Academic journal article Indian Journal of Psychiatry

Do SADQ and AUDIT Identify Independent Impacts of Alcohol Abuse - Clinical and Biochemical Markers Respectively?

Academic journal article Indian Journal of Psychiatry

Do SADQ and AUDIT Identify Independent Impacts of Alcohol Abuse - Clinical and Biochemical Markers Respectively?

Article excerpt

Byline: R. Pradeep, Andrew. Dhilip, Ashok. Mysore

Background and Objectives: We have analyzed extant data to see if Alcohol Use Disorder Identification Test (AUDIT) and Severity of Alcohol Dependence Questionnaire (SADQ) assess overlapping aspects of alcoholism, and how they relate to lab measures of alcoholism. Materials and Methods: Consecutive male patients between 20 and 50 years were recruited from varied departments of a general hospital. AUDIT and SADQ, as well as liver function tests, were part of the data obtained. Results: Despite, a significant correlation between total scores of SADQ and AUDIT (n = 0.188, P < 0.021) and some of their sub-scores. SADQ scores alone were significantly correlating with clinical variables of alcoholism such as family history and age of onset; AUDIT did not. On the other hand, AUDIT total scores correlated with total and conjugated bilirubin, while SADQ did not. Interpretation and Conclusion: Our data suggests that the two scales, AUDIT and SADQ may be tapping into two different outcomes of increased alcohol use namely clinical and biochemical markers, respectively. SADQ could be useful in studies looking at withdrawal related severity and clinical aspects of alcoholism; while AUDIT could be more suitable for studies looking at alcoholism-related medical morbidity. This needs to be confirmed in larger unselected samples from different community and clinical settings.

Introduction

In varied contexts, the assessment of alcohol misuse needs screening efforts, and in those positive, for subsequent evaluation of severity. Screening is necessary to identify subjects at risk particularly in the early phase of drinking. It helps in identifying both hazardous and harmful users. In general, the screening instruments are sensitive to low-level misuse of a substance, suitable for detecting potential abuse, and dependence but may not necessarily be a measure of severity by themselves. There have been many screening instruments available to screen problem drinkers. In India Alcohol Use Disorder Identification Test (AUDIT),[sup][1] CAGE,[sup][2] and Michigan Alcoholism Screening Test (MAST)[sup][3] have been commonly used.[sup][4],[5],[6],[7]

The severity instruments are useful in subjects with significant misuse and also help monitor treatment outcomes, but may not be sensitive to low-level use. Researchers in India also have studied the severity of alcoholism in different ways. These studies use either an Interview Format or a Questionnaire method. The interview formats include Alcohol section of the Schedules for Clinical Assessment in Neuropsychiatry [sup][8] and Addiction Severity Index.[sup][9] The questionnaire method has depended on Severity of Alcohol Dependence Data (SADD)[sup][5] and Severity of Alcohol Dependence Questionnaire (SADQ).[sup][7],[10]

As mentioned above, AUDIT is generally adopted as a screening instrument. It was primarily designed to identify people with hazardous and harmful consumption before the onset of physical dependence or psychological problems. It is 10 items instrument derived from a 150 item interview schedule. After a detailed statistical analysis and face validity, 10 items were selected which assess three conceptual domains that include alcohol consumption (items 1–3), dependence (items 4–6), and alcohol-related problems (items 7–10). It has been validated in six countries, standardized cross-nationally, and has cross-cultural applicability.[sup][1] It is the only instrument designed to be used internationally, focuses on recent use of alcohol and consistent with the International Classification of Disease tenth revision's (ICD-10) definition of harmful use and dependence pattern. It has been used by Indian researchers,[sup][11] and has been validated in the urban community in the North India.[sup][12] There are many studies, which have used AUDIT in the general population, family practice and primary care centers; however, there are only a few studies in clinical groups where the AUDIT scores are high. …

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