Validation of screening instruments for alcohol and substance use disorders among men and women in Eastern Cape, South Africa

Affiliations

¹ Psychiatry Department, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: Melissaann.stockton@pennmedicine.upenn.edu.
² Research Unit, Foundation for Professional Development, Buffalo City Metro, Eastern Cape Province, South Africa; University of California Global Health Institute, University of California, San Francisco, USA; Buffalo City Metro Health District, Eastern Cape Provincial Department of Health, Bisho, South Africa.
³ The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.
⁴ Buffalo City Health District, Eastern Cape Provincial Department of Health, Bisho, Eastern Cape, South Africa.
⁵ New York State Psychiatric Institute, New York, USA; Columbia University Vagelos College of Physicians and Surgeons, Department of Psychiatry, New York, USA.
⁶ Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA; Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York, USA.
⁷ Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA.
⁸ Department of Global Health, Boston University School of Public Health, Boston, MA, USA.
⁹ University of Pretoria, Faculty of Medicine, School of Health Systems and Public Health, Pretoria, South Africa.
¹⁰ Psychiatry Department, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.
¹¹ Buffalo City Health District, Eastern Cape Provincial Department of Health, Bisho, Eastern Cape, South Africa; Columbia University Vagelos College of Physicians and Surgeons, Department of Psychiatry, New York, USA.

PMID: 39893853
PMCID: PMC11897658 (available on 2026-03-01)
DOI: 10.1016/j.drugalcdep.2025.112559

Validation of screening instruments for alcohol and substance use disorders among men and women in Eastern Cape, South Africa

Melissa A Stockton et al. Drug Alcohol Depend. 2025.

. 2025 Mar 1:268:112559.

doi: 10.1016/j.drugalcdep.2025.112559. Epub 2025 Jan 22.

Authors

Affiliations

¹ Psychiatry Department, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: Melissaann.stockton@pennmedicine.upenn.edu.
² Research Unit, Foundation for Professional Development, Buffalo City Metro, Eastern Cape Province, South Africa; University of California Global Health Institute, University of California, San Francisco, USA; Buffalo City Metro Health District, Eastern Cape Provincial Department of Health, Bisho, South Africa.
³ The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.
⁴ Buffalo City Health District, Eastern Cape Provincial Department of Health, Bisho, Eastern Cape, South Africa.
⁵ New York State Psychiatric Institute, New York, USA; Columbia University Vagelos College of Physicians and Surgeons, Department of Psychiatry, New York, USA.
⁶ Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA; Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York, USA.
⁷ Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA.
⁸ Department of Global Health, Boston University School of Public Health, Boston, MA, USA.
⁹ University of Pretoria, Faculty of Medicine, School of Health Systems and Public Health, Pretoria, South Africa.
¹⁰ Psychiatry Department, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.
¹¹ Buffalo City Health District, Eastern Cape Provincial Department of Health, Bisho, Eastern Cape, South Africa; Columbia University Vagelos College of Physicians and Surgeons, Department of Psychiatry, New York, USA.

PMID: 39893853
PMCID: PMC11897658 (available on 2026-03-01)
DOI: 10.1016/j.drugalcdep.2025.112559

Abstract

Introduction: Valid Alcohol Use Disorder (AUD) and Substance Use Disorder (SUD) screeners are needed to identify and link people to services. We evaluated the performance of several AUD and SUD screeners in South Africa using the Mini International Neuropsychiatric Interview (MINI)-5 diagnostic gold standard.

Methods: Adults at primary and tertiary care facilities in Buffalo City Metro, South Africa, were screened by research assistants using the AUDIT and AUDIT-C (AUD), DAST-10 (SUD) and NIDA Quick Screen (AUD and SUD). Nurses administered the MINI-5 to identify AUD and SUD. We assessed the internal consistency, criterion validity, sensitivity and specificity of these tools, stratified by gender.

Results: Among 1885 participants, the prevalence of AUD and SUD were 9.5 % and 1.6 %, respectively. All tools demonstrated adequate internal consistency and criterion validity. A positive AUDIT screen (men: ≥8; women: ≥7) yielded sensitivity/specificity of 70.6/87.3 % (men: 78.7/82.6 %; women: 64.8/89.8 %). A positive AUDIT-C screen (men: ≥4; women: ≥3) yielded sensitivity/specificity of 66.1/82.0 % (men: 64.0/78.8 %; women: 67.6/81.3 %). Endorsing the NIDA alcohol use question yielded sensitivity/specificity of 71.1/68.1 % (men: 74.7/59.7 %; women: 68.6/72.5 %). Endorsing either NIDA substance use questions yielded sensitivity/specificity of 80.6/91.7 % (men: 80.8/89.0 %; women: 80.0/93.1 %). A DAST-10 cut-off of ≥ 3 yielded sensitivity/specificity of 71.0/96.0 % (men: 73.1/83.7 %; women 60.0/97.4 %).

Conclusions: The AUDIT and AUDIT-C performed similarly among men and women, although lower cut-offs may optimize performance among women. The low number of SUD cases hampered our ability to draw conclusions about the SUD screeners' performance.

Keywords: Alcohol use; Drug use; Identification; Screening; Substance use; Validation.

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Conflict of interest statement

Declaration of Competing Interest none

References

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Validation of screening instruments for alcohol and substance use disorders among men and women in Eastern Cape, South Africa

Affiliations

Validation of screening instruments for alcohol and substance use disorders among men and women in Eastern Cape, South Africa

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical