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Despite being a widely used screening questionnaire, there is no consensus on the most appropriate measurement model for the Alcohol Use Disorders Identification Test (AUDIT). Furthermore, there have been limited studies on its measurement invariance across cross-cultural subgroups, genders, and sexual orientations. The present study aimed to examine the fit of different measurement models for the AUDIT and its measurement invariance across a wide range of subgroups by country, language, gender, and sexual orientation. Responses concerning past-year alcohol use from the participants of the cross-sectional International Sex Survey were considered (N = 62,943; Mage: 32.73; SD = 12.59). Confirmatory factor analysis, as well as measurement invariance tests were performed for 21 countries, 14 languages, three genders, and four sexual-orientation subgroups that met the minimum sample size requirement for inclusion in these analyses. A two-factor model with factors describing ‘alcohol use’ (items 1–3) and ‘alcohol problems’ (items 4–10) showed the best model fit across countries, languages, genders, and sexual orientations. For the former two, scalar and latent mean levels of invariance were reached considering different criteria. For gender and sexual orientation, a latent mean level of invariance was reached. In line with the two-factor model, the calculation of separate alcohol-use and alcohol-problem scores is recommended when using the AUDIT. The high levels of measurement invariance achieved for the AUDIT support its use in cross-cultural research, capable also of meaningful comparisons among genders and sexual orientations. •The Alcohol Use Disorders Identification Test (AUDIT) is a widely used questionnaire.•A model with factors of alcohol use and alcohol problems showed the best fit.•High levels of measurement invariance were achieved across subgroups.•The AUDIT can capture genuine differences cross-culturally.•The AUDIT can capture genuine differences between genders and sexual orientations.

Purpose The self-medication hypothesis suggests people may develop Alcohol Use Disorder (AUD) or Non-Alcohol Substance Use Disorder (NA-SUD) following PTSD as a maladaptive way of coping with PTSD symptoms. Given that an accumulation of trauma experiences and interpersonal trauma increase the likelihood and severity of PTSD, we sought to determine whether the number and type of traumas additionally predict AUD and NA-SUD following PTSD. Methods We analysed data from 36,309 adult participants in the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) study ( M  = 45.63 years, SD = 17.53, 56.3% female) who were administered semi-structured diagnostic interviews of trauma exposure and PTSD, AUD and NA-SUD symptoms. Results Individuals with PTSD were more likely to have an AUD or NA-SUD than those without PTSD. Endorsement of a greater number of traumas was associated with greater odds of having PTSD, AUD, or NA-SUD. Experience of interpersonal trauma was related to greater odds of having PTSD and subsequent AUD or NA-SUD than not experiencing interpersonal trauma. Multiple experiences of interpersonal trauma compared to one interpersonal trauma exposure also increased the odds of having PTSD followed by AUD or NA-SUD. Conclusions Interpersonal trauma and multiple experiences of interpersonal trauma may result in individuals turning to alcohol and substances as a way to alleviate intolerable PTSD symptomology, aligning with the self-medication hypothesis. Our findings highlight the importance of ensuring services and support for interpersonal trauma survivors and for those who have experienced multiple traumas given their increased for unfavourable outcomes.

The CAGE is a convenient test for alcohol-related disorder due to its brevity, but it is not as effective as the alcohol use disorders identification test (AUDIT). Gamma-glutamyl transferase (GGT) is an objective blood biochemical marker of excessive alcohol intake; however, it has low sensitivity. This study tested the performance of the combined use of CAGE and GGT to screen problem drinking (PD), alcohol use disorder (AUD), and alcohol dependence (AD). A total of 394 subjects composed of 91 normal controls and 303 subjects with PD were enrolled in this study. Of the PD subjects, 147 were diagnosed with AUD (77 alcohol abuse and 70 AD). A series of multiple logistic regression models for PD, AUD, and AD discrimination were used to obtain new combined CAGE and GGT scores after adjusting for age and gender (CAGE+GGT). A receiver operating characteristic curve analysis was conducted to determine how well the CAGE+GGT score discriminated between individuals with PD, AUD, and AD. The discrimination accuracy of the AUDIT for PD was significantly better than that of the CAGE or the CAGE+GGT (z=6.927, <0.0001; z=5.301, <0.0001, respectively). The CAGE and the CAGE+GGT were better than the AUDIT at discriminating AUD (z=2.535, =0.0112; z=2.894, =0.0038, respectively). The discrimination accuracy of the AUDIT for AD was significantly better than that of the CAGE and GGT (z=3.233, =0.0012; z=6.529, <0.0001, respectively), but the CAGE+GGT was comparable with the AUDIT (z=1.652, =0.0985). Our findings support the combined use of the CAGE questionnaire and serum GGT level as a sensitive and useful tool for AD screening.

Background Alcohol use disorders are among the mental disorders with the lowest treatment rates. Increasing the treatment rates requires insight on the reasons why patients do not seek treatment. This study examined self-reported reasons for not seeking treatment and their association with alcohol use disorder severity among primary health care patients diagnosed with an alcohol use disorder. Methods Alcohol use disorders, health service utilization, and reasons for not seeking treatment were assessed via interviews on regionally representative samples of primary care patients from 6 European countries (Italy, Germany, Hungary, Latvia, Poland and Spain, total N  = 9,098). Additionally, general practitioners had to fill in a questionnaire assessing their patients’ alcohol use and alcohol use disorders. A multinomial logistic regression was performed to investigate the association between reasons for not seeking treatment and alcohol use disorder severity. Results Of 1,008 patients diagnosed with an alcohol use disorder (via general practitioner or patient interview) in the past 12 months, the majority ( N  = 810) did not receive treatment and 251 of those gave a reason for not seeking treatment. The most frequent reason was ‘lack of problem awareness’ (55.3 % of those who responded), the second most common response was ‘stigma or shame’ (28.6 %), followed by ‘encounter barriers’ (22.8 %) and ‘cope alone’ (20.9 %). The results indicated lower probabilities of reporting ‘denial’ and higher probabilities to report ‘encounter barriers’ as alcohol use disorders severity increases. However, both trends were discontinued for patients with severe alcohol use disorders. Conclusions Particularly at lower levels of alcohol use disorder severity, a lack of problem awareness prevents patients from seeking treatment. Routinely alcohol consumption monitoring in primary care practices could help primary and secondary prevention of alcohol use disorders and increase treatment coverage.

Alcohol-associated liver disease (ALD)-related morbidity and mortality are rising in the United States. Although effective medications and behavioral interventions are available for the treatment of patients with alcohol use disorder (AUD), patients with ALD are profoundly undertreated for AUD. This article reviews the management of AUD in patients with ALD, with a focus on appropriate screening and diagnosis, management of alcohol withdrawal syndrome, pharmacotherapy for AUD, alcohol biomarkers, and behavioral interventions. Expanding access to AUD treatment is imperative for improving health outcomes in patients with ALD.

OBJECTIVE: The study investigated experiences of different types of work-related gender-based harassment (GBH), specifically sexual and gender harassment, as risk factors for alcohol-related morbidity and mortality (ARMM). METHODS: Information about experiences of (i) sexual harassment (SH-I) and (ii) gender harassment (GH-I) from inside the organization and (iii) sexual harassment from a person external to the organization (SH-E) were obtained from the Swedish Work Environment Survey 1995–2013, a biannual cross-sectional survey, administered to a representative sample of the Swedish working population. The survey responses from 86 033 individuals were connected to multiple registers containing information about alcohol-related diagnoses, treatment, or cause of death. Cox proportional hazard models were fitted to assess hazard ratios (HR) of incident ARMM during a mean follow-up of eight (SH-I and GH-I) and ten (SH-E) years. RESULTS: A higher prospective risk estimate of ARMM was found among participants who reported experiences of SH-E [HR 2.01, 95% confidence interval (CI) 1.61–2.52], GH-I (HR 1.33, CI 1.03–1.70), or SH-I (HR 2.37, CI 1.42–3.00). Additional analyses, distinguishing one-time from reoccurring harassment experiences, indicated a dose–response relationship for all three harassment types. Gender did not modify the associations. Under the assumption of causality, 9.3% (95% CI 5.4–13.1) of the risk of ARMM among Swedish women and 2.1% (95% CI 0.6–3.6) among Swedish men would be attributable to any of the three types of GBH included in this study. CONCLUSIONS: Experiences of GBH in the work context may be a highly relevant factor in the etiology of ARMM.

Alcohol use disorders (AUD) are a common cause of poor treatment outcomes among people with HIV (PWH). In Malawi, routine screening for AUD among PWH is unavailable. We piloted the utility of the Alcohol Use Disorders Identification Test (AUDIT) in screening for AUD among PWH and assessed its adoption, acceptability, and fidelity in HIV clinics in Malawi. We implemented the AUDIT tool at Mchinji, Kapiri, and Kochirira hospitals in Mchinji District between April and May 2021. Participants with AUD were defined and classified based on World Health Organization (WHO) classification as low risk, harmful/hazardous alcohol use, or alcohol dependence. We calculated the prevalence of AUD, the proportion of providers who conducted AUD screening (adoption), and the proportion of providers who conducted AUD screening as intended (fidelity) and compared the results between clinics. Lastly, we assessed acceptability through a survey among providers. Out of 2036 PWH, 875 (43%) were screened for AUD and 51% were female, mean age was 41 years (SD ± 12), and 338 (39%) had AUD. Adoption was highest at Mchinji (58%) compared to Kapiri (31%) and Kochirira (29%) (p < 0.001). Overall fidelity was 96%, and it was highest at Kapiri (99%) compared to Mchinji (95%) and Kochirira (98%) (p = 0.01). AUD screening with AUDIT was highly acceptable as most providers agreed or completely agreed that the AUDIT was important (100%), easy to use (96%), satisfactory (96%), agreed to continue using (61%), and recommended it for other facilities in the district (100%). People with AUD were common among PWH. While the adoption of AUDIT for AUD screening was moderate, acceptability and fidelity were high. The impact of AUD on HIV treatment outcomes needs to be assessed to determine the role of routine AUD screening in HIV clinics in Malawi. •Alcohol use disorders are common among people with HIV in Malawi.•Use of the AUDIT tool for AUD screening is acceptable among providers.•The use of the AUDIT tool for AUD screening among providers was sub-optimal.•Among providers who accept to use the AUDIT tool, level of fidelity is high.

The present paper summarizes the preclinical and clinical studies conducted to define the \"anti-alcohol\" pharmacological profile of the prototypic GABAB receptor agonist, baclofen, and its therapeutic potential for treatment of alcohol use disorder (AUD). Numerous studies have reported baclofen-induced suppression of alcohol drinking (including relapse- and binge-like drinking) and alcohol reinforcing, motivational, stimulating, and rewarding properties in rodents and monkeys. The majority of clinical surveys conducted to date-including case reports, retrospective chart reviews, and randomized placebo-controlled studies-suggest the ability of baclofen to suppress alcohol consumption, craving for alcohol, and alcohol withdrawal symptomatology in alcohol-dependent patients. The recent identification of a positive allosteric modulatory binding site, together with the synthesis of in vivo effective ligands, represents a novel, and likely more favorable, option for pharmacological manipulations of the GABAB receptor. Accordingly, data collected to date suggest that positive allosteric modulators of the GABAB receptor reproduce several \"anti-alcohol\" effects of baclofen and display a higher therapeutic index (with larger separation-in terms of doses-between \"anti-alcohol\" effects and sedation).

Background Early identification of potential alcohol-problems is central for timely intervention and treatment referral. The Alcohol Use Disorders Identification Test (AUDIT) and AUDIT-Consumption (AUDIT-C) serve as globally recognized and validated screening tools for this purpose. We aimed to evaluate the diagnostic validity of internationally recommended AUDIT cut-off scores ≥ 8, ≥16, ≥ 20, and AUDIT-C cut-off scores ≥ 4, ≥5 using the Danish language versions of questionnaires in a hospital setting. Methods Questionnaire data were collected from 2/15/2023, to 4/27/2023 at the Department of Gastroenterology and Hepatology, Odense University Hospital, Denmark. We tested the World Health Organization’s recommended AUDIT cut-offs: ≥8 for hazardous use, ≥ 16 suggestive of dependence, ≥ 20 high likelihood of dependence, along with AUDIT-C ≥ 4 and ≥ 5 using the following reference standard: Danish low-risk drinking guidelines (≤ 10 standard drinks/week) for hazardous use and self-reported ICD-10 alcohol dependence criteria for alcohol dependence. Analyses included ROC curves, AUC, sensitivity, specificity, predictive values, and agreement. Results Three hundred patients participated, mean age 52 years (SD 17.4, median 54) and 51.3% males. Mean AUDIT score was 4.5 (SD 5.8, median 3) with fourteen (4.7%) meeting at least three self-reported ICD-10 criteria for alcohol dependence. The prevalence of hazardous use was 10.7%. AUDIT ≥ 8 exhibited a sensitivity of 56% (95% CI 40.6–73.6) and specificity 91% (95% CI 87.8–94.5) for detecting hazardous use. Against at least three self-reported ICD-10 criteria for alcohol dependence, AUDIT cut-off ≥ 16 showed a sensitivity of 85% (95% CI 66.1–98.2) with 97% specificity (95% CI 96.0-99.2), while cut-off ≥ 20 had a sensitivity of 71% (95% CI 49.2–91.6) with 99% specificity (95% CI 98.1–99.9). The AUDIT-C cut-offs ≥ 4 and ≥ 5 exhibited low positive predictive values in detecting hazardous use (30.8% for ≥ 4 and 36.8% for ≥ 5) and dependence (13.5% for ≥ 4 and 18.4% for ≥ 5) and demonstrated a specificity ranging from 68.5 to 82.1% with negative predictive values from 98.2 to 100%. Conclusion In Danish gastroenterology and hepatology departments, the AUDIT and AUDIT-C may be used to identify patients who are unlikely to have an alcohol problem, while positive screen results should be carefully considered and followed by more exhaustive assessment.

Objective The study aimed to identify the missed opportunity for detection and management of alcohol use disorder by primary health care workers. Design A cross-sectional survey Setting Outpatient services in the six governmental primary health care facilities in Moshi district council in Tanzania. Participants A total of 1604 adults were screened for alcohol use disorder (AUD) using the Alcohol Use Disorder Identification Test (AUDIT). Participants scoring 8 or above then provided details about their help-seeking behavior and barriers to seeking care. Participants’ records were reviewed to assess the screening and management of AUD. Results In the last 12 months, 60.7% reported alcohol use, and heavy episodic drinking (HED) was reported by 37.3%. AUD (AUDIT ≥ 8) was present in 23.9%. Males were more likely to have HED (aPR = 1.43;95% CI:1.3 to 1.4) or AUD (aPR = 2.9; 95% CI 1.9 to 4.2). Both HED and AUD increased with age. Only one participant (0.3%) had documented AUD screening and management. Only 5% of participants screening positive for AUD had sought help. Reasons for not seeking care were thinking that the problem would get better by itself (55.0%), wanting to handle the problem alone (42.0%), or not being bothered by the problem (40.0%). Conclusion While reported alcohol use, HED, and AUD are common among patients presenting to primary healthcare facilities in northern Tanzania, help-seeking behavior and detection are very low. Not screening for AUD in primary health care is a missed opportunity for early detection and management. There is an urgent need to develop interventions to increase the detection of AUD by health care providers, while also addressing help-seeking behavior and barriers to seeking care.