Validation of the MINI (DSM IV) Tool for the Assessment of Alcohol Dependence among Young People in Northern Tanzania Using the Alcohol Biomarker Phosphatidylethanol (PEth)

Abstract

The alcohol dependence section of the Mini International Neuropsychiatric Interview questionnaire (MINI) has not been evaluated in young Africans. We applied the MINI in a cross-sectional study of 202 alcohol users from northern-Tanzania, aged 18–24 years (103 male casual workers and 99 students), and validated it against phophatidylethanol (PEth) at a cut-off suggesting heavy chronic alcohol use (≥0.30 µmol/L). Blood was assayed for PEth (16:0/18:1-subform) by liquid chromatography-tandem mass spectrometry. The MINI dependence criteria (≥3 positive responses) were met by 39% participants although their PEth levels were low. Contrary, many young people with high PEth levels were not classified as dependent. The sensitivity of the MINI ranged from 0% to 69% (female students and male workers, respectively) and specificity from 52% to 85% (workers and female students, respectively). The highest AUROC (0.68) occurred with a cut-off of ≥4 positive responses. A modified MINI with three affirmative responses to five questions increased specificity to 92%–97%; however, sensitivity remained low. The performance of the MINI in detecting dependence among young people from northern-Tanzania is unsatisfactory. Specificity was improved using a modified version but sensitivity remained low. An accurate tool for the diagnosis of alcohol dependence is needed for epidemiological and clinical purposes.

Comparing Alcohol Use Disorders Identification Test (AUDIT) with Timeline Follow Back (TLFB), DSM-5 and Phosphatidylethanol (PEth) for the assessment of alcohol misuse among young people in Ugandan fishing communities

“…The 30-day-AUDIT and 12-months-AUDIT tools are sensitive tools for screening and monitoring for problem drinking among young people in fishing communities and will be useful for evaluation of tailored interventions in this sub-population, as well as in general population settings (Francis, Helander, et al, 2015). Furthermore, the AUC for 30-day-AUDIT and 12-months-AUDIT when compared to each of the other tools are all high with the lower bound of the 95% CIs generally greater than 0.7, indicating that both self-reported AUDIT scales had good discriminatory properties.…”

“…The new DSM-5 which was administered by trained psychiatric nurses classified nearly all participants who self-reported any alcohol use as having AUD when applying the ≥2 symptoms criteria. Previous literature suggests that the low specificity compared to other tools may result from the two questions on alcohol tolerance and compulsion to drink (Francis, Helander, et al, 2015). These same concerns have been raised previously as a limitation to the use of the MINI/DSM-4, especially when administered to young people who may over-report problem drinking (Chung and Martin, 2005, Chung et al, 2005).…”

“…Each of the available tools has a unique profile of advantages, disadvantages, and threats to validity and reliability (Babor et al, 2001, Piasecki, 2019). For instance, while the Timeline Follow Back (TLFB) calendar method is used to identify heavy episodic drinking or binging, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) assesses symptoms of alcohol use disorder, both alcohol measurement tools and the framing of questions themselves are likely to influence the adequacy of survey measures of alcohol use (Francis et al, 2015, Greenfield and Kerr, 2008).…”

“…Standard alcohol consumption measures such as AUDIT were not designed for use in young people (Reinert and Allen, 2002, Reinert and Allen, 2007). Two recent studies, both among young people in Tanzania were the first to validate AUDIT, TLFB and MINI-DSM-4 against PEth (Francis et al, 2015, Francis et al, 2015), although the performance of the alcohol dependence section of DSM-4 when compared to PEth for detecting alcohol dependence was unsatisfactory (sensitivity 69%, specificity 85%) (Francis, Helander, et al, 2015). However, both the TLFB and the 12–months-AUDIT were strongly correlated with PEth and were sensitive markers to detect alcohol misuse based on PEth in the same population (sensitivity TLFB 96.0%; AUDIT 100%) (Francis, Weiss, et al, 2015).…”

Longitudinal analysis of alcohol use and intimate partner violence perpetration among men with HIV in northern Vietnam

“…To capture patterns of severity of hazardous alcohol use, AUD was measured using the Mini International Neuropsychiatric Interview questionnaire (MINI) Diagnostic and Statistical Manual of Mental Health Disorders, 4th edition (DSM IV) tool (Francis et al, 2015). The MINI consists of a set of items that measures alcohol dependence and a set of items that measures alcohol abuse, which are defined by level of drinking and mental or physical harm due to drinking (B abor et al, 2001).…”