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2011 HSR&D National Meeting Abstract

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2011 National Meeting

1013 — Diagnostic Efficiency of the AUDIT-C in OEF/OIF Veterans

Calhoun PS (Durham COE and VISN 6 MIRECC), Crawford EF (Durham VAMC), VISN-6 MIRECC Registry Workgroup (VISN-6 MIRECC)

Objectives:
Military service in Afghanistan (Operation Enduring Freedom; OEF) and Iraq (Operation Iraqi Freedom; OIF) has been associated with high rates of mental health problems including substance use. Alcohol screening with the 3-item Alcohol Use Disorders Identification Test (AUDIT-C; Bush et al., 1998) has been implemented throughout the Veterans Health Administration, however, validation of the AUDIT-C in veteran populations has been conducted primarily in older veterans. This study was designed to assess the diagnostic accuracy of the AUDIT-C among relatively younger OEF/OIF era veterans.

Methods:
Participants included OEF/OIF veteran volunteers (n = 615) from the VISN-6 MIRECC Recruitment Database for the Study of Post-Deployment Mental Health. Participants had an average age of 37 years (SD = 10.4), were predominately male (81%), currently employed (70%), and included 40% Caucasians and 41% African Americans. Participants completed a survey containing the AUDIT and underwent clinical structured interview using the Structured Clinical Interview for DSM-IV (SCID; First et al, 2002). Signal detection analyses were used to evaluate the performance of the AUDIT and AUDIT-C. Areas under receiver operating characteristic curves (AUCs) were calculated for the screens compared to a reference standard of SCID based diagnoses of current alcohol abuse or dependence, i.e., alcohol use disorder (AUD), as well as past year abuse/dependence. The impact of demographic variables on test performance was examined.

Results:
The base rate for current AUD and past year AUD was 5% and 23.8%, respectively. The AUDIT-C (AUC = .923; SE = .028) and the full AUDIT (AUC = .931; SE = .025) performed equally well in detecting current AUD. Diagnostic accuracy was somewhat less for identification of past-year alcohol problems (AUDIT-C AUC = .723; SE = .03; AUDIT AUC = .740, SE = .03). Sensitivities and specificities of AUDIT-C scores were largely consistent with results from older veteran samples. The diagnostic accuracy of both measures did not vary according to race or age.

Implications:
The AUDIT and AUDIT-C are valid screening tests for active alcohol abuse or dependence among recently returning veterans from OEF/OIF.

Impacts:
OEF/OIF veterans should be screened for substance misuse. The AUDIT-C is a useful screen for current alcohol problems in returning veterans.


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