Alcohol screening and assessment measures for young people: A systematic review and meta-analysis of validation studies

Source: Toner, P., Böhnke, J. R., Andersen, P., & McCambridge, J. (2019). Alcohol screening and assessment measures for young people: a systematic review and meta-analysis of validation studies. Drug and alcohol dependence.

Highlights

• First review of validation evidence for measures to assess young people’s drinking.
• Alcohol frequency or quantity is an efficient single item screener for risky drinking.
• Most validation evidence for screening measures exists for the AUDIT and AUDIT-C.
• Little validation evidence for assessment measures of alcohol-related problems.
• New assessment instruments are needed to capture alcohol-related problems.

Abstract

Background

There is a strong rationale for clinicians to identify risky drinking among young people given the harms caused by alcohol. This systematic review evaluates the quality of evidence in the validation literature on alcohol screening and assessment measures for young people under 25.

Methods

Six electronic databases (MEDLINE; EMBASE; PsycINFO; SSCI; HMIC; ADAI) were searched in May 2016 for published and grey literature. Full-text reports published in English since 1980 were included if they aimed to validate an alcohol screening or assessment measure in comparison with a previously validated alcohol measure. Risk of bias was assessed in studies surpassing a priori quality thresholds for predictive validity, internal and test-retest reliability using COSMIN and QUADAS-2.

Results

Thirty nine reports comprising 135 discrete validation studies were included. Summary estimates indicated that the screening instruments performed well - AUC 0.91 (95% CI: 0.88 to 0.93); sensitivity 0.98 (0.95 to 0.99); specificity 0.78 (0.74 to 0.82). Noting a paucity of validation evidence for existing assessment instruments, aggregated reliability estimates suggest a reliability of 0.81 (0.78 to 0.83) adjusted for 10 items. Risk of bias was high for both types of studies.

Conclusions

The volume and quality of available evidence are superior for screening measures. It is recommended that clinicians use alcohol frequency or quantity items if asking a single question. If there is an opportunity to ask more questions either the 3-item AUDIT-C or the 10-item AUDIT are recommended. There is a need to develop new instruments to assess young people’s alcohol-related problems.