Technische Universtität Dresden, Institute of Clinical Psychology and Psychotherapy, Chemnitzer Str. 46, 01187 Dresden, Germany.
Technische Universtität Dresden, Institute of Clinical Psychology and Psychotherapy, Chemnitzer Str. 46, 01187 Dresden, Germany.
J Subst Abuse Treat. 2018 Mar;86:94-101. doi: 10.1016/j.jsat.2017.12.011. Epub 2017 Dec 27.
Alcohol consumption is pivotal for the subsequent development of alcohol use disorders (AUD). The Alcohol Use Disorders Identification Test (AUDIT) is a recommended AUD screening tool for prevention and primary care settings. The objectives of this study were to test how many participants with heavy drinking are unidentified by the AUDIT, if proportions of unidentified participants vary over time, and whether this unidentified risk group (URG) was clinically relevant in terms of drinking behavior reports and AUD risk factors, as well as future adverse outcomes, such as craving, dependence symptoms, or depression.
Our prospective cohort study followed 164 German males aged 18-19years without an alcohol dependence diagnosis over 24months. Only men were included due to higher AUD prevalence and gender-specific differences in metabolism, drinking patterns, and progression to AUD. All participants were screened via telephone interview and answered questionnaires both in person and via internet. Heavy drinking was classified using the AUDIT consumption score (AUDIT-C≥4.50). Standardized AUD diagnoses and symptoms, as well as alcohol use-related outcome criteria were assessed via standardized Composite International Diagnostic Interview (CIDI), and self-report questionnaires.
One in four participants (22-28% across all four follow-ups) reported heavy drinking but was unidentified by AUDIT total score (i.e. score<8), thus qualifying for URG status. The URG status did not fluctuate considerably across follow-ups (repeated-measures ANOVA, p=0.293). URG participants identified at the six-month follow-up did not generally differ from participants without URG status in terms of AUD family history or temperament (multivariate ANOVA, p=0.114), except for anxiety sensitivity (p<0.001). After two years, URG participants reported a similar level of adverse outcomes compared to low-risk participants (multivariate ANOVA, p=0.438), but less alcohol-related problems and less loss of control due to craving compared to high-risk participants (p≤0.007).
Despite the considerable number of heavy-drinking individuals unidentified by AUDIT total scores, an additional classification according to AUDIT-C values did not prove useful. Combining AUDIT and AUDIT-C scores might not be sufficient for identifying AUD risk groups among young adult German males. There is an urgent need for a replication of our findings among female participants.
饮酒是随后发生酒精使用障碍（AUD）的关键因素。《酒精使用障碍识别测试》（AUDIT）是预防和初级保健环境中推荐的 AUD 筛查工具。本研究的目的是检验 AUDIT 未识别出的重度饮酒者的数量，以及未识别参与者的比例是否随时间变化，以及这个未识别的风险群体（URG）在饮酒行为报告和 AUD 风险因素以及未来的不良后果（如渴望、依赖症状或抑郁）方面是否具有临床意义。
我们的前瞻性队列研究对 164 名年龄在 18-19 岁之间、无酒精依赖诊断的德国男性进行了 24 个月的随访。仅纳入男性是因为 AUD 的患病率更高，以及在代谢、饮酒模式和进展为 AUD 方面存在性别特异性差异。所有参与者都通过电话访谈进行筛查，并亲自和通过互联网回答问卷。重度饮酒是通过 AUDIT 消费评分（AUDIT-C≥4.50）来分类的。通过标准化的复合国际诊断访谈（CIDI）和自我报告问卷评估标准的 AUD 诊断和症状，以及与酒精使用相关的结果标准。
四分之一的参与者（所有四次随访中为 22-28%）报告了重度饮酒，但 AUDIT 总分（即得分<8）未识别，因此符合 URG 状态。URG 状态在随访中没有明显波动（重复测量方差分析，p=0.293）。在六个月的随访中确定的 URG 参与者在 AUD 家族史或气质方面与没有 URG 状态的参与者没有明显差异（多元方差分析，p=0.114），但焦虑敏感度除外（p<0.001）。两年后，URG 参与者报告的不良后果水平与低风险参与者相似（多元方差分析，p=0.438），但与高风险参与者相比，URG 参与者报告的酒精相关问题和渴望导致的失控较少（p≤0.007）。
尽管 AUDIT 总分未能识别出相当数量的重度饮酒者，但根据 AUDIT-C 值进行额外分类并没有证明有用。将 AUDIT 和 AUDIT-C 评分结合起来可能不足以识别德国年轻男性的 AUD 风险群体。迫切需要在女性参与者中复制我们的发现。
