title: Predicting the onset of hazardous alcohol drinking in primary care: development and validation of a simple risk algorithm.
abstract: BACKGROUND
  Little is known about the risk of progressing to hazardous alcohol use in abstinent or low-risk drinkers.
  
  
  OBJECTIVE
  To develop and validate a simple brief risk algorithm for the onset of hazardous alcohol drinking (HAD) over 12 months for use in primary care.
  
  
  METHODS
  Prospective cohort study in 32 health centres from six Spanish provinces, with evaluations at baseline, 6 months, and 12 months.
  
  
  METHODS
  Forty-one risk factors were measured and multilevel logistic regression and inverse probability weighting were used to build the risk algorithm. The outcome was new occurrence of HAD during the study, as measured by the AUDIT.
  
  
  RESULTS
  From the lists of 174 GPs, 3954 adult abstinent or low-risk drinkers were recruited. The 'predictAL-10' risk algorithm included just nine variables (10 questions): province, sex, age, cigarette consumption, perception of financial strain, having ever received treatment for an alcohol problem, childhood sexual abuse, AUDIT-C, and interaction AUDIT-C*Age. The c-index was 0.886 (95% CI = 0.854 to 0.918). The optimal cutoff had a sensitivity of 0.83 and specificity of 0.80. Excluding childhood sexual abuse from the model (the 'predictAL-9'), the c-index was 0.880 (95% CI = 0.847 to 0.913), sensitivity 0.79, and specificity 0.81. There was no statistically significant difference between the c-indexes of predictAL-10 and predictAL-9.
  
  
  CONCLUSIONS
  The predictAL-10/9 is a simple and internally valid risk algorithm to predict the onset of hazardous alcohol drinking over 12 months in primary care attendees; it is a brief tool that is potentially useful for primary prevention of hazardous alcohol drinking.
authors.affiliation: Instituto de Investigación Biomédica de Málaga (IBIMA), associate professor, Departamento de Medicina Preventiva y Psiquiatría, Universidad de Málaga, Málaga, Spain.
authors.forename: Juan Ángel
authors.initials: JÁ
authors.lastname: Bellón
authors.affiliation: Departamento de Bioestadística.
authors.forename: Juan
authors.initials: J
authors.lastname: de Dios Luna
authors.affiliation: Division of Psychiatry, Faculty of Brain Sciences.
authors.forename: Michael
authors.initials: M
authors.lastname: King
authors.affiliation: Department of Primary Care and Population Health, University College London, London, UK.
authors.forename: Irwin
authors.initials: I
authors.lastname: Nazareth
authors.affiliation: Departamento de Psicología, Universidad Loyola Andalucía, Sevilla, Spain.
authors.forename: Emma
authors.initials: E
authors.lastname: Motrico
authors.affiliation: Unidad Docente de Medicina Familiar y Comunitaria de La Rioja, La Rioja, Spain.
authors.forename: María Josefa
authors.initials: MJ
authors.lastname: GildeGómez-Barragán
authors.affiliation: Centro de Investigación Biomédica en Red de Salud Mental, Universidad de Granada, Granada, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Torres-González
authors.affiliation: Departamento de Medicina y Psiquiatría, Universidad de Zaragoza, Zaragoza, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Montón-Franco
authors.affiliation: Continuidad Asistencial del Hospital Universitario Infanta Sofía, Madrid, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Sánchez-Celaya
authors.affiliation: Centro de Salud Vecindario, Servicio Canario de Salud, Las Palmas, Spain.
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Díaz-Barreiros
authors.affiliation: Centro de Salud son Serra-La Vileta, Instituto Balear de la Salud, Palma de Mallorca, Illes Balears, Spain.
authors.forename: Catalina
authors.initials: C
authors.lastname: Vicens
authors.affiliation: Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Moreno-Peral
mesh_terms: D000428:Alcohol Drinking / Q000453:epidemiology* / Q000517:prevention & control / Q000523:psychology; D000437:Alcoholism / Q000453:epidemiology* / Q000517:prevention & control / Q000523:psychology; D000465:Algorithms; D003617:Dangerous Behavior; D006801:Humans; D011320:Primary Health Care / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain
keywords: alcohol consumption; clinical prediction rule; primary health care