Comparing the AUDIT and 3 Drinking Indices as Predictors of Personal and Social Drinking Problems in Freshman First Offenders
O'Hare, Thomas, Journal of Alcohol & Drug Education
The current study of 376 college freshman adjudicated the first time for breaking university drinking rules tested the predictive power of four alcohol consumption and problem drinking indices--recent changes in drinking (the Alcohol Change Index: ACI), heavy drinking, binge drinking index, and the Alcohol Use Disorders Identification Test (AUDIT) with two subscales of the College Alcohol Problem Scale (personal and social problems) as criterion measure. In addition, the ACI, heavy drinking, and the binge-drinking index were tested for receiver operating characteristics (ROC) (sensitivity, specificity, false positive rate, positive predictive value and the area under the curve) using the AUDIT as criterion. Results demonstrated that the AUDIT was the best predictor of personal and social problems, and the binge showed the best ROC data with the AUDIT as criteria. Recommendations for use of brief instruments are suggested.
Research on college drinking has catalogued an array of problems related to excessive drinking in college students including negative psychological (e.g., depression, suicide, anxiety), interpersonal (e.g., fights, unplanned and unprotected sex, date rape) and community problems (e.g., driving under the influence, vandalism) problems (Wechsler, Lee, Kuo, and Lee, 2000; Wechsler, Davenport, Dowdall, Moeykens, and Costillow, 1994; O'Hare, 1990; O'Hare and Sherrer, 1999; O'Leary, Goodhart, Sweet Jemmott, Boccher-Lattimore, 1992; Abbey, 2002). A recent review of five national college drinking surveys (O'Malley and Johnston, 2002) summarized major findings and trends over the past 20 years: over two thirds of college students drink alcohol, 40% are considered binge drinkers (i.e., consumed five or more drinks at one sitting within the past two weeks), and rates of alcohol use have not changed substantially since the 1950's. Wechsler, Lee, Kuo and Lee (2000) estimate that 44% of college students are binge drinkers, a number that has remained relatively steady throughout the 1990's. In comparison to non-college cohorts, college students consume more alcohol. Males are about one and one-half as likely to be binge drinkers compared to females, although differences in alcohol consumption have narrowed over the past ten years or so. Whites continue to consume the most alcohol per capita than the other racial groups. Overall, the consistency of the data among the large national samples supports the overall reliability and validity of these estimates (O'Malley and Johnston, 2002).
The role and importance of alcohol and problem drinking measures
Many different types of measures have been employed in surveys of youthful drinking. These include the percentage of students who drink within specific rime intervals, binge drinking, various measures of heavy drinking, self-reported problems resulting from drinking, as well as various scales, and screening devices, many of which have been validated against DSM diagnostic criteria. All of these instruments measure something different, and the meaning of each measure has different implications for public health education, primary prevention policies and early intervention strategies with young persons who drink. Data regarding the percentage of students who have "ever used" or "used in the past month," for example, can be somewhat misleading as an indicator of problem drinking since the fact that a young person drinks does not necessarily indicate a problem. Given that most people at some time use alcoholic beverages, and do so in a relatively non-problematic way, it is likely that during late adolescence and early adulthood, young persons are likely to initiate the use of beer, wine or spirits, many of them, in moderation. Measures such as binge drinking (i.e., the consumption of five or more drinks within the past two weeks), identify those who consume more than a moderate amount at one sitting, but the term also suggests an unrestrained drinking spree and may suggest an exaggeration of the current problem on college campuses. Although the consumption of five (four for women) or more drinks at one sitting may be cause for concern, an estimation of consequences would likely depend considerably on the context of drinking (e.g., whether the person is driving afterwards or not). Binge drinking has, perhaps, become the most widely used indicator of excessive drinking in college students over the last decade due largely to the reports from a large national college drinking survey (Wechsler et al. 1994).
Heavy drinking, usually measured as five drinks at one sitting within the past week, may indicate a more serious problem (given a higher overall rate of consumption), but, again, the actual risks would have to be gauged relative to situational factors. The binge measure, as employed since 1980 in national studies of college drinking, appears to be a more liberal measure of excessive consumption than heavy drinking in that the binge index allows the respondent twice the time interval within which to report an incident of having consumed five or more drinks. O'Hare, Cohen, and Sherrer (1997) compared a standard quantity-frequency indicator of heavy drinking (5 or more drinks a week, usually), a 7-day retrospective diary (five or more drinks within the past 7 days) and the binge drinking index (5 or more drinks for men, 4 or more for women, within the past 2 weeks) against a modified version of the Michigan Alcoholism Screening Test as criterion with a cohort of college first offenders and found that positive predictive values for the QFI were generally higher than for the binge, and the false positive rate for the binge was three times that of the QFI. The binge drinking index, although producing the highest sensitivity ratings overall, grossly over-estimated the number of problem drinkers. Peak drinking (O'Hare, 1991; Sobell, Cellucci, Nirenberg and Sobell, 1982) which has been defined as having had five or more drinks in one sitting within the past seven days, also performed better than the binge drinking index with undergraduates in that it had a higher positive predictive value than the binge for both women and men (O'Hare, Cohen and Sherrer, 1997). However, overall, alcohol consumption measures alone provide rather crude estimates of problem drinking in this population. In order for them to be more useful, they should be directly linked to the frequency and severity of negative psychosocial, health or community consequences or compared to the results of standardized scales that have been validated with the youthful drinking population.
Problem drinking screens such as the MAST or the AUDIT were …
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Publication information: Article title: Comparing the AUDIT and 3 Drinking Indices as Predictors of Personal and Social Drinking Problems in Freshman First Offenders. Contributors: O'Hare, Thomas - Author. Journal title: Journal of Alcohol & Drug Education. Volume: 49. Issue: 3 Publication date: September 2005. Page number: 37+. © 2009 American Alcohol & Drug Information Foundation. COPYRIGHT 2005 Gale Group.
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