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The alcohol use disorders identification test: reliability study of the Japanese version
Alcohol 45 (2011) 205e207
The alcohol use disorders identification test: reliability study of the Japanese version Tomoyuki Kawada*, Hirofumi Inagaki, Yushiro Kuratomi Department of Hygiene and Public Health, Nippon Medical School, Bunkyo-Ku, Tokyo 113-8602, Japan Received 6 December 2009; received in revised form 25 July 2010; accepted 14 August 2010
Abstract Alcohol abuse is recognized as a major health issue, and early detection of alcohol abuse is very important. The alcohol use disorders identification test (AUDIT) has been widely used as a specific tool for its detection. We conducted a cross-sectional survey of Japanese male workers to validate the Japanese version of this test. The Japanese version of AUDIT also contains 10 questions. A score greater than or equal to 11 was considered as indicative of serious alcohol abuse or dependence. A total of 168 subjects took part in the survey, and 145 of these subjects sent in their responses to the questionnaire. Among these 145 subjects, there were 136 men. The average age of these male subjects was 38.2 years (69.9). Among the 136 male subjects, 113 returned completely filled-in questionnaires. There were no significant differences in the mean values of the AUDIT score, short version of AUDIT (AUDIT-C) score, or age between the subjects who did or did not indicate their names in the questionnaire. The internal reliability (Cronbach alpha) of AUDIT was 0.67 for the total subject population and 0.45 for the subjects who indicated their names in the questionnaire (n 5 69). Cronbach’s alpha of AUDIT-C was 0.51 for the total subject population and 0.43 for the subjects who indicated their names in the questionnaire. The Spearman’s rho between AUDIT and AUDIT-C was 0.92 (P ! .01), and the percentage of subjects with an AUDIT score greater than or equal to 11 was 8.0% (9/113). Thus, the Japanese version of AUDIT showed satisfactory internal reliability. AUDIT is easy to use and is useful for the detection of alcoholrelated problems in occupational workers. Ó 2011 Elsevier Inc. All rights reserved. Keywords: The alcohol use disorders identification test; Reliability; Workers
Introduction Excessive drinking can pose substantial risk and cause harm to the individual and to the population at large. Repeated heavy drinking actually causes physical and mental harm. Undesirable drinking causes illness and distress to the target subjects and to the people around them, including family and friends. In severe cases, severe alcohol abuse leads to hospitalization, prolonged disability, and early death. Finally, economic loss to the community and to the country ensues. Alcohol causes 3.2% of all deaths, or 1.8 million deaths annually, and accounts for 4.0% of the disease burden in the community. Many of these deaths are the result of injuries caused by hazardous and harmful drinking (World Health Organization, 2007). In Japan, the percentage of subjects with a history of alcohol abuse is estimated to be 1.9% in adult male subjects (Higuchi, 2007). Alcohol abuse is related to physical and mental health problems and also leads to * Corresponding author. Tel.: þ81-3-3822-2131; fax: þ81-3-56853065. E-mail address: [email protected] (T. Kawada). 0741-8329/$ - see front matter Ó 2011 Elsevier Inc. All rights reserved. doi: 10.1016/j.alcohol.2010.08.012
financial loss (Dawson et al., 2006; World Health Organization, 2003). Early detection of alcohol abuse is very important, and one of the specific tools that can be used for the screening is the alcohol use disorders identification test (AUDIT) (Reinert and Allen, 2007). The AUDIT has been the most extensively studied alcohol-screening test worldwide. As suggested by Reinert and Allen (2007), there is a need for additional research on the psychometric properties of AUDIT among noneEnglish-speaking countries. The reported internal reliability coefficients of the translated versions of AUDIT vary from 0.75 to 0.94, with a median value of 0.82. Thus, to date, non-English versions of the AUDIT have consistently shown acceptable reliabilities (summarized by Reinert and Allen, 2007). AUDIT can detect alcohol abuse or addiction as a screening instrument, and its short version has also been prepared. The aim of this study was to validate the Japanese version of AUDIT for the Japanese population. Materials and methods AUDIT consists of 10 questions scored individually from 0 to 4. In Japan, a total score greater than or equal
206
T. Kawada et al. / Alcohol 45 (2011) 205e207
to 11 is considered as an indication of alcohol abuse (Hiro and Shima, 1996). The questionnaire contains 10 questions: three questions on (alcohol) use, four on dependence, and three about problems related to the alcohol habit. A total of 168 subjects took part, and 145 subjects (136 males and 9 females) returned their responses to the questionnaires. The subjects were drawn from workers in a car manufacturing company. As the number of female subjects was limited, the authors excluded the data of the female subjects. Among the male subjects, 113 sent in completely filled questionnaires of AUDIT. The number of subjects who indicated their names in the questionnaire was 69, whereas the remaining 44 subjects did not indicate their names in the questionnaire. Other than age, there was a lack of sufficient sociodemographic information, such as the education level, duration of employment, type of work, and working position. The subjects were mostly permanent daytime workers. The percentage of subjects drinking four days or more frequently per week was 32.4, and the percentage of subjects who never drank was 11.7. Informed consent was obtained from all participants, and the study was conducted with the approval of the Committee on Safety and Health of a company in September 2009. The ManneWhitney test was used for the analyses. All the statistical analyses were conducted using SPSS 16.0J for Windows (SPSS Japan Inc., Tokyo, Japan). P values less than 0.05 were considered to indicate statistical significance. Results The average age of the sample was 38.2 years (69.9), ranging from 20 to 67 years. The reliability of internal consistency, expressed by the Cronbach alpha index, was 0.67 for the total subject population and 0.45 for the subjects who indicated their names in the questionnaire. The Cronbach alpha of the short version of AUDIT (AUDIT-C) was 0.51 for the total subject population and 0.43 for the subjects who indicated their names in the questionnaire. The authors also calculated the Cronbach alpha index of other subscales of AUDIT, such as alcohol dependence (items 4e6, referred to as AUDIT4e6), and alcohol-related problems (items 7e10, referred to as AUDIT7e10). The Cronbach alpha index for AUDIT4e6 was 0.56 for the total subject population and 0.31 for the subjects who indicated their names in the questionnaire. Cronbach alpha of AUDIT7e10 was 0.41 for the total subject population and 0.11 for the subjects who indicated their names in the questionnaire. The geometric mean values and geometric standard deviation of the AUDIT score and AUDIT-C were 4.3 (2.1) and 3.7 (1.8), respectively. There were no significant differences in the mean values of the AUDIT score, AUDIT-C score, or age between the subjects who did or did not indicate their names in the questionnaire (Table 1). The Spearman’s r between AUDIT and AUDIT-C was 0.92 (P ! .01), and the rate of subjects with an AUDIT score greater than or equal to 11 was 8.0% (9/113).
Table 1 Mean of age and AUDIT Group 1 (n 5 69)
Group 2 (n 5 44)
Total (n 5 113)
Variables
GM
GSD
GM
GSD
GM
GSD
AUDIT AUDIT-C
4.2 3.8
1.9 1.8
4.5 3.6
2.3 1.8
4.3 3.7
2.1 1.8
Variable
Mean
S.D.
Mean
S.D.
Mean
S.D.
Age
38.8
10.0
37.4
9.9
38.2
9.9
AUDIT 5 alcohol use disorders identification test; AUDIT-C 5 the short version of AUDIT; n 5 number; GM 5 geometric mean; GSD 5 geometric standard deviation; S.D. 5 standard deviation; Group 1 5 the subjects who described personal name in a questionnaire; Group 2 5 the subjects who did not describe personal name in a questionnaire. There were no significant differences in the mean values between the two groups by ManneWhitney test.
Discussion Alcohol intake poses the risk of health and social problems, such as intoxication and dependence. Alcohol addiction is known to be related to the development of esophageal cancer, liver cirrhosis and neoplasm, encephalopathy with atrophy, and motor vehicle accidents. Alcoholrelated chronic diseases and traumatic accidents result in the loss of time, money, and life. Not only the volume but also the patterns of drinking are strongly related to the adverse effects of alcohol (World Health Organization, 2007). In this study, the age of the patients varied over a wide range. To exclude its effect, the authors stratified the subjects into two groups using the cutoff age of 40 years. The Cronbach alpha index was 0.68 for the subjects aged 40 years or older (n 5 47) and 0.67 for the subjects younger than 40 years (n 5 66). In addition, the Cronbach alpha of AUDIT-C was 0.60 for the subjects aged 40 years or older and 0.43 for the subjects younger than 40 years. Although there was no effect of age on the reliability of AUDIT, we cannot exclude the effect of age on the reliability of AUDIT-C. There is a limitation in generalizing the results of this study: The study subjects were drawn from the limited number of permanent workers of a car manufacturing company rather than from the general population, and further study is needed. A decrease of the Cronbach alpha index of subjects who revealed their personal information was observed (0.45 as compared with 0.67 for the entire subject population). We speculate that social desirability may be related to a decrease in the AUDIT score, because alcohol dependence is generally considered disadvantageous for the subjects. If this survey was conducted by an anonymous questionnaire method, the Cronbach alpha index would become greater than 0.67. In the Introduction, the authors quoted the minimum value of the Cronbach alpha index score in noneEnglish-speaking countries as being 0.75, and we do not consider our result as inconsistent with reports from past researches. The test situation and precise information on the health habits, such as on drinking and sociodemographic characteristics of the study subjects, seem important to provide an appropriate explanation.
T. Kawada et al. / Alcohol 45 (2011) 205e207
The relationship between AUDIT and AUDIT-C was quite strong, and if the space is limited to obtain information on the alcohol habit, AUDIT-C is a quick substitute tool. With regard to the 8.0% subjects with an AUDIT score greater than or equal to 11, the author thinks that the cutoff value cannot yet be determined in Japan. Further study is needed to check the validity and its implication when AUDIT is used as a screening tool in Japan. The AUDIT was developed as a simple method of screening for excessive drinking and to assist in brief assessment. It can help identify excessive drinking as the cause of the presenting illness. As excessive drinkers present with symptoms or problems that would not normally be linked to their drinking, the AUDIT will help the practitioner identify whether the person engages in hazardous (harmful) drinking or has alcohol dependence. Some drinkers can be helped to stop or reduce their alcohol consumption by appropriate interventions, namely, screening by AUDIT provides an opportunity to educate subjects about low-risk consumption levels and the risks of excessive alcohol use. AUDIT is a reliable and sensitive instrument and is used worldwide (Connor et al., 2008; De Silva et al., 2008; Kim et al., 2008; Moussas et al., 2009; Shevlin and Smith, 2007). The AUDIT was shown to have satisfactory internal consistency in this study in Japan, although a final conclusion has not been made as to the cutoff points accounting for differences in ethnic groups and circumstances (Cherpitel et al., 2005; Tsai et al., 2005). Prevention of the physical and psychiatric problems caused by alcohol abuse/addiction is important, and screening to detect early stage of the health issue is urgently required. Although the validity of AUDIT-C is still not widely accepted (Frank et al., 2008; Kriston et al., 2008), AUDIT can be used as a useful tool for the screening of high-risk population (Reinert and Allen, 2007). Conclusion Alcohol abuse/dependence is related to medical, psychiatric, and social problems. Therefore, early detection and diagnosis are essential for its prevention and treatment. The Japanese version of AUDIT has been demonstrated to show satisfactory internal reliability. AUDIT is easy to use and is useful for detection of alcohol problems in occupational workers.
207
References Cherpitel, C. J., Ye, Y., Moskalewicz, J., and Swiatkiewicz, G. (2005). Screening for alcohol problems in two emergency service samples in Poland: comparison of the RAPS4, CAGE and AUDIT. Drug Alcohol Depend. 80, 201–207. Connor, J. P., Jack, A., Feeney, G. F., and Young, R. M. (2008). Validity of the obsessive compulsive drinking scale in a heavy drinking population. Alcohol. Clin. Exp. Res. 32, 1067–1073. Dawson, D. A., Grant, B. F., Stinson, F. S., and Chou, P. S. (2006). Estimating the effect of help-seeking on achieving recovery from alcohol dependence. Addiction 101, 824–834. De Silva, P., Jayawardana, P., and Pathmeswaran, A. (2008). Concurrent validity of the alcohol use disorders identification test (AUDIT). Alcohol Alcohol. 43, 49–50. Frank, D., DeBenedetti, A. F., Volk, R. J., Williams, E. C., Kivlahan, D. R., and Bradley, K. A. (2008). Effectiveness of the AUDIT-C as a screening test for alcohol misuse in three race/ethnic groups. J. Gen. Intern. Med. 23, 781–787. Higuchi, S. (2007). Present status and future prospects in therapy for alcoholism. Seishin Shinkeigaku Zasshi 109, 534–535. [in Japanese]. Hiro, H., and Shima, S. (1996). Availability of the alcohol use disorders identification test (AUDIT) for a complete health examination in Japan. Nihon Arukoru Yakubutsu Igakkai Zasshi 31, 437–450. [in Japanese]. Kim, S. S., Gulick, E. E., Nam, K. A., and Kim, S. H. (2008). Psychometric properties of the alcohol use disorders identification test: a Korean version. Arch. Psychiatr. Nurs. 22, 190–199. Kriston, L., Holzel, L., Weiser, A. K., Berner, M. M., and Harter, M. (2008). Meta-analysis: are 3 questions enough to detect unhealthy alcohol use? Ann. Intern. Med. 149, 879–888. Moussas, G., Dadouti, G., Douzenis, A., Poulis, E., Tzelembis, A., Bratis, D., et al. (2009). The alcohol use disorders identification test (AUDIT): reliability and validity of the Greek version. Ann. Gen. Psychiatry 8, 11. Reinert, D. F., and Allen, J. P. (2007). The alcohol use disorders identification test: an update of research findings. Alcohol. Clin. Exp. Res. 31, 185–199. Shevlin, M., and Smith, G. W. (2007). The factor structure and concurrent validity of the alcohol use disorder identification test based on a nationally representative UK sample. Alcohol Alcohol. 42, 582–587. Tsai, M. C., Tsai, Y. F., Chen, C. Y., and Liu, C. Y. (2005). Alcohol Use Disorders Identification Test (AUDIT): establishment of cut-off scores in a hospitalized Chinese population. Alcohol. Clin. Exp. Res. 29, 53–57. World Health Organization (2003). Screening and Brief Intervention for Alcohol Problems in Primary Health Care. Geneva, Switzerland: World Health Organization. www.who.int/substance_abuse/activities/ sbi/en/index.html. World Health Organization (2007). Summary of the Report from the WHO Collaborative Study on Alcohol and Injuries. Geneva, Switzerland: World Health Organization. www.who.int/substance_abuse/publications/ alcohol_injury_summary.pdf.
The alcohol use disorders identification test: reliability study of the Japanese version Tomoyuki Kawada*, Hirofumi Inagaki, Yushiro Kuratomi Department of Hygiene and Public Health, Nippon Medical School, Bunkyo-Ku, Tokyo 113-8602, Japan Received 6 December 2009; received in revised form 25 July 2010; accepted 14 August 2010
Abstract Alcohol abuse is recognized as a major health issue, and early detection of alcohol abuse is very important. The alcohol use disorders identification test (AUDIT) has been widely used as a specific tool for its detection. We conducted a cross-sectional survey of Japanese male workers to validate the Japanese version of this test. The Japanese version of AUDIT also contains 10 questions. A score greater than or equal to 11 was considered as indicative of serious alcohol abuse or dependence. A total of 168 subjects took part in the survey, and 145 of these subjects sent in their responses to the questionnaire. Among these 145 subjects, there were 136 men. The average age of these male subjects was 38.2 years (69.9). Among the 136 male subjects, 113 returned completely filled-in questionnaires. There were no significant differences in the mean values of the AUDIT score, short version of AUDIT (AUDIT-C) score, or age between the subjects who did or did not indicate their names in the questionnaire. The internal reliability (Cronbach alpha) of AUDIT was 0.67 for the total subject population and 0.45 for the subjects who indicated their names in the questionnaire (n 5 69). Cronbach’s alpha of AUDIT-C was 0.51 for the total subject population and 0.43 for the subjects who indicated their names in the questionnaire. The Spearman’s rho between AUDIT and AUDIT-C was 0.92 (P ! .01), and the percentage of subjects with an AUDIT score greater than or equal to 11 was 8.0% (9/113). Thus, the Japanese version of AUDIT showed satisfactory internal reliability. AUDIT is easy to use and is useful for the detection of alcoholrelated problems in occupational workers. Ó 2011 Elsevier Inc. All rights reserved. Keywords: The alcohol use disorders identification test; Reliability; Workers
Introduction Excessive drinking can pose substantial risk and cause harm to the individual and to the population at large. Repeated heavy drinking actually causes physical and mental harm. Undesirable drinking causes illness and distress to the target subjects and to the people around them, including family and friends. In severe cases, severe alcohol abuse leads to hospitalization, prolonged disability, and early death. Finally, economic loss to the community and to the country ensues. Alcohol causes 3.2% of all deaths, or 1.8 million deaths annually, and accounts for 4.0% of the disease burden in the community. Many of these deaths are the result of injuries caused by hazardous and harmful drinking (World Health Organization, 2007). In Japan, the percentage of subjects with a history of alcohol abuse is estimated to be 1.9% in adult male subjects (Higuchi, 2007). Alcohol abuse is related to physical and mental health problems and also leads to * Corresponding author. Tel.: þ81-3-3822-2131; fax: þ81-3-56853065. E-mail address: [email protected] (T. Kawada). 0741-8329/$ - see front matter Ó 2011 Elsevier Inc. All rights reserved. doi: 10.1016/j.alcohol.2010.08.012
financial loss (Dawson et al., 2006; World Health Organization, 2003). Early detection of alcohol abuse is very important, and one of the specific tools that can be used for the screening is the alcohol use disorders identification test (AUDIT) (Reinert and Allen, 2007). The AUDIT has been the most extensively studied alcohol-screening test worldwide. As suggested by Reinert and Allen (2007), there is a need for additional research on the psychometric properties of AUDIT among noneEnglish-speaking countries. The reported internal reliability coefficients of the translated versions of AUDIT vary from 0.75 to 0.94, with a median value of 0.82. Thus, to date, non-English versions of the AUDIT have consistently shown acceptable reliabilities (summarized by Reinert and Allen, 2007). AUDIT can detect alcohol abuse or addiction as a screening instrument, and its short version has also been prepared. The aim of this study was to validate the Japanese version of AUDIT for the Japanese population. Materials and methods AUDIT consists of 10 questions scored individually from 0 to 4. In Japan, a total score greater than or equal
206
T. Kawada et al. / Alcohol 45 (2011) 205e207
to 11 is considered as an indication of alcohol abuse (Hiro and Shima, 1996). The questionnaire contains 10 questions: three questions on (alcohol) use, four on dependence, and three about problems related to the alcohol habit. A total of 168 subjects took part, and 145 subjects (136 males and 9 females) returned their responses to the questionnaires. The subjects were drawn from workers in a car manufacturing company. As the number of female subjects was limited, the authors excluded the data of the female subjects. Among the male subjects, 113 sent in completely filled questionnaires of AUDIT. The number of subjects who indicated their names in the questionnaire was 69, whereas the remaining 44 subjects did not indicate their names in the questionnaire. Other than age, there was a lack of sufficient sociodemographic information, such as the education level, duration of employment, type of work, and working position. The subjects were mostly permanent daytime workers. The percentage of subjects drinking four days or more frequently per week was 32.4, and the percentage of subjects who never drank was 11.7. Informed consent was obtained from all participants, and the study was conducted with the approval of the Committee on Safety and Health of a company in September 2009. The ManneWhitney test was used for the analyses. All the statistical analyses were conducted using SPSS 16.0J for Windows (SPSS Japan Inc., Tokyo, Japan). P values less than 0.05 were considered to indicate statistical significance. Results The average age of the sample was 38.2 years (69.9), ranging from 20 to 67 years. The reliability of internal consistency, expressed by the Cronbach alpha index, was 0.67 for the total subject population and 0.45 for the subjects who indicated their names in the questionnaire. The Cronbach alpha of the short version of AUDIT (AUDIT-C) was 0.51 for the total subject population and 0.43 for the subjects who indicated their names in the questionnaire. The authors also calculated the Cronbach alpha index of other subscales of AUDIT, such as alcohol dependence (items 4e6, referred to as AUDIT4e6), and alcohol-related problems (items 7e10, referred to as AUDIT7e10). The Cronbach alpha index for AUDIT4e6 was 0.56 for the total subject population and 0.31 for the subjects who indicated their names in the questionnaire. Cronbach alpha of AUDIT7e10 was 0.41 for the total subject population and 0.11 for the subjects who indicated their names in the questionnaire. The geometric mean values and geometric standard deviation of the AUDIT score and AUDIT-C were 4.3 (2.1) and 3.7 (1.8), respectively. There were no significant differences in the mean values of the AUDIT score, AUDIT-C score, or age between the subjects who did or did not indicate their names in the questionnaire (Table 1). The Spearman’s r between AUDIT and AUDIT-C was 0.92 (P ! .01), and the rate of subjects with an AUDIT score greater than or equal to 11 was 8.0% (9/113).
Table 1 Mean of age and AUDIT Group 1 (n 5 69)
Group 2 (n 5 44)
Total (n 5 113)
Variables
GM
GSD
GM
GSD
GM
GSD
AUDIT AUDIT-C
4.2 3.8
1.9 1.8
4.5 3.6
2.3 1.8
4.3 3.7
2.1 1.8
Variable
Mean
S.D.
Mean
S.D.
Mean
S.D.
Age
38.8
10.0
37.4
9.9
38.2
9.9
AUDIT 5 alcohol use disorders identification test; AUDIT-C 5 the short version of AUDIT; n 5 number; GM 5 geometric mean; GSD 5 geometric standard deviation; S.D. 5 standard deviation; Group 1 5 the subjects who described personal name in a questionnaire; Group 2 5 the subjects who did not describe personal name in a questionnaire. There were no significant differences in the mean values between the two groups by ManneWhitney test.
Discussion Alcohol intake poses the risk of health and social problems, such as intoxication and dependence. Alcohol addiction is known to be related to the development of esophageal cancer, liver cirrhosis and neoplasm, encephalopathy with atrophy, and motor vehicle accidents. Alcoholrelated chronic diseases and traumatic accidents result in the loss of time, money, and life. Not only the volume but also the patterns of drinking are strongly related to the adverse effects of alcohol (World Health Organization, 2007). In this study, the age of the patients varied over a wide range. To exclude its effect, the authors stratified the subjects into two groups using the cutoff age of 40 years. The Cronbach alpha index was 0.68 for the subjects aged 40 years or older (n 5 47) and 0.67 for the subjects younger than 40 years (n 5 66). In addition, the Cronbach alpha of AUDIT-C was 0.60 for the subjects aged 40 years or older and 0.43 for the subjects younger than 40 years. Although there was no effect of age on the reliability of AUDIT, we cannot exclude the effect of age on the reliability of AUDIT-C. There is a limitation in generalizing the results of this study: The study subjects were drawn from the limited number of permanent workers of a car manufacturing company rather than from the general population, and further study is needed. A decrease of the Cronbach alpha index of subjects who revealed their personal information was observed (0.45 as compared with 0.67 for the entire subject population). We speculate that social desirability may be related to a decrease in the AUDIT score, because alcohol dependence is generally considered disadvantageous for the subjects. If this survey was conducted by an anonymous questionnaire method, the Cronbach alpha index would become greater than 0.67. In the Introduction, the authors quoted the minimum value of the Cronbach alpha index score in noneEnglish-speaking countries as being 0.75, and we do not consider our result as inconsistent with reports from past researches. The test situation and precise information on the health habits, such as on drinking and sociodemographic characteristics of the study subjects, seem important to provide an appropriate explanation.
T. Kawada et al. / Alcohol 45 (2011) 205e207
The relationship between AUDIT and AUDIT-C was quite strong, and if the space is limited to obtain information on the alcohol habit, AUDIT-C is a quick substitute tool. With regard to the 8.0% subjects with an AUDIT score greater than or equal to 11, the author thinks that the cutoff value cannot yet be determined in Japan. Further study is needed to check the validity and its implication when AUDIT is used as a screening tool in Japan. The AUDIT was developed as a simple method of screening for excessive drinking and to assist in brief assessment. It can help identify excessive drinking as the cause of the presenting illness. As excessive drinkers present with symptoms or problems that would not normally be linked to their drinking, the AUDIT will help the practitioner identify whether the person engages in hazardous (harmful) drinking or has alcohol dependence. Some drinkers can be helped to stop or reduce their alcohol consumption by appropriate interventions, namely, screening by AUDIT provides an opportunity to educate subjects about low-risk consumption levels and the risks of excessive alcohol use. AUDIT is a reliable and sensitive instrument and is used worldwide (Connor et al., 2008; De Silva et al., 2008; Kim et al., 2008; Moussas et al., 2009; Shevlin and Smith, 2007). The AUDIT was shown to have satisfactory internal consistency in this study in Japan, although a final conclusion has not been made as to the cutoff points accounting for differences in ethnic groups and circumstances (Cherpitel et al., 2005; Tsai et al., 2005). Prevention of the physical and psychiatric problems caused by alcohol abuse/addiction is important, and screening to detect early stage of the health issue is urgently required. Although the validity of AUDIT-C is still not widely accepted (Frank et al., 2008; Kriston et al., 2008), AUDIT can be used as a useful tool for the screening of high-risk population (Reinert and Allen, 2007). Conclusion Alcohol abuse/dependence is related to medical, psychiatric, and social problems. Therefore, early detection and diagnosis are essential for its prevention and treatment. The Japanese version of AUDIT has been demonstrated to show satisfactory internal reliability. AUDIT is easy to use and is useful for detection of alcohol problems in occupational workers.
207
References Cherpitel, C. J., Ye, Y., Moskalewicz, J., and Swiatkiewicz, G. (2005). Screening for alcohol problems in two emergency service samples in Poland: comparison of the RAPS4, CAGE and AUDIT. Drug Alcohol Depend. 80, 201–207. Connor, J. P., Jack, A., Feeney, G. F., and Young, R. M. (2008). Validity of the obsessive compulsive drinking scale in a heavy drinking population. Alcohol. Clin. Exp. Res. 32, 1067–1073. Dawson, D. A., Grant, B. F., Stinson, F. S., and Chou, P. S. (2006). Estimating the effect of help-seeking on achieving recovery from alcohol dependence. Addiction 101, 824–834. De Silva, P., Jayawardana, P., and Pathmeswaran, A. (2008). Concurrent validity of the alcohol use disorders identification test (AUDIT). Alcohol Alcohol. 43, 49–50. Frank, D., DeBenedetti, A. F., Volk, R. J., Williams, E. C., Kivlahan, D. R., and Bradley, K. A. (2008). Effectiveness of the AUDIT-C as a screening test for alcohol misuse in three race/ethnic groups. J. Gen. Intern. Med. 23, 781–787. Higuchi, S. (2007). Present status and future prospects in therapy for alcoholism. Seishin Shinkeigaku Zasshi 109, 534–535. [in Japanese]. Hiro, H., and Shima, S. (1996). Availability of the alcohol use disorders identification test (AUDIT) for a complete health examination in Japan. Nihon Arukoru Yakubutsu Igakkai Zasshi 31, 437–450. [in Japanese]. Kim, S. S., Gulick, E. E., Nam, K. A., and Kim, S. H. (2008). Psychometric properties of the alcohol use disorders identification test: a Korean version. Arch. Psychiatr. Nurs. 22, 190–199. Kriston, L., Holzel, L., Weiser, A. K., Berner, M. M., and Harter, M. (2008). Meta-analysis: are 3 questions enough to detect unhealthy alcohol use? Ann. Intern. Med. 149, 879–888. Moussas, G., Dadouti, G., Douzenis, A., Poulis, E., Tzelembis, A., Bratis, D., et al. (2009). The alcohol use disorders identification test (AUDIT): reliability and validity of the Greek version. Ann. Gen. Psychiatry 8, 11. Reinert, D. F., and Allen, J. P. (2007). The alcohol use disorders identification test: an update of research findings. Alcohol. Clin. Exp. Res. 31, 185–199. Shevlin, M., and Smith, G. W. (2007). The factor structure and concurrent validity of the alcohol use disorder identification test based on a nationally representative UK sample. Alcohol Alcohol. 42, 582–587. Tsai, M. C., Tsai, Y. F., Chen, C. Y., and Liu, C. Y. (2005). Alcohol Use Disorders Identification Test (AUDIT): establishment of cut-off scores in a hospitalized Chinese population. Alcohol. Clin. Exp. Res. 29, 53–57. World Health Organization (2003). Screening and Brief Intervention for Alcohol Problems in Primary Health Care. Geneva, Switzerland: World Health Organization. www.who.int/substance_abuse/activities/ sbi/en/index.html. World Health Organization (2007). Summary of the Report from the WHO Collaborative Study on Alcohol and Injuries. Geneva, Switzerland: World Health Organization. www.who.int/substance_abuse/publications/ alcohol_injury_summary.pdf.