SCREENING WITH THE ALCOHOL-USE DISORDERS IDENTIFICATION TEST (AUDIT) IN AN INNER-CITY POPULATION

Objectives: 1) To determine the operating characteristics of the Alcoh ol Use Disorders Identification Test (AUDIT) in an inner-city populati on and 2) to compare AUDIT performance with physician recognition of a lcohol-related problems. Design: New patients were administered a heal th habits questionnaire, which included the AUDIT and the alcohol port ion of the Structured Clinical Interview for DSM-III-R (used as the '' gold standard'' for alcohol abuse or dependence). The findings were co mpared with physician recognition based on chart review. Setting: Inne r-city general medicine clinic staffed by resident physicians with fac ulty supervision. Patients/participants: Consecutive new patients over a ten-week period. Of 166 consecutive new patients, 23 were not conta cted, 17 refused to participate, two were excluded for gross cognitive deficits, and 124 completed the study. Results: Of the 124 patients, 41 (33%) met criteria for past or present alcohol abuse or dependence. The AUDIT correctly identified 26/27 (sensitivity of 96%) of patients with current problems and 0/14 of patients with past problems only. P hysician rates of recognition of current and past alcohol-related prob lems based on chart review were 12/27 (sensitivity of 44%) and 1/14 (7 %), respectively. The specificities of both the AUDIT and physician re cognition were high, 96% and 99%, respectively. Conclusions: 1) Alcoho l-related problems were common in this setting. 2) The AUDIT had a hig h sensitivity and a high specificity for detection of current alcohol problems in this setting, but it failed to detect patients with only p ast histories of alcohol problems. 3) The AUDIT performed significantl y better than did the physicians in detecting alcohol problems. 4) The addition of an assessment of past alcohol use to supplement informati on from the AUDIT would appear to represent a promising screening stra tegy worthy of further investigation.