From clinical research to secondary prevention: international collaboration in the development of the Alcohol Disorders Identification Test (AUDIT)
From Clinical Research to Secondary Prevention
International Collaboration in the Development of the Alcohol Use Disorders Identification Test (AUDIT)
In 1982 the World Health Organization (WHO) asked an international group of investigators to develop a simple screening instrument to identify persons who are at risk of developing alcohol problems, using procedures that are suitable for use by health workers in both developing and developed countries. The result of this collaborative effort is the Alcohol Use Disorders Identification Test (AUDIT). This article will describe briefly how clinical research that employed alcohol-related assessment procedures developed this international screening instrument. For a complete description of the study, the reader is referred to the detailed reports and articles cited below.
DEVELOPMENT OF AUDIT
Health workers utilize screening procedures to identify treatable disorders in early or presymptomatic stages. Health professionals often use screening tests for case-finding, that is, for identifying persons who already show a serious alcohol problem, such as alcohol dependence. By contrast, AUDIT was designed to give primary emphasis to screening, not case-finding, by focusing on the preliminary signs of harmful and hazardous drinking and identifying mild dependence symptoms.
Harmful alcohol use is defined as a pattern of drinking that is already causing damage to health. The damage may be either physical (e.g., alcohol-related injuries) or mental (e.g., mild dysphoria secondary to heavy drinking). Hazardous alcohol use is defined as an established pattern of drinking that carries with it a high risk of future damage to physical or mental health, but which has not yet resulted in significant medical or psychiatric ill effects. High risk of future damage to health is crucial to the concept of hazardous use.
To devise an instrument capable of identifying hazardous as well as harmful alcohol use, the collaborating investigators reviewed a variety of behavioral, laboratory, and clinical procedures that have been used for alcohol screening in different countries. They then initiated a cross-national study to select the best features of these various national approaches to screening. This comparative field study was conducted in six countries--Norway, Australia, Kenya, Bulgaria, Mexico, and the United States. U.S. participation in this project was supported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) through a grant to the University of Connecticut Alcohol Research Center. (For detailed information about the procedures and findings of this complex project, see Saunders and Aasland 1987; Saunders et al. in press; Babor et al. 1989a.)
The investigators developed the screening instrument from data collected from a representative sample of patients attending health care facilities. Nearly 2,000 patients were assessed by means of a comprehensive assessment of drinking habits and related problems in conjunction with a clinical examination and several biological tests. The assessment instrument consisted of approximately 150 questions that cover socioeconomic variables, past medical history, current symptomatology, the level and frequency of alcohol consumption, psychological reactions to...
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