Donovan - REVISED - Clinical Correlates of the AUDIT in an Outpatient Treatment

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Donovan - REVISED - Clinical Correlates of the AUDIT in an Outpatient Treatment

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ƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒƒClinical Correlates of the AUDIT in an Outpatient Alcohol Treatment Population1 1 2 3Dennis M. Donovan , Daniel R. Kivlahan , Richard Longabaugh , and Shelly S. Greenfield1 2 3University of Washington, Brown University, and Harvard UniversityPercent of Subjects within Each AUDIT Zone Positive RESULTSfor Tolerance or WithdrawalABSTRACTDemographics2 2χ = 31.23, p < .001 χ = 57.75, p < .001We evaluated the concurrent validity of “zones” of total scores for the Zone 4 subjects significantly younger and less well educatedAlcohol Use Disorders Identification Test (AUDIT) at baseline among 100%No differences across zones in minority status or genderoutpatients randomized to treatment conditions in the COMBINE 90%study. Subjects (942 males, 426 females) were categorized into one Zone 4 subjects less likely to be employed full time or to be inof 3 AUDIT zones (AUDIT total score = 8-15,16-19, 20-40) and higher income brackets80%compared for differences in concurrent measures of demographics,Dependence-Related VariablesAlcohol Dependence Scale, DrInC, OCDS, SCID alcohol dependence 70%symptoms, GGT, % CDT, and categorical measures of physiological Zone 4 subjects more likely to experience physiological 60%dependence, tolerance, and withdrawal. MANOVA and chi square dependence, tolerance, and withdrawalindicated significant increasing linear trends across AUDIT zones. Threshold50%Zone 4 ...

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Nombre de lectures	13
Langue	English

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Clinical Correlates of the AUDIT in an Outpatient Alcohol Treatment Population

Dennis M. Donovan

, Daniel R. Kivlahan

, Richard Longabaugh

, and

Shelly S. Greenfield

University of Washington,

Brown University, and

Harvard University

ABSTRACT

We evaluated the concurrent validity of “zones” of total scores for the

Alcohol Use Disorders Identification Test (AUDIT) at baseline among

outpatients randomized to treatment conditions in the COMBINE

study.

Subjects (942 males, 426 females) were categorized into one

of 3 AUDIT zones (AUDIT total score = 8-15,16-19, 20-40) and

compared for differences in concurrent measures of demographics,

Alcohol Dependence Scale, DrInC, OCDS, SCID alcohol dependence

symptoms, GGT, % CDT, and categorical measures of physiological

dependence, tolerance, and withdrawal. MANOVA and chi square

indicated significant increasing linear trends across AUDIT zones.

These results suggest that the AUDIT is a marker of severity of

dependence in a clinical sample seeking outpatient treatment and

warrants further investigation as a possible brief outcome measure,

extending its potential utility beyond its current more traditional role as

a screening instrument.

BACKGROUND

The Alcohol Use Disorders Identification Test (AUDIT) is widely used

in various clinical settings as a screening measure for identifying

individuals with hazardous and/or harmful drinking patterns. The World

Health Organization has suggested 4 “zones” of AUDIT scores (0-7, 8-

15, 16-19, and 20-40) reflecting increasing risk levels. However, these

zones have not been empirically validated as a measure of severity in

a clinical population that has been diagnosed as alcohol dependent.

We evaluated the concurrent validity of the AUDIT zones among

participants in the COMBINE study, a multisite outpatient trial

evaluating the efficacy of combining pharmacotherapies and

behavioral interventions for alcohol dependence.

METHODS

AUDIT was completed during brief telephone screening

Baseline Battery

Alcohol Dependence Scale (ADS)

Drinkers’ Inventory of Consequences (DrInC)

Obsessive-Compulsive Drinking Scale (OCD)

Structured Clinical Interview for DSMIV Disorders (SCID)

(total symptoms, tolerance, withdrawal, or physiological

dependence)

% Carbohydrate deficient Tramsferrin (% CDT)

Gamma Glutamyltransferase (GGT)

Sample Characteristics

Excluded: 2 participants with AUDIT < 8

Participants (942 males, 426 females)

Gender: 69.0% Male

Age: M = 44.5

Years of Education:

M = 14.5

Ethnicity: Non-Hispanic White (76.8%)

Alcohol Problem Duration M = 13.8 Years

Prior Treatment for Alcohol Problem: 49.3%

Zone 2

Zone 3

Zone 4

Percent of Subjects Within Each AUDIT Zone Positive for

Physiological Dependence

Percent with Physiological Dependence

= 71.17, p < .001

Zone 2

Zone 3

Zone 4

= 53.21, p < .001

Percent with Prior Alcohol Treatment

Percent of Subjects Within Each AUDIT Zone with Any

Prior Alcohol Treatment

(8 – 15)

(16 – 19)

(20 – 40)

AUDIT Zones

RESULTS

Demographics

Zone 4 subjects significantly younger and less well educated

No differences across zones in minority status or gender

Zone 4 subjects less likely to be employed full time or to be in

higher income brackets

Dependence-Related Variables

Zone 4 subjects more likely to experience physiological

dependence, tolerance, and withdrawal

Zone 4 subjects significantly more likely to have prior

treatment for alcohol problems

Multivariate Analyses of Clinically Relevant Variables

Significant overall multivariate difference across zones

This multivariate difference remains even when age is

entered as a covariate

SUMMARY

Increasing scores on the AUDIT, as reflected in the zones suggested

by the WHO, are associated with higher rates of physiological

dependence, tolerance, withdrawal, and prior treatment for alcohol

problems

AUDIT Zones 2 through 4 are linearly associated with severity of

dependence, negative consequences, craving, and lab markers of

recent drinking (%CDT)

These results suggest that the AUDIT may serve as a marker of

alcohol dependence and severity of dependence, extending its

potential utility beyond its current more traditional role as a screening

instrument

Future research should test empirically derived and gender-specific

cutpoints for clinically meaningful “zones” and investigate the

sensitivity to change of the AUDIT score as a brief outcome measure

This research was supported in part by grant U10-AA11799

from the National Institute on Alcohol Abuse and Alcoholism

Variable

AUDIT

Total

Zone 2

(8-15)

N = 65

Zone 3

(16-19)

N = 144

Zone 4

(20-40)

N =1159

DrInC

.57

28.2

31.4

50.7

83.6

ADS

.59

8.9

11.7

17.7

73.3

SCI D Alcohol

Dependence Sx

.43

4.0

4.4

5.3

64. 8

CIWA-Ar

.16

1.3

2.0

8.2

OCDS

.41

19.4

22.2

27.6

49.7

%CDT

.11

2.7

4.2

GGT

.09

62.0

55.4

77.9

1.9

Comparison of AUDIT Zones on Drinking-Related

Variables

M ultivariate F = 16.73, df = 14/2320, p < .0001

p < .001

p < .025

D ifferences in colors reflect significant pairw ise differences

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Zone 2

Zone 3

Zone 4

Zone 2

Zone 3

Zone 4

Threshold

Subthreshold

Absent

Percent of Subjects

Percent of Subjects within Each AUDIT Zone Positive

for

Tolerance or Withdrawal

SCID Tolerance

SCID Withdrawal

= 31.23, p < .001

= 57.75, p < .001

Study Limitations

Selection bias based on inclusion/exclusion criteria for

efficacy

trial

All measures cross-sectional

No evaluation of the reliability of clinical diagnosis based on

SCID

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