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Constructs

Measure Details

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Measure Name:	AUDIT-C (Alcohol Consumption Questions)
Measure Type:	Multi-item Scale
Construct:	Risky Drinking
Primary Content Area:	Substance Abuse
Secondary Content Area:
Brief Description:	Brief screener for problem drinking
Keywords:	alcohol, drinking, binge, risky drinking
Target Population:	general population
Mode of Administration:	Self-administered, Face-to-face, Web, Telephone, Fax

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Source Measure:	No source measure has been specified.
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Submission Status: Publicly Available Download: 82 Average Rating: (0 users)

(Last Updated: 2/24/2011 3:48:54 PM by Alicia Sukup)

Comments & Ratings (3 comments)

Benefits of the AUDIT-C, 4/3/2011 5:22:48 PM By Katharine Bradley, Group Health Research Institute USPSTF recommends screening for risky drinking/excessive alcohol use due to demonstrated benefits of brief intervention. Validated screens that identify excessive use or alcohol use disorders (i.e. the spectrum of "unhealthy drinking" or alcohol misuse) include the 10-item AUDIT, 3-item AUDIT-C, and single-item binge questions, among others. I recommend the first 3 AUDIT questions (called the AUDIT-C for Consumption) be used as the screen for alcohol misuse. In addition, to reporting the typical reported alcohol consumption (AUDIT Q#2), and frequency of binge drinking (AUDIT Q#3), and a positive or negative screen (Yes/no) in the EHR, the AUDIT-C score should be calculated by the EHR and documented and can be viewed over time. The AUDIT-C score has been shown to be associated with alcohol-related symptoms on the remainder of the AUDIT, self-management of hypertension and diabetes, and medication adherence, as well as risk for alcohol dependence, hospitalizations for GI complications of drinking, fractures, potentially preventable hospitalizations, surgical complications, and death.4-11 i. What is a positive screen? A positive screen should be considered any patients who screen positive on the AUDIT-C score (>= 3 for women and >= 4 for men)1 OR report of binge drinking in the past year on the gender-specific version of the AUDIT-C question #3.3 This is easily calculated by the EHR. ii. Why we recommend the AUDIT-C over single-item binge questions for EHRs: The AUDIT-C includes a binge question (Q#3) but also provides important information on typical drinking. Many medical conditions and medications are impacted by and/or interact with typical alcohol use. Therefore, medical providers would want to know if men drink 3-4 drinks weekly or more often (non-binge drinking), which could complicate health care (e.g. hypertension, hepatitis C, or anticoagulation). iii. Why we recommend the AUDIT-C be included even if the full 10-item AUDIT is also included: The AUDIT-C is as effective a screen for excessive use or DSM-IV alcohol use disorders as the full 10-item AUDIT, 1,12and has been found feasible for routine administration in VA. 13,14 In the mid-1990’s we sought a briefer alcohol screen than the full AUDIT when we were not permitted to implement the 10-AUDIT in a VA primary care clinic due to its length. Others have used the AUDIT-C,15 reflecting that it is likely a more practical first line screen in many primary care settings. iv. Why isn’t patient report of drinking better than having to score as screen? The use of the AUDIT-C score is essential because questions about typical drinking underestimate alcohol consumption. For example, in VA only 54% of male patients who drank over 14 drinks a week reported doing so on the AUDIT’s questions #1-2. References 1. Bradley KA, DeBenedetti AF, Volk RJ, Williams EC, Frank D, Kivlahan DR. AUDIT-C as a brief screen for alcohol misuse in primary care. Alcohol. Clin. Exp. Res. Jul 2007;31(7):1208-1217. 2. Bradley KA, Bush KR, Epler AJ, et al. Two brief alcohol-screening tests From the Alcohol Use Disorders Identification Test (AUDIT): validation in a female Veterans Affairs patient population. Arch. Intern. Med. Apr 14 2003;163(7):821-829. 3. Bradley KA, Kivlahan DR, Williams EC. Brief approaches to alcohol screening: practical alternatives for primary care. J. Gen. Intern. Med. Jul 2009;24(7):881-883. 4. Rubinsky AD, Kivlahan DR, Volk RJ, Maynard C, Bradley KA. Estimating risk of alcohol dependence using alcohol screening scores. Drug Alcohol Depend. Apr 1 2010;108(1-2):29-36. 5. Bradley KA, Kivlahan DR, Zhou XH, et al. Using alcohol screening results and treatment history to assess the severity of at-risk drinking in Veterans Affairs primary care patients. Alcohol. Clin. Exp. Res. Mar 2004;28(3):448-455. 6. Bryson CL, Au DH, Sun H, Williams EC, Kivlahan DR, Bradley KA. Alcohol screening scores and medication nonadherence. Ann. Intern. Med. Dec 2 2008;149(11):795-804. 7. Au DH, Kivlahan DR, Bryson CL, Blough D, Bradley KA. Alcohol Screening Scores and Risk of Hospitalizations for GI Conditions in Men. Alcohol. Clin. Exp. Res. Mar 2007;31(3):443-451. 8. Harris AH, Bryson CL, Sun H, Blough D, Bradley KA. Alcohol Screening Scores Predict Risk of Subsequent Fractures. Subst. Use Misuse. Jun 17 2009;44:1055-1069. 9. Chew RB, Bryson CL, Au DH, Maciejewski ML, Bradley KA. Are smoking and alcohol misuse associated with subsequent hospitalizations for ambulatory care sensitive conditions? 2011. 10. Bradley KA, Rubinsky AD, Sun H, et al. Alcohol Screening and Risk of Postoperative Complications in Male VA Patients Undergoing Major Non-cardiac Surgery. J. Gen. Intern. Med. Sep 28 2010. 11. Harris AHS, Reeder R, Ellerbe L, Bradley KA, Rubinsky AD, Giori NJ. Preoperative Alcohol Screening Scores are Associated with Number of Surgical Complications in Male Total Joint Arthroplasty Patients. The Journal of Bone and Joint Surgery. In Press. 12. Kriston L, Holzel L, Weiser AK, Berner MM, Harter M. Meta-analysis: are 3 questions enough to detect unhealthy alcohol use? Ann. Intern. Med. Dec 16 2008;149(12):879-888. 13. Bradley KA, Williams EC, Achtmeyer CE, Volpp B, Collins BJ, Kivlahan DR. Implementation of evidence-based alcohol screening in the Veterans Health Administration. Am. J. Manag. Care. Oct 2006;12(10):597-606. 14. Lapham GT, Achtmeyer CE, Williams EC, Hawkins EJ, Kivlahan DR, Bradley KA. Increased Documented Brief Alcohol Interventions With a Performance Measure and Electronic Decision Support. Med. Care. Sep 28 2010. 15. Rose HL, Miller PM, Nemeth LS, et al. Alcohol screening and brief counseling in a primary care hypertensive population: a quality improvement intervention. Addiction. Aug 2008;103(8):1271-1280.
CAGE doesnot identify patients who benefit from brief intervention, 4/3/2011 5:18:35 PM By Katharine Bradley, Group Health Research Institute The CAGE is a screen for alcohol use disorders and does not screen for risky drinking/excessive alcohol use.( 1) Many patients who screen positive may no longer drink alcohol.(2) Because brief interventions have been demonstrated efficacious for risky drinking,(3) are recommended by USPSTF,(4) and were designated the third highest prevention priority for US adults,5 alcohol screening supported by EHRs should not be limited to the CAGE. [1.Buchsbaum DG, Buchanan R, Centor R. Interpreting CAGE scores. Ann. Intern. Med. 1992;116(12):1032-1033. 2.Bradley KA, Maynard C, Kivlahan DR, McDonell MB, Fihn SD. The relationship between alcohol screening questionnaires and mortality among male veteran outpatients. J. Stud. Alcohol. Nov 2001;62(6):826-833. 3.Kaner EF, Dickinson HO, Beyer F, et al. The effectiveness of brief alcohol interventions in primary care settings: A systematic review. Drug Alcohol Rev. May 2009;28(3):301-323. 4.Whitlock EP, Polen MR, Green CA, Orleans T, Klein J. Behavioral counseling interventions in primary care to reduce risky/harmful alcohol use by adults: A summary of the evidence for the U.S. Preventive Services Task Force. Ann. Intern. Med. 2004;140:557-568. 5.Solberg LI, Maciosek MV, Edwards NM. Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness. Am. J. Prev. Med. Feb 2008;34(2):143-152.]
utility in primary care, 3/23/2011 6:10:47 PM By William Sieber, UC San Diego I prefer the CAGE acronym to assess degree/impact of drinking. The 'score' from the AUDIT adds little to our sensitivity of assessment and change in drinking behavior.