Research Article: 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
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.
Introduction:
Excessive alcohol use carries major negative health, work-related and societal consequences. 1–4 Population-based studies have documented high rates of binge drinking, heavy weekly drinking and general alcohol misuse among military service members (SMs) and veterans in Canada, 5 6 the UK 7–11 and the US. 12–14 Research has also shown that these rates are exacerbated by deployment and combat experiences, and alcohol overuse often co-occurs with post-traumatic stress disorder, depression, traumatic brain injury and…
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