Screening criteria of alcoholism by alcohol use disorders identification test(AUDIT) in Korea

ABSTRACT

BACKGROUND: Such screening tools for alcoholism as MAST, NAST, CAGE focused on the alcohol-related psyhosocial problems. But some men can be exduded in a study using these tools whereas they might be at risk for alcohol related physical problems. From this perspective the new tools focusing under quantity and frequency of intake for detection of early-stage drinkers not yet manifesting evident psychosocial problems but having alcohol- related potential harms, are being developed. With focus on these aspects, 10 itemed AUDIT was developed by WHO and this study was developed to provide standard points for screening alcohol problems in Korea with cultural difference through AUDIT. METHOD: The subjects were 85 drinking men and 11 male alcohol dependents who visited Kangmung hospital af Asan foundation from July until August 1998. The team composed of 2 family physicians and 1 psychiatrist, who delivered structured interviews based on DSM-IV criteria in terms of psychosocial problems, and examined them and reviewed the patient records in terms of alcohol-related physical problems. Accordingly the subjects were classified into 'normal', 'physical problems-related drinkers' without psychosocial problems, and 'alcohol abuser' and 'alcohol dependent' according to DSM-IV criteria. Aside from physicians diagnostic procedures, they were again made to complete a questionnaire induding all the items of AUDIT, MAST, NAST and CAGE. RESULTS: As regards physicians' diagnostic results, 31 were normal, 8 had physical problems without psychosocial problems, 36 abused alcohol, and 21 were alcohol-dependent. The mean AUD1T scores of all the sub were 17.5(+/-9.5) and the mean AUDIT scores of each group were 7.1(+/-4.3), 16.6(+/-3.4), 19.9(+/-5.0), 29.3(+/-5.1), respectively and revealed significant difference among them AUDlT scores were significantly correlated with those marked from physicians' diagnostic results and also significantly correlated with MAST, NAST and CAGE, respectively. After consideration of mean AUDIT scores and standard deviations of each group according to diagnostic results, the preliminary standard AUDIT scores for detection of a broader sense of 'problem drinker' including physical as well as psychosocial problems were most possibly 12, 13, 14 points. Their sensitivity and specificity were 96.9% and 87.1% in 12 points, 92.3% and 90.8% and 90.3% in 14 points, respectively. The preliminary standard AUDIT scores concerning alcohol use disorders hased on DSM IV criteria were most possibly 14, 15, 16 with its sensitivity and specificity of 91.2% and 74.4% in 14 points, 89.5% and 79.5% in 15 points, and 84.2% and 84.6% in 16 points. The preliminary standard AUDIT scores for 'alcohol dependence' were most possibly 25, 26, 27 with its sensitivity and specificity of 85.7% and 90.7% in 25 points, 85.7% and 93.3 in 26 points, and 71.4% and 94.7% in 27 points. CONCLUSIONS: The authors recommend AUDIT cut-off scores of 12 points as the standard value for a broader sense of problem drinking including physical as well as psychasocial problems, 15 for 'alcohol use disorders' based on DSM IV criteria, and 26 for 'alcohol dependence' in Korea.