Factor structure of the Alcohol Use Disorders Identification Test (AUDIT) in a mental health clinic sample.

Abstract

To examine the factor structure of the Alcohol Use Disorders Identification Test (AUDIT) and to identify the implications of this structure for its clinical use. Method: The AUDIT was administered to mental health clinic outpatients (N = 197; 86% men) at high risk for alcohol-use disorders. Confirmatory and exploratory factor analyses were used to determine the underlying factor structure of the AUDIT for this high-risk population. Results: Confirmatory analyses indicated that the a priori three-and one-factor solutions did not fit the observed data. The exploratory analyses supported a two-factor solution that included level of alcohol consumption and drinking problems, with both factors explaining substantial variance in AUDIT scores. These findings contrast the original three-factor design of the AUDIT and the conventional use of the AUDIT as a one-factor screening device with a single cutoff score. Conclusions: Other screening methods that incorporate this two-factor model may be important for mental health patient populations. Replication of these findings among other mental health samples is needed. (J. Stud. Alcohol 61:751-758, 2000) HE Alcohol Use Disorders Identification Test (AUDIT) (Babor et al., 1992) contains 10 items created to tap multiple domains associated with problematic alcohol use. Items were selected for inclusion on the basis of face validity, factor analysis and empirical reliability criteria to measure four areas related to alcohol use. The four areas (see Appendix) are: alcohol consumption (Items 1-3), alcohol drinking behaviors that are symptoms of dependence (Items 4-6), adverse psychological reactions to alcohol use (Items 7, 8) and alcohol-related problems (Items 9, 10) (Saunders et al., 1993). The latter two constructs, adverse psychological reactions and alcohol problems, were combined into a single alcohol-related problems construct, apparently to conform the AUDIT to the World Health Organization and ICD-10 concepts of hazardous use, dependence and harmful use (Saunders et al., 1993). It is, therefore, conventionally thought that the AUDIT measures the three domains of alcohol consumption, dependence and alcohol-related problems. However, studies of the empirical validity of this three-factor model in clinical populations are rare. A recent literature review of the utility of the AUDIT called for factor analysis of the instrument to evaluate whether the test items reflect the originally intended constructs (Allen et al., 1997).

Treatment May Influence Self-Report and Jeopardize Our Understanding of Outcome

“…also was used separately to assess whether the respondent drank or did not drink at all during the 6-month pre-conviction period. There are three subscale scores that can be derived from the AUDIT items-alcohol consumption (Items 1-3), drinking behavior related to dependence (Items 4-6), and alcohol-related problems (Items 7-10) (Karno et al, 2000). The total and subscale scores are used in the analysis.…”

Gender differences in the factor structure of the Alcohol Use Disorders Identification Test in multinational general population surveys

“…The majority of studies to date support a two-factor model, with Items 1–3 loading on factor one (generally labeled “alcohol consumption”) and Items 4–10 loading on factor two (labeled “alcohol-related problems”; Maisto et al, 2000; Medina-Mora, 1998; O’Hare and Sherrer, 1999; Smith et al, 2010). Other researchers who compared one-, two-, and three-factor structures have concluded that the two-factor solution was superior to the one- or three-factor solutions (Bergman and Kallmen, 2002; Chung et al, 2002; Karno et al, 2000; Kelly and Donovan, 2001; Lima et al, 2005; Shields et al, 2004). Gmel, however, proposed a four-factor solution in a study that used CFA with a modified version of the AUDIT (Gmel et al, 2001).…”

Factor structure and validity of the Alcohol Use Disorders Identification Test (AUDIT) in a sample of mentally disordered offenders

“…However, they may also suggest, in line with the contention by several authors (e.g. Allen, Litten, Fertig, & Babor, 1997;Karno et al, 2000), that a better understanding of the factor structure of the AUDIT can only be reached by carefully considering the method of factor analysis and the specific characteristics of the sample involved (e.g. severity of alcohol problems, gender and culture).…”

“…Overall, they concluded that, despite evidence supporting both a two and three-factor solution, the two-factor solution (alcohol consumption: items 1-3 and alcohol-related consequences: items 4-10) was 'distinct and more parsimonious' (p. 477). Likewise, a number of other studies have concluded that, whilst a three-factor solution is a good fit, a two-factor solution again is more parsimonious (Chung, Colby, Barnett, & Monti, 2002;Karno et al, 2000;Kelly & Donovan, 2001;Lima et al, 2005;Maisto et al, 2000;Medina-Mora et al, 1998;O'Hare & Sherrer, 1999;Shevlin & Smith, 2007;Shields et al, 2004). Thus, the weight of evidence, to date, appears to support a two-factor solution across a diverse range of sample groups.…”