title: Validation of the AUDIT-C in adults seeking help with their drinking online.
abstract: The abbreviated Alcohol Use Disorder Identification Test for Consumption (AUDIT-C) is rapidly becoming the alcohol screening tool of choice for busy practitioners in clinical settings and by researchers keen to limit assessment burden and reactivity. Cut-off scores for detecting drinking above recommended limits vary by population, setting, country and potentially format. This validation study aimed to determine AUDIT-C thresholds that indicated risky drinking among a population of people seeking help over the Internet.
  
  
  
  The data in this study were collected in the pilot phase of the Down Your Drink trial, which recruited people seeking help over the Internet and randomised them to a web-based intervention or an information-only website. Sensitivity, specificity, and positive and negative likelihood ratios were calculated for AUDIT-C scores, relative to weekly consumption that indicated drinking above limits and higher risk drinking. Receiver-operating characteristic (ROC) curves were created to assess the performance of different cut-off scores on the AUDIT-C for men and women. Past week alcohol consumption was used as the reference-standard and was collected via the TOT-AL, a validated online measure of past week drinking.
  
  
  
  AUDIT-C scores were obtained from 3720 adults (2053 female and 1667 male) searching the internet for help with drinking, mostly from the UK. The area under the ROC curve for risky drinking was 0.84 (95% CI 0.80, 0.87) (female) and 0.80 (95% CI 0.76, 0.84) (male). AUDIT-C cut-off scores for detecting risky drinking that maximise the sum of sensitivity and specificity were ≥8 for women and ≥8 for men; whereas those identifying the highest proportion of correctly classified individuals were ≥4 for women and ≥5 for men. AUDIT-C cut-off scores for detecting higher risk drinking were also calculated.
  
  
  
  AUDIT-C cut-off scores for identifying alcohol consumption above weekly limits in this largely UK based study population were substantially higher than those reported in other validation studies. Researchers and practitioners should select AUDIT-C cut-off scores according to the purpose of identifying risky drinkers and hence the relative importance of sensitivity and/or specificity.
authors.affiliation: Department of Primary Care and Population Health, UCL Royal Free Campus, Upper Third Floor, Rowland Hill Street, London, NW3 2PF, UK.|Health Service and Population Research Department, Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
authors.forename: Zarnie
authors.identifier: 0000-0002-2958-9555
authors.initials: Z
authors.lastname: Khadjesari
authors.affiliation: MRC Biostatistics Unit, Cambridge Institute of Public Health, Forvie Site, Robinson Way, Cambridge Biomedical Campus, Cambridge, CB2 0SR, UK.
authors.forename: Ian R
authors.initials: IR
authors.lastname: White
authors.affiliation: Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York, YO10 5DD, UK.
authors.forename: Jim
authors.initials: J
authors.lastname: McCambridge
authors.affiliation: Department of Primary Care and Population Health, UCL Royal Free Campus, Upper Third Floor, Rowland Hill Street, London, NW3 2PF, UK. l.marston@ucl.ac.uk.
authors.forename: Louise
authors.initials: L
authors.lastname: Marston
authors.affiliation: Department of Primary Care and Population Health, UCL Royal Free Campus, Upper Third Floor, Rowland Hill Street, London, NW3 2PF, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Wallace
authors.affiliation: Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York, YO10 5DD, UK.
authors.forename: Christine
authors.initials: C
authors.lastname: Godfrey
authors.affiliation: Department of Primary Care and Population Health, UCL Royal Free Campus, Upper Third Floor, Rowland Hill Street, London, NW3 2PF, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Murray
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000517:prevention & control*; D005260:Female; D000066505:Help-Seeking Behavior; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D011594:Psychometrics; D015203:Reproducibility of Results; D012650:Self Disclosure; D011795:Surveys and Questionnaires / Q000592:standards*; D006113:United Kingdom
keywords: AUDIT-C; Alcohol; Online; Past week drinking; Validation