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. 2023 May 2;13(5):e068619.
doi: 10.1136/bmjopen-2022-068619.

Calibrating the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) for detecting alcohol-related problems among Canadian, UK and US soldiers: cross-sectional pre-deployment and post-deployment survey results

Farifteh Firoozmand Duffy  1   2 , Kerry Sudom  3 , Margaret Jones  4 , Nicola T Fear  4   5 , Neil Greenberg  4 , Amy B Adler  6 , Charles W Hoge  6 , Joshua E Wilk  6 , Lyndon A Riviere  6
Affiliations

Calibrating the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) for detecting alcohol-related problems among Canadian, UK and US soldiers: cross-sectional pre-deployment and post-deployment survey results

Farifteh Firoozmand Duffy et al. BMJ Open. .

Abstract

Objectives: Excessive alcohol use can bring about adverse health and work-related consequences in civilian and military populations. Screening for excessive drinking can help identify individuals at risk for alcohol-related problems who may require clinical interventions. The brief validated measures of alcohol use such as the Alcohol Use Disorders Identification Test (AUDIT), or abbreviated AUDIT-Consumption (AUDIT-C), are often included in military deployment screening and epidemiologic surveys, but appropriate cut-points must be used to effectively identify individuals at risk. Although the conventional AUDIT-C cut-points ≥4 for men and ≥3 for women are commonly used, recent validation studies of veterans and civilians recommend higher cut-points to minimise misclassification and overestimation of alcohol-related problems. This study aims to ascertain optimal AUDIT-C cut-points for detecting alcohol-related problems among serving Canadian, UK and US soldiers.

Design: Cross-sectional pre/post-deployment survey data were used.

Settings: Comprised Army locations in Canada and UK, and selected US Army units.

Participants: Included soldiers in each of the above-mentioned settings.

Outcome measures: Soldiers' AUDIT scores for hazardous and harmful alcohol use or high levels of alcohol problems served as a benchmark against which optimal sex-specific AUDIT-C cut-points were assessed.

Results: Across the three-nation samples, AUDIT-C cut-points of ≥6/7 for men and ≥5/6 for women performed well in detecting hazardous and harmful alcohol use and provided comparable prevalence estimates to AUDIT scores ≥8 for men and ≥7 for women. The AUDIT-C cut-point ≥8/9 for both men and women performed fair-to-good when benchmarked against AUDIT ≥16, although inflated AUDIT-C-derived prevalence estimates and low positive predictive values were observed.

Conclusion: This multi-national study provides valuable information regarding appropriate AUDIT-C cut-points for detecting hazardous and harmful alcohol use, and high levels of alcohol problems among soldiers. Such information can be useful for population surveillance, pre-deployment/post-deployment screening of military personnel, and clinical practice.

Keywords: alcohol use disorders identification test; epidemiology; mental health; patient reported outcome measures; substance misuse.

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Conflict of interest statement

Competing interests: NTF is a trustee (unpaid) of Help for Heros and is a specialist advisor to the Advisory Group for Data (for NHS England). Materials for this study has been reviewed by the Walter Reed Army Institute of Research, and the Surgeon General Health Research Program of Canada. This research has been coordinated by the DND/CAF Social Science Research Review Board. There is no objection to its presentation and/or publication. The opinions or assertions contained herein are the private views of the authors, and are not to be construed as official, or as reflecting true views of the Department of the Army or the Department of Defense. The investigators have adhered to the policies for protection of human subjects as prescribed in AR 70–25.

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