Past Year Alcohol Consumption Patterns, Alcohol Problems and Alcohol-Related Diagnoses in the New Zealand Mental Health Survey

Abstract Background: Criteria for the diagnosis of alcohol abuse or dependence in DSM-IV or ICD-10 do not include measures of alcohol consumption. However the Alcohol Use Disorders Identification Test (AUDIT) contains three consumption questions (AUDIT-C) plus seven problem questions. The AUDIT-C has often been used as a short screening questionnaire. Here drinking patterns in the past year are analysed, and the AUDIT-C and other combinations of those three questions are related to alcohol problems or diagnoses in the same period. Method: The 2003-2004 New Zealand Mental Health Survey(N=12,992), a nationally representative survey, included the AUDIT and the Composite International Diagnostic Interview (CIDI) 3.0. Latent class analyses were used to discover patterns of alcohol consumption (AUDIT-C) and patterns of alcohol problems. Cross-tabulations, Receiver Operating Characteristic Curves and logistic regression were used to relate consumption to problems and diagnoses. Results: Analyses indicated that drinking frequency (Q1) was an ineffective screening question. Amount consumed per drinking day (Q2) plus frequency of per-occasion heavy drinking (Q3) was as good as or better than the AUDIT-C, with Q3 alone nearly as good. For a given consumption score, males were only slightly more likely than females to experience negative consequences from their drinking whereas age differences were more substantial. For both sexes and all age groups, a reasonable sensitivity of around 80% was achieved with often rather low specificity for detection of any drinking problems (specificities 57-81%). However there was higher specificity for detection of multiple problems, or diagnosis (specificities 72-85%). Conclusions: Usual drinking frequency is a poor screening indicator of past year alcohol problems and alcohol diagnoses, and does not improve on frequency of heavy per-occasion drinking, or that question plus usual quantity consumed. Retention of the usual drinking frequency question in the AUDIT-C must be based on considerations apart from its value in screening.