Distribution of self-reported alcohol consumption: comments on Gregson and Stacey

Short screening tools for risky drinking in Aboriginal and Torres Strait Islander Australians: modified AUDIT-C and a new approach

BACKGROUND

Alcohol consumption among Indigenous Australians can involve a stop-start pattern of drinking, with consumption well above recommended guidelines on each occasion. Such intermittent drinking patterns can make screening for risky drinking difficult. This study evaluates the ability of several short alcohol screening tools, contained in the Grog Survey Application, to detect short- or long-term risky drinking as defined by Australian guidelines. Tested tools include a modification of Alcohol Use Disorders Identification Test-Consumption (AUDIT-Cm).

METHODS

Alcohol consumption was assessed in current drinkers in the past year (n = 184) using AUDIT-Cm and using the last four drinking occasions (Finnish method). Sensitivity and specificity were assessed relative to the Finnish method, for how AUDIT-Cm score (3 + for women, 4 + for men), and how subsets of AUDIT-Cm questions (AUDIT-1m and AUDIT-2m; and AUDIT-3mV alone) were able to determine short- or long-term risk from drinking. Responses to AUDIT-Cm were used to calculate the average standard drinks consumed per day, and the frequency at which more than four standard drinks were consumed on single occasions. Finally, shorter versions of the Finnish method (1, 2, or 3 occasions of drinking) were compared to the full Finnish method, by examining the percentage of variance retained by shorter versions.

RESULTS

AUDIT-Cm has a high sensitivity in detecting at-risk drinking compared with the Finnish method (sensitivity = 99%, specificity = 67%). The combination of AUDIT-1m and AUDIT-2m was able to classify the drinking risk status for all but four individuals in the same way as the Finnish method did. For the Finnish method, two drinking sessions to calculate drinks per drinking occasion, and four to calculate frequency resulted in nearly identical estimates to data on all four of the most recent drinking occasions (r² = 0.997).

CONCLUSIONS

The combination of AUDIT-1m and AUDIT-2m may offer advantages as a short screening tool, over AUDIT-3mV, in groups where intermittent and high per occasion drinking is common. As an alternative to the full Finnish method, the quantity consumed on the last two occasions and timing of the last four occasions may provide a practical short screening tool.

Measuring Alcohol Consumption

This article is an overview of different approaches to measuring alcohol consumption: self-reports and objective measures such as blood alcohol concentration (BAC) and aggregate level measures. These approaches are evaluated as regards their ability to capture quantity, frequency, volume and variability of drinking. This review focuses on self-report measures and on the current knowledge of undercoverage error when compared with sales data. In the comparative evaluation of measures, two analytical aims are examined: a) description and testing of differences across groups for which ordinal information is sufficient and b) establishment of cutoff points and risk relationships for which unbiased interval scale level is required. First, minimal differences were found between self-report measures when the recall period was sufficiently long enough. Second, prospective diaries appear to be stronger measures than retrospective recalls. However, prospective diaries commonly cover only short reporting periods and should be combined with simple retrospective measures to capture rare and infrequent drinking episodes. In regard to undercoverage, the discrepancy cannot be fully explained by non-response or concealment of consumption by drinkers. It is argued that undercoverage of sales data may be more related to sample frame defects–-e.g., the non-inclusion of particular subpopulations such as the homeless or institutionalized.

Towards agreement on ways to measure and report drinking patterns and alcohol-related problems in adult general population surveys: the Skarpö conference overview

A thematic conference of the Kettil Bruun Society (KBS) for Social and Epidemiological Research on Alcohol was held in Skarpö, near Stockholm, on April 3-7, 2000. The goals of the meeting were to develop consensus sets of questionnaire items for measuring alcohol consumption and social harm, to delineate statistical and practical concerns related to the aggregation of consumption and harm data and to identify summary measures to be used for descriptive purposes and in analyses of the association between alcohol intake and alcohol-related outcomes. The results of the conference discussions are summarized below, with emphasis on both areas where the conference yielded recommendations for measures and methods of aggregation for analysis, and on areas where consensus could not be obtained and/or where additional research is needed.

Comparison of six alcohol consumption measures from survey data

Data were collected from a national sample of 1680 New Zealanders that allowed comparison of six different alcohol consumption measures. A measure based on reports of typical frequency and the amount typically consumed in 15 specified drinking locations produced the highest estimate of consumption. This measure and three others showed a particularly high degree of correlation, these being: a measure based on typical frequency and typical occasion amount; a variation of the Finnish period estimate; and a New Zealand variation of the period estimate that incorporated a typical frequency measure. The four measures just described, together with a last 7 days measure, showed generally consistent results when data were examined at the level of the total population and age, gender and socio-economic sub-groups. A measure based on the last two drinking occasions showed the least consistency with the other measures. The high degree of consistency found in the present study is similar to that found in a previous Finnish study and gives confidence that different ways of obtaining information about alcohol consumption, including relatively quick methods, can lead to similar conclusions about the comparative drinking of population sub-groups.

Estimating drug consumption in opioid users: reliability and validity of a 'recent use' episodes method

The efficient and accurate measurement of recent drug use is an essential component of treatment and research among opioid users. Urinalysis results alone will not give sufficient information to either the clinician or researcher, due to limitations in detection and an inability to distinguish extent of use. The present paper describes a 'recent use episodes method', adapted from the measurement of alcohol consumption, for obtaining self-reported drug use in eleven different drug categories. Reliability and validity data indicate that the method provides a quick means by which accurate information may be obtained on the overall recent drug use of opioid users.

Self-reported alcohol consumption; a real psychophysical problem

There are good practical reasons for wanting to know how much alcohol people consume, at what rate, and in what patterns over time. Various measures of consumption and their associated frequency distributions are described. Self-report data on alcohol consumption present problems of interpretation. A detailed rationale for the use of the self-report method by Gregson and Stacey (1980) is presented. Measurement problems arising with the method, emphasized by Skog (1981), are discussed.