Validation of the AUDIT and AUDIT-C for Hazardous Drinking in Community-Dwelling Older Adults

Background: One of the best-known tools in screening for hazardous drinking is the Alcohol Use Disorders Identification Test (AUDIT) and its abbreviated form, the AUDIT-C. The aim of the present study is to determine the cut-offs of both instruments in identifying hazardous drinking in older adults. Method: A sample of 1577 older adults completed a questionnaire regarding alcohol behavior. Hazardous drinking was defined as drinking >10 units/week. Receiver operating characteristics (ROC) curves of AUDIT and AUDIT-C were calculated and cut-off scores were derived. Results: Respectively 27.3% and 12.3% of older men and women drank >10 units/week. For the AUDIT the best trade-off between sensitivity and specificity was using a cut-off of ≥5 for men and ≥4 for women, which yielded in men sensitivity and specificity values respectively of 80.7% and 81.3% and in women 100% and 71.7%, respectively. We found the AUDIT-C to perform well with an optimal cut-off of ≥5 for men and ≥4 for women, which generated in men sensitivity and specificity values respectively of 76.5% and 85.3% and in women 100% and 74.1%, respectively. Conclusion: The AUDIT-C is accurate and sufficient in screening for hazardous drinking in community-dwelling older adults if the cut-offs are tailored by gender.

Women's Involvement in Alcohol Consumption as an Element of Asocial Adaptation at the Present Stage

The aim of the work is to consider the features of alcoholic behavior of a modern woman. The situation with the involvement of various groups of women in alcohol consumption is analyzed on the basis of quantitative and qualitative long – term studies conducted by the team of Sector of Sociology of Deviant Behavior of ISRAS – FCTAS RAS at the end of the 20th century, at the turn of the century – in the “zero” years and in modern times. The results of comparative studies conducted by the authors, allowed us to reveal and identify the mechanism of cause-and-effect relationships that led to new models of women’s alcohol behavior. These new patterns of alcohol behavior should be considered as one of the forms of strategic adaptation to changing living conditions. The revealed patterns indicate a significant influence of gender and age on the frequency, intensity and type of alcohol consumption. These new patterns of alcohol behavior represent a form of strategic adaptation to changed living conditions. In this sense, alcohol acts as a universal and most accessible means, satisfying, on the one hand, the need for state of intoxication, for changing one’s state of consciousness, fixed in modern society, and on the other hand, it is a fashionable and exemplary standard of behavior, a socio-cultural norm or ritual. This attitude allows and justifies the “quiet” alcoholization of women managers, housewives, drunkenness in the workplace, holidays in the team, “relaxation” on the way home, including driving, or in the evening at home, after work. In other words, alcohol in moderate doses takes its place in labor, business, leisure, and communication activities of modern women.

Screening, Brief Intervention and Referral to Treatment Implementation in the Emergency Department

We sought to qualitatively evaluate impediments in implementing a novel Screening, Brief Intervention and Referral to Treatment (SBIRT) protocol into normal emergency department (ED) workflow for patients with at-risk drug/alcohol behavior. From 2010, administrative and nursing champions trained nurses at a single ED (census: 50,000 visits/yr) in SBIRT and incorporated SBIRT into normal ED nursing workflow in 2012. To qualitatively analyze impediments in SBIRT implementation, we created a semi-structured questionnaire for protocol champions with subsequent follow-up. Investigators analyzed responses using qualitative methodology based on a modified grounded theory framework. In 2012, 47693 visits by 31525 patients met SBIRT protocol initiation criteria with a protocol execution rate of 83.4%. Interview data identified the following impediments: (1) Need for multi-layer leadership support; (2) Application of an overarching vision to constantly address personnel attitudes towards SBIRT appropriateness in the ED; (3) Continuous performance monitoring to address implementation barriers close to real time; (4) Strategic and adaptive SBIRT training; and (5) External systemic changes through internal leadership. Qualitative analysis suggests that impediments to SBIRT implementation in the ED include views of SBIRT appropriateness in the ED, need for continuous reinforcement/refinement of personnel training / protocol execution, and fostering of additional administrative/financial champions.