Association of Alcohol Screening Scores With Adverse Mental Health Conditions and Substance Use Among US Adults

Abstract

IMPORTANCE Alcohol screening may be associated with health outcomes that cluster with alcohol use (ie, alcohol-clustering conditions), including depression, anxiety, and use of tobacco, marijuana, and illicit drugs. OBJECTIVE To quantify the extent to which alcohol screening provides additional information regarding alcohol-clustering conditions and to compare 2 alcohol use screening tools commonly used for this purpose. DESIGN, SETTING, AND PARTICIPANTS This longitudinal cohort study used data from the Veterans Aging Cohort Study. Data were collected at 8 Veterans Health Administration facilities from 2003 through 2012. A total of 7510 participants were enrolled, completed a baseline survey, and were followed up. Veterans with HIV were matched with controls without HIV by age, race, sex, and site of care. Data were analyzed from January 2019 to December 2019. EXPOSURES The Alcohol Use Disorders Identification Test (AUDIT) and Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) were used to assess alcohol use, with 4 risk groups delineated for each test: score 0 to 7 (reference), score 8 to 15, score 16 to 19, and score 20 to 40 (maximum score) for the full AUDIT and score 0 to 3 (reference), score 4 to 5, score 6 to 7, and score 8 to 12 (maximum score) for the AUDIT-C. MAIN OUTCOMES AND MEASURES Alcohol-clustering conditions, including self-reported symptoms of depression and anxiety and use of tobacco, marijuana, cocaine, other stimulants, opioids, and injection drugs. RESULTS A total of 6431 US patients (6104 [95%] men; median age during survey years 2003-2004, 50 years [range, 28-86 years; interquartile range, 44-55 years]) receiving care in the Veterans Health Administration completed 1 or more follow-up surveys when the AUDIT was administered and were included in the present analyses. Of the male participants, 4271 (66%) were African American, 1498 (24%) were white, and 590 (9%) were Hispanic. The AUDIT and AUDIT-C scores were associated with each alcohol-clustering condition. In particular, an AUDIT score of 20 or higher

Does Reducing Drinking in Patients with Unhealthy Alcohol Use Improve Pain Interference, Use of Other Substances, and Psychiatric Symptoms?

“…Pain interference and anxiety symptoms were both assessed using single‐item screening tools. This exposure and outcome measurement error and misclassification could be differential or non‐differential, though these measures are widely used (Becker et al, 2009; Edelman et al, 2020; Khan et al, 2020; Novak et al, 2009). Second, our analyses dichotomized unhealthy alcohol use and co‐occurring conditions based on clinically relevant but somewhat arbitrary cut‐points.…”

“…Each item is scored from 0 to 4 for a total score ranging from 0 to 40. Those reporting no alcohol use in the past year are given a score of 0 on all items with the exception of items 9 and 10, which are not restricted to the past year, and those with missing AUDIT items who report never drinking are given a score of 0 (Khan et al, 2020). The World Health Organization guidelines consider AUDIT scores ≥ 8 consistent with at‐risk, hazardous, or harmful drinking (which we considered consistent with “unhealthy alcohol use” (Saitz, 2005)) and scores < 8 consistent with low‐risk drinking and/or abstinence (World Health Organization, 2001).…”

“…At each survey, individuals were asked about their substance use over the past‐year, including use of cannabis, crack/cocaine, other stimulants (e.g., amphetamine), heroin, and prescription opioids (e.g., Oxycontin, Vicodin, Percocet). We defined self‐reported illicit opioid use as non‐medical use of prescription opioids or heroin use (Edelman et al, 2020; Khan et al, 2020).…”

“…At the next follow‐up visit (1‐year postbaseline), individuals with an AUDIT score < 8 were classified as reducing drinking and individuals with an AUDIT score ≥ 8 were classified as not reducing drinking. Individuals who were missing AUDIT items 9 and/or 10 but reported no drinking in the past year and individuals who were missing 1 AUDIT item but the sum of the remaining 9 AUDIT items was less than or equal to 3 were also classified as having an AUDIT score less than 8 (Khan et al, 2020). Individuals who had a missing AUDIT score at the next follow‐up visit or who did not attend the next follow‐up visit were classified as having an unknown drinking reduction status.…”

“…Potential advantages of integrated screening and treatment include economies of scope (i.e., leveraging an existing screening infrastructure for a new screening target may reduce cost), and patient‐centeredness (i.e., fewer distinct clinic visits at separate sites and times). Screening for one condition might provide incidental information regarding a second condition, because the conditions co‐occur and/or because the screening test for the first condition has unrecognized diagnostic value for the second condition (Khan et al, 2020). Similarly, treating one condition might treat a second condition because resolution of the first condition may have an incidental “spillover” effect on the co‐occurrence of the second condition and/or because the treatment is effective against both conditions.…”