Alcohol misuse plays a role in up to 1 in 20 deaths worldwide. It costs countries billions of dollars, and places a burden on countless families, according to the National Institute on Alcohol Abuse and Alcoholism. Nearly every healthcare provider will encounter alcohol use disorders that are directly or indirectly impacting the health of their patients, making it essential to have a tool for identifying alcohol dependency as part of diagnosis and treatment planning.
The Alcohol Use Disorders Identification Test (AUDIT) is a short screening questionnaire designed to assess alcohol consumption, drinking behaviours, and alcohol-related problems. It is now available within CBS Health to administer alongside measures of cognitive performance, allowing clinicians to efficiently measure and track alcohol use and misuse.
What is the AUDIT?
The AUDIT is the world’s most widely used alcohol screening tool. It was developed in 1989 by the World Health Organization (WHO) to assess three domains related to alcohol use:
- Alcohol intake
- Potential dependence on alcohol
- Experience of alcohol-related harm
The tool contains only 10 items and takes about 2 minutes, making it ideal to quickly screen for alcohol-related problems. Each item asks about activity in the past year, covering areas such as the frequency, amount, and harmful effects of alcohol consumption. In CBS Health, the AUDIT can be administered in person or self-administered remotely, and includes written guidance on the purpose of the assessment and definitions for standard drinks to help patients provide accurate information.
Responses to each item are scored from 0 to 4, then a total score is calculated with a possible range from 0 to 40. According to the WHO’s guidelines, a score of 1 to 7 suggests low-risk consumption, scores from 8 to 14 suggest hazardous or harmful alcohol consumption, and scores of 15 or more indicate alcohol dependence, or moderate to severe alcohol use disorder.
The CBS Health version of the AUDIT is scored automatically, and a report is generated for the healthcare administrator to view and potentially share with patients. The report includes the classification of the total score, guidance on interpretation, and raw scores. If the patient has taken the AUDIT more than once, scores are tracked over time and graphed.
The AUDIT has proven to be a reliable and valid tool to screen for early stage alcohol problems. Reiner and Allen (2002) reviewed the scientific literature and found that the AUDIT generally matches longer diagnostic methods, with sensitivity and specificity usually superior to other self-report measures. They concluded that the test is reliable, valid, and practical, urging its use in clinical contexts.
For more information on using the AUDIT in clinical practice, see the WHO’s AUDIT: Guidelines for Use in Primary Health Care.
Important note: the purpose of the AUDIT is to assess alcohol consumption, drinking behaviours, and alcohol-related problems. However, it is not a standalone diagnostic tool. Any conclusions drawn from the AUDIT should be paired with clinical interviews and observations, other health examinations or assessments administered, other evaluations of the patient, and/or the patient’s family history.
How are problems with alcohol related to cognition?
Substance use is intertwined with cognition—multiple factors, such as drug effects, withdrawal effects, and probability of relapse, are all linked with cognitive capacity. Alcohol abuse in particular can destroy brain health. Alcohol-related dementia (ARD) and Wernicke-Korsakoff Syndrome (WKS) are two examples of cognitive impairment resulting from the misuse of alcohol, with symptoms including deficits in visuospatial function, memory, and executive function (see Ridley, Draper, & Withall, 2013).
Measuring cognitive deficits using tools like CBS Health’s neuropsychological tasks can complement the AUDIT and other information when diagnosing alcohol-related disorders. ARD and WKS may have different patterns of cognitive deficits, for example. Abstinence, as well as certain supplements and medications, have been shown to lead to at least partial recovery in cognitive function, so ongoing cognitive assessments may assist in promoting and maintaining the positive effects of treatments for alcohol-related disorders, or act as an early warning sign about deterioration or relapse. An improvement in cognitive test scores after abstinence from alcohol may also assist in differentiating alcohol-related dementia from other neurodegenerative conditions.
Furthermore, cognitive function is essential for full recovery and abstinence, leading some experts (e.g., Rezapour et al., 2015, Verdejo-Garcia et al., 2019) to recommend that treatments for addiction include neurocognitive rehabilitation and testing in addition to directly addressing addictive behaviours.
Which types of healthcare providers will gain value from measuring alcohol abuse with the AUDIT?
Rehab centers and addiction specialists have an obvious use for the AUDIT—find out more about why addiction specialists and rehab centers use CBS Health here. However, screening for harmful alcohol use is important in almost any healthcare practice, even if substance abuse is not a main focus.
Although alcohol abuse is extremely common, having patients agree to treatment for alcohol-related disorders is notoriously difficult, and most excessive drinkers go undiagnosed (WHO, 2001). However, these patients do frequently seek treatment or become hospitalized for another health condition, so a quick AUDIT may present a rare opportunity for any clinician to play a role in early screening, diagnosis, and intervention. That can start with administering the AUDIT and collecting a baseline cognitive assessment to better understand changes over time.
A significant proportion of people who have problems with alcohol also experience mental health disorders such as anxiety and depression (Anthenelli, 2010), making the AUDIT a valuable tool for clinical psychologists and psychiatrists. As mentioned, alcohol abuse can occur with, or resemble, neurodegenerative diseases and other disorders of the nervous system, so the AUDIT will find use in the practices of neurologists as well. Traumatic brain injuries can result from alcohol abuse, and continued alcohol abuse reduces the chances of a successful recovery (Weil, Corrigan, & Karelina, 2016), so concussion specialists and occupational therapists will also benefit from the screening tool.
As these examples demonstrate, clinicians of many types can benefit from having the AUDIT close at hand. CBS Health provides an easy way to integrate the instrument into any practice.
How to administer a computerized AUDIT in CBS Health
Administering the AUDIT is easy in CBS Health, where it can be given to a patient on its own, or included as part of any protocol that mixes questionnaires and cognitive assessments. When creating a protocol within CBS Health, click the Questionnaires section, then check off the AUDIT. You can then check off and rearrange other questionnaires and tasks from the Cognitive Assessments section for an integrated flow.
For detailed instructions on administering questionnaires within CBS Health, please see our previous blog post on administering a digital PHQ-9.
The CBS Health version of the AUDIT is computerized, and thus the questionnaire can be administered to a patient in-clinic or at home, and requires no special training. The scale can also be added to a CBS Health schedule, allowing you to automatically send it via email at predefined times. The results are scored instantly, and if a patient completes the questionnaire more than once, results are added to the patient’s report to track changes in response to treatments, or to monitor for variations over time. No registration or login are required, and the AUDIT takes about 2 minutes. With minimal effort, you as the healthcare provider, patients, and caregivers can all benefit from the valuable information provided by a standardized, validated screener for alcohol-related problems.
Need more computerized health questionnaires and screeners?
If there are additional questionnaires you would like integrated in CBS Health, such as any you currently administer in pen-and-paper form, please do not hesitate to let us know by commenting on this blog post or contacting us directly by email at email@example.com. We are always happy to hear your feedback.
Thank you, as always,
— The Cambridge Brain Sciences Team