The Value of CAGE, CUGE, and AUDIT in Screening for Alcohol Abuse and Dependence Among College Freshmen

Addictions, Social Deprivation and Cessation Failure in Head and Neck Squamous Cell Carcinoma Survivors

AIM

To evaluate the evolution of addictions (tobacco and alcohol) and social precarity in head and neck squamous cell carcinoma survivors when these factors are addressed from the time of diagnosis.

METHODS

Addictions and social precarity in patients with a new diagnosis of HNSCC were assessed through the EPICES score, the Fagerström score, and the CAGE questionnaire. When identified as precarious/dependent, patients were referred to relevant addiction/social services.

RESULTS

One hundred and eighty-two patients were included. At the time of diagnosis, an active tobacco consumption was associated with alcohol drinking (Fisher's exact test, p < 0.001). Active smokers were more socially deprived (mean EPICES score = mES = 36.2 [±22.1]) than former smokers (mES = 22.8 [±17.8]) and never smokers (mES = 18.9 [±14.5]; Kruskal-Wallis, p < 0.001). The EPICES score was correlated to the Fagerström score (Kruskal-Wallis, p < 0.001). Active drinkers (mES = 34.1 [±21.9]) and former drinkers (mES = 32.7 [±21]) were more likely to be socially deprived than those who never drank (mES = 20.8 [±17.1]; Krukal-Wallis, p < 0.001). A Fagerström score improvement at one year was associated to a CAGE score improvement (Fisher's exact test, p < 0.001). Tobacco and alcohol consumption were more than halved one year after treatment. Patients who continued to smoke one year after diagnosis were significantly more likely to continue to drink (Fisher's exact test, p < 0.001) and had a significantly higher initial EPICES score (Kruskal-Wallis, p < 0.001).

CONCLUSIONS

At one year, addictions and social deprivation tend to improve when taken care of from the diagnosis. The most dependent patients and those with multiple frailties are at highest risk of cessation failure.

Mindfulness facets, self-compassion, and drinking to cope: How do associations differ by gender in undergraduates with harmful alcohol consumption?

Objective: Undergraduate students show high rates of harmful alcohol consumption, and coping-motivated use has been consistently shown to be the most problematic. The present study examines associations between mindfulness facets, self-compassion, and coping-motivated use, and how these associations differ by gender. Participants and Methods: Undergraduate students reporting harmful alcohol consumption (N = 146; 55.5% women) completed self-report measures assessing their dispositional mindfulness facets, self-compassion, and drinking motives. Results: Regression analyses revealed that for both genders, mindfulness facets and self-compassion were negatively associated with drinking to cope with depression, but not anxiety. Non-judging was uniquely negatively associated with drinking to cope with depression in women, but in men, non-reactivity was the sole unique association. Conclusions: Future research should investigate whether mindfulness and self-compassion training for undergraduates with harmful alcohol consumption is more effective if they target students who drink to cope with depression and emphasize different skills depending on the student's gender.

Alcohol-Related Behaviour in Freshmen University Students in Sardinia, Italy

This study aims to provide a picture of University of Cagliari students’ alcohol-related behaviour and to explore factors associated with it. Data were collected by administering a questionnaire to 992 freshmen university students from different programs consisting of twelve closed questions, including three questions from the Alcohol Use Disorders Identification Test for Consumption (AUDIT-C short form). Three subgroups of alcohol-related behaviour were distinguished (risky drinkers, social drinkers and abstainers). In order to explore factors associated with patterns of alcohol consumption, a multivariate logistic regression was performed. The prevalence of risky drinkers was 35%. A binge-drinking behaviour at least once in the last twelve months was declared by 65% (more widespread in men and in students living away from their parents). Risky consumption is significantly associated with age of onset of alcohol use, living away from parents’ home, drinking outside meals and attending health courses. Regarding the levels of daily alcohol consumption perceived as a health risk, 66% of men and 88% of women indicate values higher than those recommended. The results underline the need for tailored prevention measures. University could be a promising setting to implement actions according to a health promotion perspective, to empower students to control their alcohol consumption.

Potential alcohol use disorder among MSM in Ireland - Findings from the European MSM internet survey (EMIS 2017)

BACKGROUND

Alcohol consumption is a major public health concern in Ireland. Alcohol use disorder (AUD) disproportionately affects men who have sex with men (MSM). However, little is known about the prevalence of AUD in this group in Ireland specifically, and the characteristics of MSM who may struggle with this.

METHODS

The European MSM Internet Survey 2017 was an online, self-completed, anonymous questionnaire among MSM in Ireland. Standardised questions were used to explore a variety of topics. The validated CAGE-4 questionnaire was used to screen for potential AUD, defined as a CAGE-4 score of ≥2 out of 4. Multivariable-adjusted logistic regression analysis was used to identify factors associated with potential AUD.

RESULTS

In total, 1793 MSM met inclusion criteria. 31 % screened positive for AUD. We observed higher odds of possible AUD among MSM who were bisexual (vs. gay/homosexual) (aOR 1.48 95 %CI 1.01-2.18), native to Ireland (vs. non-native) (aOR 1.49 95 %CI 1.12-1.96), unemployed (vs. employed) (aOR 1.80 95 %CI 1.02-3.16), had used illicit drugs in the previous year (vs. none) (cannabis only, aOR 1.74 95 %CI 1.14-2.63) (other illicit drugs, aOR 2.28 95 %CI 1.67-3.09), reported anxiety/depression (vs. none) (aOR 1.73 95 %CI 1.12-2.66), and MSM who experienced homophobic abuse (vs. never) (aOR 1.55 95 %CI 1.09-2.22). Student MSM were less likely to screen positive for AUD (vs. employed) (aOR 0.65 95 %CI 0.46-0.93).

CONCLUSIONS

The prevalence of AUD appears to be higher in the MSM population compared to the general male population in Ireland. Targeted interventions may be warranted to reduce the burden of AUD among MSM.

The Effects of Sleep Quality and Resilience on Perceived Stress, Dietary Behaviors, and Alcohol Misuse: A Mediation-Moderation Analysis of Higher Education Students from Asia, Europe, and North America during the COVID-19 Pandemic

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has increased the already high levels of stress that higher education students experience. Stress influences health behaviors, including those related to dietary behaviors, alcohol, and sleep; yet the effects of stress can be mitigated by resilience. To date, past research studying the connections between dietary behaviors, alcohol misuse, sleep, and resilience commonly investigated singular relationships between two of the constructs. The aim of the current study was to explore the relationships between these constructs in a more holistic manner using mediation and moderation analyses.

METHODS

Higher education students from China, Ireland, Malaysia, South Korea, Taiwan, the Netherlands, and the United States were enrolled in a cross-sectional study from April to May 2020, which was during the beginning of the COVID-19 pandemic for most participants. An online survey, using validated tools, was distributed to assess perceived stress, dietary behaviors, alcohol misuse, sleep quality and duration, and resilience.

RESULTS

2254 students completed the study. Results indicated that sleep quality mediated the relationship between perceived stress and dietary behaviors as well as the relationship between perceived stress and alcohol misuse. Further, increased resilience reduced the strength of the relationship between perceived stress and dietary behaviors but not alcohol misuse.

CONCLUSION

Based on these results, higher education students are likely to benefit from sleep education and resilience training, especially during stressful events.

Healthcare-related stigma among men who have sex with men and transgender women in sub-Saharan Africa participating in HIV Prevention Trials Network (HPTN) 075 study

ABSTRACT The inability to access health services when needed is a critical barrier to HIV prevention, treatment and care among men who have sex with men (MSM) and transgender women (TGW). Using data collected in HPTN 075, we explored factors associated with any experienced healthcare-related stigma. HPTN 075 was a cohort study to assess the feasibility of recruiting and retaining MSM and TGW in clinical trials in sub-Saharan Africa. Of 401 MSM and TGW enrolled at four sites (Kisumu, Kenya; Blantyre, Malawi; Cape Town, Soweto, South Africa) 397 contributed to the analysis (79.9% cis-gender and 20.1% TGW). Of these, (45.3%; 180/397) reported one or more of healthcare-related stigma experiences. Most frequently reported experiences included fear to seek healthcare services (36.3%) and avoiding seeking such services because of the discovery of MSM status (29.2%). Few men and TGW (2.5%) reported having been denied health services because of having sex with men. In multivariable analysis, more participants in Soweto [adjusted odds ratio (AOR) = 2.60] and fewer participants in Blantyre (AOR = 0.27) reported any healthcare-related stigma experiences, in comparison to participants in Kisumu. MSM and TGW that did not have a supportive gay community to rely on were more likely to report any healthcare-related stigma experiences (AOR = 1.46), whereas MSM and TGW who reported high social support and who never had engaged in transactional sex were less likely to report such experiences (AOR = 0.76 and AOR = 0.43, respectively). Our results suggest that encouraging support groups for MSM and TGW as well as training and sensitizing healthcare staff, and the general community, on MSM and TGW health issues and cultural competence may reduce stigma, improve access to healthcare, which could ultimately reduce HIV transmission.

Screening and brief interventions for adolescent alcohol use disorders presenting through emergency departments: a research programme including two RCTs

Background

Alcohol consumption and related harm increase steeply from the ages of 12–20 years. Adolescents in the UK are among the heaviest drinkers in Europe. Excessive drinking in adolescents is associated with increased risk of accidents, injuries, self-harm, unprotected or regretted sex, violence and disorder, poisoning and accidental death. However, there is lack of clear evidence for the most clinically effective and cost-effective screening and brief interventions for reducing or preventing alcohol consumption in adolescents attending emergency departments (EDs).

Objectives

To estimate the distribution of alcohol consumption, alcohol-related problems and alcohol use disorders in adolescents attending EDs; to develop age-appropriate alcohol screening and brief intervention tools; and to evaluate the clinical effectiveness and cost-effectiveness of these interventions.

Design

The research has been conducted in three linked stages: (1) a prevalence study, (2) intervention development and (3) two linked randomised controlled trials (RCTs).

Setting

Twelve EDs in England (London, North East, and Yorkshire and The Humber).

Participants

A total of 5376 participants in the prevalence study [mean age 13.0 years, standard deviation (SD) 2.0 years; 46.2% female] and 1640 participants in the two linked RCTs (mean age 15.6 years, SD 1.0 years; 50.7% female).

Interventions

Personalised feedback and brief advice (PFBA) and personalised feedback plus electronic brief intervention (eBI), compared with alcohol screening alone. These age-appropriate alcohol interventions were developed in collaboration with the target audience through a series of focus groups and evaluations during stage 2 of the research programme and following two literature reviews.

Main outcome measures

Total alcohol consumed in standard UK units (1 unit = 8 g of ethanol) over the previous 3 months at 12-month follow-up, assessed using the Alcohol Use Disorders Identification Test, Consumption (3 items) (AUDIT-C).

Results

In the prevalence study, 2112 participants (39.5%) reported having had a drink of alcohol that was more than a sip in their lifetime, with prevalence increasing steadily with age and reaching 89.5% at the age of 17 years. The prevalence of at-risk alcohol consumption was 15% [95% confidence interval (CI) 14% to 16%] and the optimum cut-off point of the AUDIT-C in identifying at-risk drinking was ≥ 3. Associations of alcohol consumption and early onset of drinking with poorer health and social functioning were also found. In the RCT, the analysis of the primary outcome (average weekly alcohol consumption at month 12) identified no significant differences in effect between the three groups in both trials. In the high-risk drinking trial, the mean difference compared with control was 0.57 (95% CI –0.36 to 1.70) for PFBA and 0.19 (95% CI –0.71 to 1.30) for eBI. In the low-risk drinking trial, the mean difference compared with control was 0.03 (95% CI –0.07 to 0.13) for PFBA and 0.01 (95% CI –0.10 to 0.11) for eBI. The health economic analysis showed that eBI and PFBA were not more cost-effective than screening alone.

Conclusions

The ED can offer an opportunity for the identification of at-risk alcohol use in adolescents. A simple, short, self-completed screening instrument, the AUDIT-C, is an effective tool for identifying adolescents who are at risk of alcohol-related problems. Associations of alcohol consumption and earlier onset of drinking with poorer health and social functioning were observed in the prevalence study. The trials were feasible to implement and exceeded the recruitment target and minimum follow-up rates. However, PFBA and eBI were not found to be more effective than screening alone in reducing or preventing alcohol consumption in 14- to 17-year-olds attending EDs.

Limitations and future work

Only one-third of participants engaged with the application program; this is likely to have limited the effect of the intervention. We recommend that future research should focus on methods to maximise engagement with digital interventions and evaluate the effect of such engagement on clinical outcomes.

Trial registration

Current Controlled Trials ISRCTN45300218.

Funding

This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 8, No. 2. See the NIHR Journals Library website for further project information.

Alcohol screening and assessment measures for young people: A systematic review and meta-analysis of validation studies

BACKGROUND

There is a strong rationale for clinicians to identify risky drinking among young people given the harms caused by alcohol. This systematic review evaluates the quality of evidence in the validation literature on alcohol screening and assessment measures for young people under 25.

METHODS

Six electronic databases (MEDLINE; EMBASE; PsycINFO; SSCI; HMIC; ADAI) were searched in May 2016 for published and grey literature. Full-text reports published in English since 1980 were included if they aimed to validate an alcohol screening or assessment measure in comparison with a previously validated alcohol measure. Risk of bias was assessed in studies surpassing a priori quality thresholds for predictive validity, internal and test-retest reliability using COSMIN and QUADAS-2.

RESULTS

Thirty nine reports comprising 135 discrete validation studies were included. Summary estimates indicated that the screening instruments performed well - AUC 0.91 (95% CI: 0.88 to 0.93); sensitivity 0.98 (0.95 to 0.99); specificity 0.78 (0.74 to 0.82). Noting a paucity of validation evidence for existing assessment instruments, aggregated reliability estimates suggest a reliability of 0.81 (0.78 to 0.83) adjusted for 10 items. Risk of bias was high for both types of studies.

CONCLUSIONS

The volume and quality of available evidence are superior for screening measures. It is recommended that clinicians use alcohol frequency or quantity items if asking a single question. If there is an opportunity to ask more questions either the 3-item AUDIT-C or the 10-item AUDIT are recommended. There is a need to develop new instruments to assess young people's alcohol-related problems.

Psychometric properties and factor structure of an Ecuadorian version of the Alcohol Use Disorders Identification Test (AUDIT) in college students

BACKGROUND

The Alcohol Use Disorders Identification Test (AUDIT) is the gold standard in assessing harmful alcohol intake, which is responsible for substantial morbidity and mortality.

OBJECTIVE

The goal of this study is to evaluate the psychometric properties and factor structure of an Ecuadorian adaptation of a Spanish translation of the AUDIT in a large sample of college students in Ecuador.

METHODS

A total of 7905 students, including 46.26% males, and 53.75% females, from 11 universities in Ecuador, were surveyed. The questionnaire was tested for two- and three-factor structures, reliability, and correlations with other health related measures.

RESULTS

The Kaiser-Meyer-Olkin test for sampling adequacy was satisfactory (.0885), and Bartlett´s test for sphericity was significant (p < .001). Although both models showed a good fit to the data, the two-factor model was preferred based on the high correlations between the factors 2 and 3 within the three-factor model (.86 for the total sample, .77 for females, and .91 for males). The reliability for the two-factor model was good, as indicated by Cronbach´s α = .806 (factor I) and .716 (factor II) for the total sample, .808 (factor I) and .667 (factor II) for females, and .787 (factor I) and .728 (factor II) for males. Additionally, the AUDIT scores positively correlated with several health-related measures: stress, psychological inflexibility, loneliness and depression/anxiety symptomatology.

CONCLUSION

The Ecuadorian adaptation of the Spanish version of the AUDIT has good reliability, and internal consistency and correlates with other health related measures, proving to be a reliable tool that can be used by researchers and clinicians to screen hazardous alcohol intake in college students.

Opportunistic screening for alcohol use problems in adolescents attending emergency departments: an evaluation of screening tools

Objective

To estimate and compare the optimal cut-off score of Alcohol Use Disorders Identification Test (AUDIT) and AUDIT-C in identifying at-risk alcohol consumption, heavy episodic alcohol use, ICD-10 alcohol abuse and alcohol dependence in adolescents attending ED in England.

Design

Opportunistic cross-sectional survey.

Setting

10 emergency departments across England.

Participants

Adolescents (n = 5377) aged between their 10th and 18th birthday who attended emergency departments between December 2012 and May 2013.

Measures

Scores on the AUDIT and AUDIT-C. At-risk alcohol consumption and monthly episodic alcohol consumption in the past 3 months were derived using the time-line follow back method. Alcohol abuse and alcohol dependence was assessed in accordance with ICD-10 criteria using the MINI-KID.

Findings

AUDIT-C with a score of 3 was more effective for at-risk alcohol use (AUC 0.81; sensitivity 87%, specificity 97%), heavy episodic use (0.84; 76%, 98%) and alcohol abuse (0.98; 91%, 90%). AUDIT with a score of 7 was more effective in identifying alcohol dependence (0.92; 96%, 94%).

Conclusions

The 3-item AUDIT-C is more effective than AUDIT in screening adolescents for at-risk alcohol use, heavy episodic alcohol use and alcohol abuse. AUDIT is more effective than AUDIT-C for the identification of alcohol dependence.

Profiles of adverse childhood experiences and impulsivity

The influence of adverse childhood experiences (ACEs), which often include childhood exposure to maltreatment and household dysfunction, on health risk behaviors during young adulthood has been widely documented. A vulnerability marker for the increased risky behaviors among young ACEs victims such as impulsivity remains to be explored. The present study investigated how different profiles of ACEs influence impulsivity in young adulthood. Respondents were young people (N = 336; ages 18-25) who were recruited from the community. Latent class analysis (LCA) was used to identify subpopulations of individuals based on varying exposure to 13 types of ACEs, including childhood maltreatment, household dysfunction, and community violence. Four distinct classes emerged: Low ACEs (56%), Household Dysfunction/Community Violence (14%), Emotional ACEs (14%), and High/Multiple ACEs (16%). Multiple regression analyses found that compared to those in the Low ACEs class, young adults in the Emotional ACEs and High/Multiple ACEs respectively, reported increased levels of negative urgency, controlling for sociodemographic characteristics and other impulsivity traits. This result suggests that childhood exposure to multiple ACEs at high levels is particularly related to impulsive self-control in the context of intense negative emotionality.

Validity of the AUDIT-C screen for at-risk drinking among students utilizing university primary care

OBJECTIVE

Research is needed to establish the psychometric properties of brief screens in university primary care settings. This study aimed to assess the construct validity of one such screen, the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), for detecting at-risk drinking among students who have utilized on-campus primary care.

PARTICIPANTS

389 students recently seen in university primary care completed a confidential online survey in December 2014.

METHODS

Bivariate correlations between the AUDIT-C and measures of alcohol consumption and negative drinking consequences provided concurrent evidence for construct validity. Receiver Operating Characteristic curve analyses determined optimal cut-off scores for at-risk drinking.

RESULTS

The AUDIT-C significantly correlated with measures of alcohol consumption and negative drinking consequences (p < .001). Analyses support optimal AUDIT-C cut-off scores of 5 for females and 7 for males.

CONCLUSIONS

The AUDIT-C is a valid screen for at-risk drinking among students who utilize university primary care.

AUDIT and AUDIT-C as screening instruments for alcohol problem use in adolescents

BACKGROUND

The Alcohol Use Disorders Identification Test (AUDIT) is commonly used in adults to screen for harmful alcohol consumption but few studies exist on its use among adolescents. Our aim was to validate the AUDIT and its derivative consumption questionnaire (AUDIT-C) as screening instruments for the detection of problem use of alcohol in adolescents.

METHODS

621 adolescents (age-range, 12-19 years) were drawn from clinical and population samples who completed the AUDIT questionnaire. Psychiatric diagnoses were assessed using K-SADS-PL. A rating based on the K-SADS-PL was used to assess alcohol use habits, alcohol use disorders, screening and symptom criteria questions. Screening performance of the AUDIT and AUDIT-C sum scores and Receiver Operating Characteristic (ROC) curves were calculated. The diagnostic odds ratios (dOR) were calculated to express the overall discrimination between cut-offs.

RESULTS

Comparisons of ROC between the AUDIT and AUDIT-C pairs indicated a slightly better test performance by AUDIT for the whole sample and in a proportion of the subsamples. Optimal cut-off value for the AUDIT was ≥5 (sensitivity 0.931, specificity 0.772, dOR 45.22; 95% CI: 24.72-83.57) for detecting alcohol problem use. The corresponding optimal cut-off value for the AUDIT-C was ≥3 in detecting alcohol problem use (sensitivity 0.952, specificity 0.663, dOR 39.31; 95% CI: 19.46-78.97). Agreement between the AUDIT and AUDIT-C using these cut-off scores was high at 91.9%.

CONCLUSIONS

Our results for the cut-off scores for the early detection of alcohol problem use in adolescents are ≥5 for AUDIT, and ≥3 for AUDIT-C.

Reasons for Utilizing Mental Health Services as Predictors of College Students' Alcohol Risk

The authors examined college student drinkers' (N = 153) reasons for seeking counseling services and risk for alcohol problems. Students seeking help for impulse- or anger-related issues and depression were at heightened risk for alcohol problems. Only 10% of students sought alcohol-related help despite high rates of hazardous alcohol use (80%) and dependence (39%). Targeted screening and intervention in college counseling centers may enable providers to effectively identify and treat students in need of alcohol treatment.

Both alcoholic and non-alcoholic steatohepatitis association with cardiovascular risk and liver fibrosis

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of liver disease worldwide. Mortality in NAFLD is mainly related to cardiovascular disease (CVD) and cancer. NAFLD and its association with both CVD and liver disease risk have been well evaluated, but the association of NAFLD with alcohol, known as "both alcoholic and non-alcoholic steatohepatitis" (BASH), remains uncertain. The objective of this study was to assess the influence of alcohol and obesity in the development of liver and cardiovascular disease risk.

METHODS

This was a case-control study that included patients from a regular check-up. Alcohol consumption was evaluated with MAST, AUDIT, and CAGE. Cardiovascular risk was evaluated using the Framingham score, and liver fibrosis was evaluated with APRI and NAFLD score. Patients were classified in five groups: healthy patients, steatosis with obesity, steatosis with alcoholism, BASH, and idiopathic steatosis.

RESULTS

A total of 414 patients were included. The BASH group represented 16% of patients, and showed a greater proportion of patients with high cardiovascular risk with 17% (p = 0.001), and liver fibrosis with 9%, according to the APRI score (p = 0.10). A multivariate logistic regression showed that alcohol consumption >140 g/week (OR 2.546, 95% CI 1.11-5.81, p = 0.003) and BMI >25 kg/m² (OR 12.64, 95% CI 1.66 96.20, p = 0.001) were related to high cardiovascular risk. Liver fibrosis according to APRI was only related to alcohol consumption >140 g/week (OR 2.74, 95% CI 1-7.48, p = 0.03).

CONCLUSIONS

BASH remains an area not well explored, and of great implication given the increasing number of patients affected. We observed an additive effect of both etiologies in the development of high cardiovascular and liver disease risk.

Tests of Theories of Crime in Female Prisoners

Several general theories of crime were tested with path models on 293 female prisoners in a U.S. State prison. The theories tested included Social Bond and Control, Thrill/Risk Seeking, and a new attachment-based Developmental Dynamic Systems model. A large battery of different instruments ranging from measures of risk taking, to a crime addiction scale, to Childhood Adverse Events, to attachments and clinical issues were used. The older general theories of crime did not hold up well under the rigor of path modeling. The new dynamic systems model was supported that incorporated adverse childhood events leading to (a) peer crime, (b) crime addiction, and (c) a measure derived from the Attachment and Clinical Issues Questionnaire (ACIQ) that takes individual differences in attachments and clinical issues into account. The results were discussed in terms of new approaches to Research Defined Criteria of Diagnosis (RDoC) and new approaches to intervention.

The latent structure of impulsivity: impulsive choice, impulsive action, and impulsive personality traits

RATIONALE

Impulsivity has been strongly linked to addictive behaviors, but can be operationalized in a number of ways that vary considerably in overlap, suggesting multidimensionality.

OBJECTIVE

This study tested the hypothesis that the latent structure among multiple measures of impulsivity would reflect the following three broad categories: impulsive choice, reflecting discounting of delayed rewards; impulsive action, reflecting ability to inhibit a prepotent motor response; and impulsive personality traits, reflecting self-reported attributions of self-regulatory capacity.

METHODS

The study used a cross-sectional confirmatory factor analysis of multiple impulsivity assessments. Participants were 1252 young adults (62 % female) with low levels of addictive behavior, who were assessed in individual laboratory rooms at the University of Chicago and the University of Georgia. The battery comprised a Delay (replace hyphen with space) Discounting Task, Monetary Choice Questionnaire, Conners' Continuous Performance Test, Go/NoGo Task, Stop Signal Task, Barratt Impulsiveness Scale, and the UPPS-P Impulsive Behavior Scale.

RESULTS

The hypothesized three-factor model provided the best fit to the data, although sensation seeking was excluded from the final model. The three latent factors were largely unrelated to each other and were variably associated with substance use.

CONCLUSIONS

These findings support the hypothesis that diverse measures of impulsivity can broadly be organized into three categories that are largely distinct from one another. These findings warrant investigation among individuals with clinical levels of addictive behavior and may be applied to understanding the underlying biological mechanisms of these categories.

Examination of trait impulsivity on the response to a brief mindfulness intervention among college student drinkers

Mindfulness-based strategies show promise for targeting the construct of impulsivity and associated variables among problematic alcohol users. This study examined the moderating role of intervention (mindfulness vs relaxation vs control) on trait impulsivity and three outcomes examined post-intervention (negative affect, positive affect, and urge to drink) among 207 college students with levels of at-risk drinking. Moderation analyses revealed that the relationship between baseline impulsivity and the primary outcomes significantly differed for participants who underwent the mindfulness versus relaxation interventions. Notably, simple slope analyses revealed that negative urgency was positively associated with urge to drink following the mindfulness intervention. Among participants who underwent the relaxation intervention, analysis of simple slopes revealed that negative urgency was negatively associated with urge to drink, while positive urgency was positively associated with positive affect following the relaxation intervention. Findings suggest that level (low vs high) and subscale of impulsivity matter with regard to how a participant will respond to a mindfulness versus relaxation intervention.

The Alcohol Use Disorders Identification Test for Consumption (AUDIT-C) is more useful than pre-existing laboratory tests for predicting hazardous drinking: a cross-sectional study

BACKGROUND

It is important to screen for alcohol consumption and drinking customs in a standardized manner. The aim of this study was 1) to investigate whether the AUDIT score is useful for predicting hazardous drinking using optimal cutoff scores and 2) to use multivariate analysis to evaluate whether the AUDIT score was more useful than pre-existing laboratory tests for predicting hazardous drinking.

METHODS

A cross-sectional study using the Alcohol Use Disorders Identification Test (AUDIT) was conducted in 334 outpatients who consulted our internal medicine department. The patients completed self-reported questionnaires and underwent a diagnostic interview, physical examination, and laboratory testing.

RESULTS

Forty (23 %) male patients reported daily alcohol consumption ≥ 40 g, and 16 (10 %) female patients reported consumption ≥ 20 g. The optimal cutoff values of hazardous drinking were calculated using a 10-fold cross validation, resulting in an optimal AUDIT score cutoff of 8.2, with a sensitivity of 95.5 %, specificity of 87.0 %, false positive rate of 13.0 %, false negative rate of 4.5 %, and area under the receiver operating characteristic curve of 0.97. Multivariate analysis revealed that the most popular short version of the AUDIT consisting solely of its three consumption items (AUDIT-C) and patient sex were significantly associated with hazardous drinking. The aspartate transaminase (AST)/alanine transaminase (ALT) ratio and mean corpuscular volume (MCV) were weakly significant.

CONCLUSIONS

This study showed that the AUDIT score and particularly the AUDIT-C score were more useful than the AST/ALT ratio and MCV for predicting hazardous drinking.

Tests of the Attachment and Clinical Issues Questionnaire as It Applies to Alcohol Dependence

OBJECTIVES

Although many major theories tie the addictions to specific pathways and neurochemical systems evolutionarily implicated in food and social behavioral systems, there is a paucity of instruments from the psychological level that can measure these important attachment, social, and emotional counterparts. Two studies were designed to examine whether the Attachment and Clinical Issues Questionnaire (ACIQ) could help fill this limitation in psychological measurement.

METHODS

In study 1, the ACIQ was given to patients in a substance abuse unit and control participants funneled to match from a larger population. To address the issue of their hypothesized tendency to blame everything on past experiences, study 2 tested whether the above results would be replicated with high school students predicted to develop alcohol dependence.

RESULTS

In study 1, on the patient population, significant differences were found on the attachment and clinical scales in predicted directions. In study 2, on the high school students, the central predictions were again confirmed with this different and larger population, but with interesting developmental differences.

CONCLUSIONS

The 2 studies using different populations and definitions of alcohol dependence converged on similar results. The ACIQ was found to be a robust battery for measuring attachment and clinical issues displayed by both patient populations and high school students only predicted to develop alcohol dependence. The results were further discussed in terms of how they move us toward Research Domain Criteria (RDoC) approaches to diagnosis and treatment, paying attention to important individual differences in attachments, and clinical issues.

Drinking Motives Mediate the Relationship between Facets of Mindfulness and Problematic Alcohol Use

Mindfulness is a multi-faceted construct, and research suggests that certain components (e.g., Acting with Awareness, Nonjudging) are associated with less problematic alcohol use. Recent research has examined whether specific drinking motives mediate the relationship between facets of mindfulness and alcohol use. The current study sought to extend this research by examining whether certain drinking motives would mediate the relationship between facets of mindfulness and problematic alcohol use in a sample of 207 college students classified as engaging in problematic drinking. Participants completed the Five Facet Mindfulness Questionnaire (FFMQ), Drinking Motives Questionnaire-Revised (DMQ-R), and Alcohol Use Disorders Identification Test (AUDIT). Results indicated that lower levels of Coping motives significantly mediated the relationship between greater Acting with Awareness and lower AUDIT score and between greater Nonjudging and lower AUDIT score. Lower levels of Conformity motives significantly mediated the relationship between greater Acting with Awareness and lower AUDIT score. These findings offer insight into specific mechanisms through which mindfulness is linked to less problematic drinking, and also highlight associations among mindfulness, drinking motives, and alcohol use among a sample of problematic college student drinkers. Future research should determine whether interventions that emphasize Acting with Awareness and Nonjudging facets of mindfulness and/or target coping and conformity motives could be effective for reducing problematic drinking in college students.

Alcohol consumption among university students in Ireland and the United Kingdom from 2002 to 2014: a systematic review

Background

Alcohol is a leading cause of global suffering. Europe reports the uppermost volume of alcohol consumption in the world, with Ireland and the United Kingdom reporting the highest levels of binge drinking and drunkenness. Levels of consumption are elevated among university students. Thus, this literature review aims to summarise the current research on alcohol consumption among university students in the Republic of Ireland and the United Kingdom.

Methods

MEDLINE, CINAHL, EMBASE and PsychInfo were systematically searched for literature from January 2002 until December 2014. Each database was searched using the following search pillars: alcohol, university student, Ireland or the United Kingdom and prevalence studies.

Results

Two thousand one hundred twenty eight articles were retrieved from electronic database searching. These were title searched for relevance. 113 full texts were retrieved and assessed for eligibility. Of these, 29 articles were deemed to meet inclusion criteria for the review. Almost two thirds of students reported a hazardous alcohol consumption score on the AUDIT scale. Over 20 % reported alcohol problems over their lifetime using CAGE while over 20 % exceed sensible limits each week. Noteworthy is the narrowing of the gender gap throughout the past decade.

Conclusion

This is the first review to investigate consumption patterns of university students in Ireland and the United Kingdom. A range of sampling strategies and screening tools are employed in alcohol research which preclude comparability. The current review provides an overview of consumption patterns to guide policy development.

Different versions of the Alcohol Use Disorders Identification Test (AUDIT) as screening instruments for underage binge drinking

BACKGROUND

The changes experienced in recent years in the conceptualization of binge drinking (BD) make it necessary to revise the usefulness of the existing instruments for its detection among minors. The AUDIT and its abbreviated versions have shown their utility in different populations and consumption ranges, but there has been little research into their use in the detection of BD among adolescents. This study tests the capacity of the AUDIT, AUDIT-C and AUDIT-3 to identify BD adolescents, indicating the optimal cut-off points for each sex.

METHODS

High school students self-administered the AUDIT and completed a weekly self-report of their alcohol intake. BD is classified into different groups according to parameters like the quantity consumed and its frequency in the past six months, adjusting the cut-off points for each case.

RESULTS

The results obtained with a sample of 634 adolescents (15-17 years old/52.2% female) indicate that cut-off points of 4 on the AUDIT and 3 on the AUDIT-C show the best fit. Dividing the sample by sexes, the AUDIT and the AUDIT-C would detect BD males with scores of 5 and 4, respectively (with the AUDIT-C being more sensitive), and BD females with a score of 3 on both (the more sensitive being the AUDIT).

CONCLUSIONS

All three versions are adequate to classify BD adolescents but none of them made it possible to safely differentiate binge drinkers with different consumption intensities.

Randomized controlled trial of computerized alcohol intervention for college students: role of class level

BACKGROUND

Because of their ability to reach a much wider audience than face-to-face counseling or psychoeducation, computer-delivered interventions for risky or potentially problematic use have been increasing on college campuses. However, there are very few studies that examine who benefits most from such interventions.

OBJECTIVES

The purpose of this study was to determine if participation in Alcohol-Wise, a computerized intervention, is associated with changes in alcohol drinking behavior and its consequences, perceptions of college drinking norms, and expectancies. It was hypothesized that class level (i.e. freshman/sophomore versus junior/senior) would moderate the effectiveness of Alcohol-Wise.

METHOD

College students (n = 58) were randomly assigned to one of two conditions: (i) the computer-delivered intervention or (ii) wait-list control. Measures were completed at baseline and approximately 30-days later.

RESULTS

At follow-up, freshman and sophomore students in the intervention group showed significant reduction in peak number of standard drinks and blood alcohol concentration, but the effect was not observed for juniors and seniors. The intervention group reported more accurate estimates of drinking norms at follow-up relative to controls. There were no significant changes over time in alcohol expectancies in either group.

CONCLUSION

This study provides support for the potential usefulness of Alcohol-Wise intervention at reducing short-term drinking among underclassmen but not upperclassmen in a 4-year college setting. These findings suggest that computerized interventions may be more effective when provided early, but not later, in a student's college career.

Profiles of Intimate Partner Violence Victimization, Substance Misuse, and Depression Among Female Caregivers Involved with Child Protective Services

Intimate partner violence (IPV) victimization, substance misuse, and depression are highly prevalent among female caregivers involved with child protective services (CPS). Understanding heterogeneity in the occurrence of these problems is essential to improving pathways to intervention for women in this population. Latent class analysis was employed to determine whether there exist homogeneous subgroups of female caregivers who experience different patterns of IPV victimization, substance misuse, and depression. A restricted three-class solution best fit the data, suggesting high risk, moderate risk, and no risk subgroups. A substantial number of female caregivers comprise the high-risk subgroup (33%) in which caregivers reported very high rates of IPV victimization, substance misuse, and depression. Only a very small proportion comprised the no-risk subgroup (9%). Findings emphasize the heterogeneity among subgroups of female caregivers based on these risk factors, which may have implications for practitioners, such as CPS caseworkers, and researchers alike.

Comparison of self-reported alcohol use with the alcohol biomarker phosphatidylethanol among young people in northern Tanzania

BACKGROUND

The one-month Time Line Follow Back calendar (TLFB) and the Alcohol Use Disorders Identification Test (AUDIT) are used to collect self-reported alcohol intake data. We compared these instruments with the alcohol biomarker phosphatidylethanol (PEth) among young-people in northern Tanzania.

METHODS

AUDIT and TLFB were applied in a cross-sectional study of 202 young people (18-24 years), who reported using alcohol during the past year (103 male casual labourers; 99 college students). We assayed whole blood for PEth 16:0/18:1, using liquid chromatography-tandem mass spectrometry.

RESULTS

For both self-report methods, alcohol consumption was high, particularly among men (e.g. a median of 54 drinks per month in labourers), and about half of male students (48%) reported hazardous or harmful levels of drinking (AUDIT ≥8). Almost half (49%) of participants were PEth-positive (median concentration 0.03μmol/L). There were significant positive correlations between reported total alcohol intake and PEth concentration in males (Spearman's correlation rs=0.65 in college students and rs=0.57 in casual labourers; p<0.001). Self-reported use in the past month was a sensitive marker of having a positive PEth result (≥0.01μmol/L) with 89% of those with a PEth positive result reporting alcohol use, and this was similar in all groups. The proportion of those with AUDIT scores ≥8 and AUDIT-C scores ≥6 among those with a high cut-off positive PEth result (≥0.30μmol/L) ranged between 94 and 100%.

CONCLUSION

TLFB and AUDIT are sensitive measures to detect heavy alcohol use among young-people in northern Tanzania. They can be used to identify young people who may benefit from alcohol-focused interventions.

Impulsivity and substance use in young adulthood

BACKGROUND AND OBJECTIVES

Although the significant role of impulsive personality on substance use has been widely documented, distinct aspects of impulsivity and their relation to substance use during young adulthood have received scant attention. We sought to fill this research gap and explored impulsivity subtraits in relation to hazardous drinking and illicit substance use in young adulthood.

METHODS

The present study used cross-sectional survey data collected from a community sample of 257 young adults aged 18-25 (53% female). Data were primarily analyzed by three different types of regression models.

RESULTS

We found impulsivity to be more strongly associated with illicit substance use than hazardous drinking during young adulthood. Among the four impulsivity subtraits examined, lack of premeditation (p < .01) and sensation seeking (p < .05) were significantly related to illicit substance use in young adulthood.

CONCLUSIONS AND SIGNIFICANCE

These findings suggest that each impulsivity subtrait might play different roles in illicit substance use during young adulthood. For young adults, assessment of differential patterns of impulsive personality in individuals with substance use problems may have important implication for treatment strategies.

The effectiveness of a Web-based personalized feedback and social norms alcohol intervention on United Kingdom university students: randomized controlled trial

Background

Alcohol consumption in the student population continues to be cause for concern. Building on the established evidence base for traditional brief interventions, interventions using the Internet as a mode of delivery are being developed. Published evidence of replication of initial findings and ongoing development and modification of Web-based personalized feedback interventions for student alcohol use is relatively rare. The current paper reports on the replication of the initial Unitcheck feasibility trial.

Objective

To evaluate the effectiveness of Unitcheck, a Web-based intervention that provides instant personalized feedback on alcohol consumption. It was hypothesized that use of Unitcheck would be associated with a reduction in alcohol consumption.

Methods

A randomized control trial with two arms (control=assessment only; intervention=fully automated personalized feedback delivered using a Web-based intervention). The intervention was available week 1 through to week 15. Students at a UK university who were completing a university-wide annual student union electronic survey were invited to participate in the current study. Participants (n=1618) were stratified by sex, age group, year of study, self-reported alcohol consumption, then randomly assigned to one of the two arms, and invited to participate in the current trial. Participants were not blind to allocation. In total, n=1478 (n=723 intervention, n=755 control) participants accepted the invitation. Of these, 70% were female, the age ranged from 17-50 years old, and 88% were white/white British. Data were collected electronically via two websites: one for each treatment arm. Participants completed assessments at weeks 1, 16, and 34. Assessment included CAGE, a 7-day retrospective drinking diary, and drinks consumed per drinking occasion.

Results

The regression model predicted a monitoring effect, with participants who completed assessments reducing alcohol consumption over the final week. Further reductions were predicted for those allocated to receive the intervention, and additional reductions were predicted as the number of visits to the intervention website increased.

Conclusions

Unitcheck can reduce the amount of alcohol consumed, and the reduction can be sustained in the medium term (ie, 19 weeks after intervention was withdrawn). The findings suggest self-monitoring is an active ingredient to Web-based personalized feedback.

Comparing short versions of the AUDIT in a community-based survey of young people

Background

The 10-item Alcohol Use Disorders Identification Test (AUDIT-10) is commonly used to monitor harmful alcohol consumption among high-risk groups, including young people. However, time and space constraints have generated interest for shortened versions. Commonly used variations are the AUDIT-C (three questions) and the Fast Alcohol Screening Test (FAST) (four questions), but their utility in screening young people in non-clinical settings has received little attention.

Methods

We examined the performance of established and novel shortened versions of the AUDIT in relation to the full AUDIT-10 in a community-based survey of young people (16–29 years) attending a music festival in Melbourne, Australia (January 2010).

Among those reporting drinking alcohol in the previous 12 months, the following statistics were systematically assessed for all possible combinations of three or four AUDIT items and established AUDIT variations: Cronbach’s alpha (internal consistency), variance explained (R²) and Pearson’s correlation coefficient (concurrent validity). For our purposes, novel shortened AUDIT versions considered were required to represent all three AUDIT domains and include item 9 on alcohol-related injury.

Results

We recruited 640 participants (68% female) reporting drinking in the previous 12 months. Median AUDIT-10 score was 10 in males and 9 in females, and 127 (20%) were classified as having at least high-level alcohol problems according to WHO classification.

The FAST scored consistently high across statistical measures; it explained 85.6% of variance in AUDIT-10, correlation with AUDIT-10 was 0.92, and Cronbach’s alpha was 0.66. A number of novel four-item AUDIT variations scored similarly high. Comparatively, the AUDIT-C scored substantially lower on all measures except internal consistency.

Conclusions

Numerous abbreviated variations of the AUDIT may be a suitable alternative to the AUDIT-10 for classifying high-level alcohol problems in a community-based population of young Australians. Four-item AUDIT variations scored more consistently high across all evaluated statistics compared to three-item combinations. Novel AUDIT versions may be more effective than many established shortened versions as an alternative screening tool to the AUDIT-10 to measure hazardous or harmful alcohol consumption in this population.

Harm reduction text messages delivered during alcohol drinking: feasibility study protocol

BACKGROUND

Recent research using mobile phone interventions to address public health issues such as smoking, obesity, depression, and diabetes provides a basis for trialing a similar approach toward reducing the negative consequences of risky drinking.

OBJECTIVE

This feasibility study aims to recruit drinkers between 18-34 years to a website where they will design and enter their own personal messages (repeating or one-off) to be sent to their mobile phones when they are drinking to remind them of their pre-drinking safety intentions.

METHODS/DESIGN

Participants in the treatment group will have access to the messaging function for 3 months and will be compared to a control group who will have 3 months access to a web chat site only. Data collection will occur at baseline, 3 months, and 6 months. The primary outcome is a change in unintended negative consequences from drinking at 3 months. Secondary outcomes include the acceptability of the intervention to this population, recruitment rate, participant retention, reduction in alcohol consumption, and the self-motivation discourse in participant messages.

DISCUSSION

Existing alcohol interventions in New Zealand attempt to reduce alcohol consumption in the population, but with little effect. This study aims to target unintended negative consequences resulting from drinking by empowering the drinkers themselves to deliver safety messages during the drinking session. If proven effective, this strategy could provide a cost-effective means of reducing the public health burden associated with risky drinking.

TRIAL REGISTRATION

Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12611000242921.

Neural processes of an indirect analog of risk taking in young nondependent adult alcohol drinkers-an FMRI study of the stop signal task

BACKGROUND

Alcohol abuse and dependence are common problems in the United States that stem from a variety of factors, one of which may be a period of high level social drinking during college and early adulthood. Extant study implicates risk taking as a cognitive factor that contributes to habitual and heavy drinking. We sought to examine the neural processes of risk taking in young, nondependent drinkers.

METHODS

We compared 20 young adult social drinkers with a high level of alcohol use (AH), as defined by number of drinks per month, and 21 demographically matched drinkers with low to moderate alcohol use (ALM) in a functional magnetic resonance imaging study of the stop signal task. By contrasting risk taking (speeded) to risk aversion (slowed) trials, we examined the neural correlates of risk taking. Brain imaging data were analyzed with Statistical Parametric Mapping. Regions of interest were identified and corresponding effect sizes were examined for correlations with self-reported alcohol use.

RESULTS

The results showed that, compared with ALM, AH demonstrated decreased activation in right superior frontal gyrus and left caudate nucleus when contrasting risk taking and risk aversion trials at p < 0.001, uncorrected. Furthermore, examination of the effect size data showed that the extent of these decreased regional activations correlated with frequency of drinking in women, but not men.

CONCLUSIONS

These findings suggest a neural analog of nondependent, high level drinking. Specifically, high level social drinking is associated with altered activation of the caudate and superior frontal cortex, an association that appears to be stronger in women than in men and is strongly tied to the frequency of drinking. These results are relevant in understanding risk taking behavior in social drinking as well as in examining the potential path from high level social use in young adults to dangerous alcohol consumption later in life.

Factor Structure Validation of the Alcohol Dependence Scale in a Heavy Drinking College Sample

The prevalence of alcohol use disorders in college students necessitates that adequate measures exist to assess students for abuse and dependence. The Alcohol Dependence Scale (ADS) is a continuous measure of the severity of alcohol involvement found to have a unidimensional factor structure in clinical samples. The latent factor structure of the ADS in college drinkers has not been examined and this study sought to replicate unidimensionality. Heavy college drinkers (N=343) completed the ADS. Performance was examined using confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). The CFA did not support a single factor solution. Follow-up EFA revealed a two factor structure. The first, termed "Acute Excessive Drinking" consisted of relatively commonly endorsed items relating to loss of behavioral control, blackouts, and obsessive/compulsive drinking. The second, termed "Severe Withdrawal Symptoms," consisted of relatively infrequently endorsed items relating to withdrawal symptoms. The ADS does not appear to have the same factor structure in college and clinical samples, making it inadvisable as a linear measure of alcohol problems within a college population.

Binge drinking and declarative memory in university students

BACKGROUND

Binge drinking (BD), which is characterized by sporadic consumption of large quantities of alcohol in short periods, is prevalent among university students. Animal studies have shown that BD is associated with damage to the hippocampus, a region of the brain that plays a key role in learning and memory. The temporal cortex undergoes structural and functional changes during adolescence. The aim of the present study was to examine the association between BD and declarative memory in male and female university students.

METHODS

The participants were 122 students (between 18 and 20 years of age): 62 BD (30 women) and 60 non-BD (29 women). The neuropsychological assessment included the Rey Auditory Verbal Learning Test (RAVLT) and Weschler Memory Scale-3rd ed. (WMS-III) Logical Memory subtest, to evaluate verbal declarative memory, and the WMS-III Family Pictures subtest, to measure visual declarative memory.

RESULTS

The BD students remembered fewer words in the interference list and displayed greater proactive interference in the RAVLT; they performed worse in the Logical Memory subtest, both on immediate and delayed recall. There were no differences between the groups in performance of the Family Pictures subtest. No significant interactions were observed between BD and sex.

CONCLUSIONS

Binge drinking is associated with poorer verbal declarative memory, regardless of sex. The findings are consistent with the vulnerability of the adolescent hippocampus to the neurotoxic effects of alcohol. Longitudinal studies will help determine the nature of this relationship, the neurodevelopmental trajectories for each sex, and the repercussions on academic performance.

Screening for alcohol problems among 4-year colleges and universities

OBJECTIVE

To assess the use of alcohol screening tools across US colleges.

PARTICIPANTS

Directors of health services at 333 four-year colleges.

METHODS

An online survey was conducted regarding the use of alcohol screening tools. Schools reporting use of formal tools were further described in terms of 4 tools (AUDIT, CUGE, CAPS, and RAPS) that the authors judged to be the most favorable based on prior empirical comparative studies.

RESULTS

Forty-four percent of colleges reported use of at least 1 formal alcohol screening tool and nearly all of these used a tool appropriate for college students. However, less than half of the 44% of colleges that used a screening tool used 1 of the 4 most favorable tools.

CONCLUSIONS

Continued efforts are needed to encourage colleges to use the most effective available screening tools to identify alcohol-related problems that require intervention among students.

Screening and brief interventions for alcohol use in college health centers: a review

OBJECTIVES

to provide a critical review of the efficacy of brief interventions for alcohol use in college health centers.

METHODS

studies were included if (a) they examined brief intervention trials that were conducted in college- or university-based student health centers or emergency departments, and (b) they provided pre-post data to estimate change.

RESULTS

twelve studies suggested that screening and brief interventions in these settings are acceptable, feasible, and promote risk reduction.

CONCLUSIONS

findings support continued use of time-limited, single-session interventions with motivational interviewing and feedback components.

The Alcohol Use Disorders Identification Test (AUDIT) as a screening instrument for adolescents

BACKGROUND

The Alcohol Use Disorders Identification Test (AUDIT) is an international screening instrument extensively employed in adult target groups. However, there is scarce information on screening with the AUDIT in adolescent populations. The purpose of this study was to determine the cut-off point for hazardous, harmful, and dependent alcohol use through the validation of the AUDIT in a Chilean adolescent sample.

METHODS

The original English version of the AUDIT was translated into Spanish, using the procedure recommended by the World Health Organization. The text was then back-translated and sent to one of the original authors (Thomas Babor), who approved the translation. Students attending public schools in Santiago, Chile, self-administered the AUDIT, and those older than 15 years completed the Composite International Diagnostic Interview-Substance Abuse Module (CIDI-SAM), which served as a gold standard. Between 1 and 4 weeks after the CIDI-SAM, participants answered a second AUDIT.

RESULTS

A total of 42 female and 53 male adolescents (mean age: 15.9 [SD=1.2]) completed the AUDIT, with a mean score of 4.3. Reliability according to Cronbach's alpha was 0.83. Test-retest correlation was also satisfactory (intra-class correlation 0.81 [95% CI 0.73-0.87]). Analysis of the receiver operating characteristic (ROC) curve yielded cut-off points for hazardous, harmful, and dependent alcohol use of 3, 5, and 7 points, respectively.

CONCLUSIONS

The Chilean version of the AUDIT is a valid and reliable tool for identifying adolescents with hazardous, harmful, and dependent alcohol use. The suggested cut-off points make screening with the AUDIT more accurate for adolescent populations.

Bestimmung der konkurrenten Validität des CRAFFT-d

Fragestellung: Überprüft wurde, wie gut der CRAFFT-d problematischen Alkoholkonsum bei Jugendlichen identifizieren kann. Methodik: Die Kriteriumsvalidität des CRAFFT-d wurde anhand eines zweiten Tests erfasst. Parallel zum CRAFFT-d wurde der Alcohol Use Disorders Identification Test (AUDIT) verwendet. Es wurde überprüft, in wie weit die erzielten Urteile übereinstimmen. Die Instrumente wurden im Rahmen der Webseite www.drugcom.de («check your drinking») eingesetzt. Ergebnisse: Von den 12250 befragten Jugendlichen wiesen 54.2 % nach dem AUDIT und 63.6 % nach dem CRAFFT-d einen problematischen Alkoholkonsum auf. Die Testergebnisse zeigen eine hohe Übereinstimmung (Phi φ = .57; χ² 3978.671**, df = 1, p > .001). Bei einem Cut-off-Wert von 2 Punkten erzielte der CRAFFT-d eine Sensitivität von 88.8 % und eine Spezifität von 66.2 %. Schlussfolgerung: Die Ergebnisse der Untersuchung legen nahe, dass der CRAFFT-d ein geeignetes Instrument zur Früherkennung von problematischem Alkoholkonsum bei Jugendlichen sein kann. Eine weitere Validierung anhand diagnostischer Kriterien ist jedoch nötig.

Relationship of age of first drink to alcohol-related consequences among college students with unhealthy alcohol use

This study investigated the relationship between age of first drink (AFD) and a broad range of negative alcohol-related outcomes among college students exhibiting unhealthy alcohol use. We conducted an anonymous on-line survey to collect self-report data from first-year college students at a large northeastern university. Among 1,792 respondents who reported ever drinking, 14% reported an AFD before age 14. These early onset drinkers were more likely than later onset drinkers to report frequent drinking, heavy drinking, and other unhealthy alcohol use behaviors. Among the subset of drinkers with unhealthy alcohol use (36%), early drinkers were more likely than later onset drinkers to report experiencing five out of 13 alcohol-related consequences, including driving while intoxicated, missing work or school due to drinking, getting into trouble at work or school due to drinking, receiving lower grades than they should have due to drinking, and developing a tolerance to alcohol.