Alcohol screening in young persons attending a sexually transmitted disease clinic

Abstract

OBJECTIVE:To compare the ability of 3 brief alcohol screens (Alcohol Use Disorders Identification Test [AUDIT], CRAFFT, and CAGE) to identify adolescents and young adults with a current alcohol use disorder (AUD) and to determine whether there are gender-based or race-based differences in screening performance. DESIGN, PARTICIPANTS, AND SETTING:Cross-sectional study of 358 young persons (55% males; 49% blacks; age range, 15-24 years; mean age, 20.6 years) who were attending an urban clinic for sexually transmitted diseases and reported alcohol use during the past year. MEASUREMENTS:Receiver operating characteristic (ROC) curve analysis was used to determine the ability of the 3 screens to discriminate between participants with and without AUDs detected in the Structured Clinical Interview for DSM-IV (SCID). RESULTS:One third (33%) of participants met Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria for a current AUD (24% with alcohol abuse and 9% with alcohol dependence). The AUDIT performed best at a cut score of 9 (sensitivity, 0.76; specificity, 0.79), CRAFFT at a cut score of 2 (sensitivity, 0.94; specificity, 0.33), and CAGE at a cut score of 1 (sensitivity, 0.69; specificity, 0.63). The AUDIT had the best overall performance (area under the curve [AUC], 0.84), followed closely by CRAFFT (AUC, 0.79) and then CAGE (AUC, 0.70). Performance of screens did not differ by gender. The AUDIT performed slightly better in whites than blacks, but no racebased differences were observed for the CAGE or CRAFFT.CONCLUSIONS: Clinicians should use the AUDIT or CRAFFT, rather than the CAGE, to screen young persons for AUDs. The AUDIT performs best, but its length may limit its utility in this setting. The CRAFFT is a suitable alternative, with excellent sensitivity and no gender-based or race-based differences.

Padrão de consumo de álcool e fatores associados entre adolescentes estudantes de escolas públicas em município do interior brasileiro

“…REV BRAS EPIDEMIOL JAN-MAR 2015; 18(1): [13][14][15][16][17][18][19][20][21][22][23][24] No significant differences among analyzed variables from students of peripheral and central schools were found (data not shown), and for this they formed the urban group [n = 557; 306/555 (55.1%) girls; two students did not inform their gender]; sociodemographic characteristics are described in Table 1. In total, 1,012 (61.3%) of the invited students did not participate in the study by reason of not bringing the signed informed consent form, absence to classes in days of questionnaire administration, and one student was not authorized by the mother.…”

“…AUDIT was developed by the World Health Organization (WHO), consists of 10 questions, and classifies individuals as to alcohol use in low risk or abstinence (score 0 -7), risk consumption (score 8 -15), harmful consumption (score 16 -19), and probable alcohol dependence (score ≥ 20) 18 . This tool has been validated for the Brazilian population 19 and has good sensitivity (0.76) and specificity (0.79) for the identification of risk consumption (score ≥ 8) among adolescents 20 . The questionnaires were applied by one of the authors (TGR), and students had privacy for filling the questionnaire and took on average 20 minutes for this.…”

“…REV BRAS EPIDEMIOL JAN-MAR 2015; 18(1): [13][14][15][16][17][18][19][20][21][22][23][24] The questionnaire Alcohol Use Disorders Identification Test (AUDIT) -also self-administered -was used to assess alcohol consumption in the past 12 months. AUDIT was developed by the World Health Organization (WHO), consists of 10 questions, and classifies individuals as to alcohol use in low risk or abstinence (score 0 -7), risk consumption (score 8 -15), harmful consumption (score 16 -19), and probable alcohol dependence (score ≥ 20) 18 .…”

Screening and Brief Intervention for Underage Drinkers

“…At a threshold score of 2 of 6, some studies have found that CRAFFT has acceptable sensitivity and specificity for identifying adolescents likely to have AUDs or other substance use disorders (eg, sensitivity, 0.80; specificity, 0.86; positive predictive value, 0.53; and negative predictive value, 0.96). 10 However, other studies have found that CRAFFT has poor specificity (0.33 in the study by Cook et al 12 and 0.44 in the study by Kelly et al 13 ). The advantages of CRAFFT include a broadened screening focus to the inclusion of "drugs," the interview format, and simple response options (yes or no).…”

“…15 Studies of older adolescents (ie, >18 years) have found that a threshold score of 8 has yielded acceptable results on both sensitivity and specificity. 12,13 We recommend a threshold of 3 to maximize sensitivity of the scale for use in adolescents younger than 18 years. For those aged 18 through 20 years, a threshold of 8 is recommended.…”