Full AUDIT screening Vs shorter tools (FAST, AUDIT-C etc) for IBA

16 May

The 10 question full AUDIT is the ‘gold standard’ screening tool for the identification of alcohol use disorders. But does IBA always require the full AUDIT to be completed, or can shorter versions like FAST and AUDIT-C alone be used for effective brief intervention?quantity-versus-quality

Using the full AUDIT tool for IBA has two clear advantages. Firstly, it is proven to be more accurate. That is, it will correctly identify more at-risk or harmful drinkers who may potentially have been missed by a shorter tool. Additionally it is less likely to score a ‘false-positive’ whereby a lower risk drinker might be identified as at-risk. Of course screening scores to some degree are artificial cut-offs, but their role in ‘identification’ is the crucial cog in triggering contemplation.

However perhaps the main benefit of the full AUDIT is that the score specifically identifies one of four main drinking categories: low risk, increasing risk (hazardous), higher risk (harmful), or possibly dependent. Shorter versions only indicate either a lower risk or a ‘positive score’ – that is falling into one of the other three categories. Crucially we know that those with probable dependency (AUDIT score of 20+) are typically best suited to something beyond brief advice, so an offer of a referral to a treatment service should be suggested.

Shorter versions alone do not allow us to identify whether a referral for treatment should be offered, but they can of course save time. This is why many approaches to IBA start with shorter versions, which when positive, result in the remaining AUDIT questions being asked to give a full AUDIT score. This seems like the best of both worlds – busy practitioners can save time by using shorter versions, but accurately identify possible dependence by completing the remaining AUDIT questions when necessary. A useful integrated AUDIT C + remaining AUDIT questions tool is available.

Can shorter tools be used alone for IBA?

So what about using shorter tools to lead directly to brief advice for all positive scores, without asking the remaining full AUDIT questions? Some areas and indeed research trials have taken this approach. Certainly for the primary aim of IBA in identifying at-risk drinkers to deliver brief advice this is sufficient. But what about those who may be possibly dependent?

Following the SIPS trial, there is some concern that an over-emphasis may be placed on leaflet giving as part of IBA. Crucially it is identification of that person’s level of risk followed by feedback that is crucial (e.g. “your answers indicate you are placing your health at risk. How do you feel about that?”). A leaflet may well help a person to reflect further, and identify steps to cut down. A leaflet can also offer information on where to get further help, either listing local services or at least the Drinkline number (0800 917 8282).

Like many challenges, the ‘gold standard’ approach is not always achievable in the real world, so a practical compromise has to be made. Convincing busy A&E workers to ask 10 extra questions is understandably unlikely. One alcohol question (e.g the SASQ), resulting in some quick feedback and a leaflet has a greater chance. A common conclusion is arrived at – a good full AUDIT brief intervention with the opportunity for some brief advice discussion should be the goal. But in the real world, worthwhile benefits are still likely to arise from shorter approaches, as long as clients know where to go for further help or support.

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