title: The reliability and validity of the Alcohol Use Disorders Identification Test (AUDIT) in a German general practice population sample.
abstract: OBJECTIVE
  Our goal was to analyze the retest reliability and validity of the Alcohol Use Disorders Identification Test (AUDIT) in a primary-care setting and recommend a cut-off value for the different alcohol-related diagnoses.
  
  
  METHODS
  Participants recruited from general practices (GPs) in two northern German cities received the AUDIT, which was embedded in a health-risk questionnaire. In total, 10,803 screenings were conducted. The retest reliability was tested on a subsample of 99 patients, with an intertest interval of 30 days. Sensitivity and specificity at a number of different cut-off values were estimated for the sample of alcohol consumers (n=8237). For this study, 1109 screen-positive patients received a diagnostic interview. Individuals who scored less than five points in the AUDIT and also tested negative in a second alcohol-related screen were defined as "negative" (n=6003). This definition was supported by diagnostic interviews of 99 screen-negative patients from which no false negatives could be detected. As the gold standard for detection of an alcohol-use disorder (AUD), we used the Munich-Composite International Diagnostic Interview (MCIDI), which is based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria.
  
  
  RESULTS
  On the item level, the reliability, measured by the intraclass correlation coefficient (ICC), ranged between .39 (Item 9) and .98 (Item 10). For the total score, the ICC was .95. For cut-off values of eight points and five points, 87.5% and 88.9%, respectively, of the AUDIT-positives, and 98.9% and 95.1%, respectively, of the AUDIT-negatives were identically identified at retest, with kappa = .86 and kappa = .81. At the cut-off value of five points, we determined good combinations of sensitivity and specificity for the following diagnoses: alcohol dependence (sensitivity and specificity of .97 and .88, respectively), AUD (.97 and .92), and AUD and/or at-risk consumption (.97 and .91).
  
  
  CONCLUSIONS
  Embedded in a health-risk questionnaire in primary-care settings, the AUDIT is a reliable and valid screening instrument to identify at-risk drinkers and patients with an AUD. Our findings strongly suggest a lowering of the recommended cut-off value of eight points.
authors.affiliation: Department of Psychiatry and Psychotherapy, Research Group S:TEP, University of Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany. ingadybek@yahoo.de
authors.forename: Inga
authors.initials: I
authors.lastname: Dybek
authors.forename: Gallus
authors.initials: G
authors.lastname: Bischof
authors.forename: Janina
authors.initials: J
authors.lastname: Grothues
authors.forename: Susa
authors.initials: S
authors.lastname: Reinhardt
authors.forename: Christian
authors.initials: C
authors.lastname: Meyer
authors.forename: Ulfert
authors.initials: U
authors.lastname: Hapke
authors.forename: Ulrich
authors.initials: U
authors.lastname: John
authors.forename: Andreas
authors.initials: A
authors.lastname: Broocks
authors.forename: Fritz
authors.initials: F
authors.lastname: Hohagen
authors.forename: Hans-Jürgen
authors.initials: HJ
authors.lastname: Rumpf
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000175:diagnosis* / Q000453:epidemiology*; D005194:Family Practice / Q000379:methods*; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods*; D012372:ROC Curve; D015203:Reproducibility of Results; D015813:Substance Abuse Detection / Q000379:methods*; D011795:Surveys and Questionnaires