to AUDIT question 3 with a sex-specific threshold for binge drinking (4 drinks/occasion), and in-person interviews with the Alcohol Use Disorder and Associated Disabilities Interview Schedule. The AUDIT-C, AUDIT question 3 alone, and the 10-item AUDIT were each evaluated with and without the sex-specific binge question and compared with past-year hazardous drinking (>7 drinks/week or 4 drinks/occasion) and/or active Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition alcohol abuse or dependence, based on interviews.

Results  Eighty-nine women (22.6%) met interview criteria for past-year hazardous drinking and/or active alcohol abuse or dependence. Standard and sex-specific AUDIT-Cs were sensitive (0.81 and 0.84, respectively) and specific (0.86 and 0.85, respectively). Their areas under the receiver operating characteristic curves were equivalent (0.91, and 0.92, respectively) and slightly higher than for the standard 10-item AUDIT (0.87). A single, sex-specific question about binge drinking (modified AUDIT question 3) had a sensitivity of 0.69 and specificity of 0.94, whereas the standard AUDIT question 3 was specific (0.96) but relatively insensitive (0.45).

Conclusions  The standard and sex-specific AUDIT-Cs are effective screening tests for past-year hazardous drinking and/or active alcohol abuse or dependence in female patients in a VA study.

From the Veteran Women's Alcohol Problems Study, Department of Veterans Affairs, Veterans Health Administration, Veterans Affairs Puget Sound Health Care System, Health Services Research and Development Service (Drs Bradley, Maynard, and Burman and Mss Epler and Sporleder), the Primary and Specialty Medical Care Service (Drs Bradley, Dobie, and Burman), the Center of Excellence in Substance Abuse Treatment and Education (Ms Bush and Drs Davis and Kivlahan), the Mental Illness Research, Education, and Clinical Center (Drs Dobie and Kivlahan), and the Departments of Medicine (Drs Bradley and Burman), Health Services (Drs Bradley and Maynard), and Psychiatry and Behavioral Sciences (Drs Dobie, Davis, and Kivlahan), University of Washington, Seattle.
Dr Burman died October 11, 2001.

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