臨床強力なエビデンス

Hazardous and Harmful Alcohol Use

Saunders, J. B., Aasland, O. G., Babor, T. F., de la Fuente, J. R. & Grant, M. · 1993

別名: Hazardous drinking · Harmful drinking · AUDIT framework

This framework replaces the binary question of whether someone is alcohol dependent with a graded risk continuum running from low-risk drinking through hazardous use (a pattern that increases the risk of harm) and harmful use (a pattern already causing harm) to probable dependence. The clinical payoff is that the largest group causing population-level harm is not the dependent minority but the much larger hazardous-drinking majority, who are invisible to dependence-focused screening and who respond well to brief intervention. Assessment therefore covers consumption, dependence symptoms and alcohol-related problems as three separate domains.

Framework that separates drinking into a graded risk continuum rather than a yes-or-no diagnosis. It comes from the World Health Organization's ICD-10 vocabulary, where hazardous use is a pattern that raises the risk of harm before any harm has happened, and harmful use is a pattern that has already damaged physical or mental health. Dependence sits beyond both and is a separate category. The point of the distinction is timing: it was built to find people early, in general health care, while the pattern is still cheap to change, which is why the measurement asks about ordinary drinking behaviour instead of about symptoms of illness. Three things get read together and none of them alone: how much and how often a person drinks, whether the drinking has started to run itself, and whether it has begun to cost anything. A reading on this continuum is a screening signal about a pattern of behaviour over a period, not a statement about a person and not a diagnosis.

出典:: Saunders, J. B., Aasland, O. G., Babor, T. F., de la Fuente, J. R., & Grant, M. (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption II. Addiction, 88(6), 791-804. Babor, T. F., Higgins-Biddle, J. C., Saunders, J. B., & Monteiro, M. G. (2001). AUDIT: Guidelines for Use in Primary Care (2nd ed.). Geneva: World Health Organization. WHO/MSD/MSB/01.6a.
デジタルオブジェクト識別子 — ジャーナル記事への直接リンク。:: 10.1111/j.1360-0443.1993.tb02093.x

測定する

この理論に基づいて構築された検証済みテストを受ける

構成概念について読むことは何であるかを教えてくれます。検証済み測定具はそこでの自分の位置を教えてくれます。無料で受けられ、数分で結果が出ます。

無料で開始 1件のテストをすべて見る

エビデンス概要

実証的サポート: 強力なエビデンス
再現性: 十分に再現
異文化: ほぼ普遍的
メタ分析: 16件索引済み

研究領域依存症研究プライマリケア公衆衛生精神科疫学

これらの評価は、理論に関する公開文献を要約したもので、それに基づいて構築された個々のテストの品質ではありません。以下に記載された出典に基づく編集判断であり、エビデンスが蓄積されるにつれて変化します。

歴史的背景

The World Health Organization commissioned the Alcohol Use Disorders Identification Test in the early 1980s as a cross-nationally valid screen, developed and validated across six countries — Norway, Australia, Kenya, Bulgaria, Mexico and the United States — which is unusual among psychiatric instruments and explains its cross-cultural performance. Saunders and colleagues published the validation in 1993. The shorter AUDIT-C, covering consumption items only, followed in 1998. The instrument is central to the WHO's screening and brief intervention strategy, which has substantial trial evidence behind it.

構成概念

アルコール使用リスク

The risk carried by a person's current pattern of drinking, read across three things at once: how much and how often they drink, whether the drinking has begun to run itself (not stopping once started, needing a morning drink, blackouts), and whether it has already cost something (guilt, failed obligations, injury, other people saying so). It is graded rather than binary, and it is deliberately about a pattern over a period rather than about a person: the same reading can describe a stretch of months that ends. Because the questions are transparent, the measurement is easy to understate on purpose, which limits what a low reading can prove and leaves a high one hard to explain away.

機器

The Alcohol Use Disorders Identification Test(AUDIT)Saunders, J. B., Aasland, O. G., Babor, T. F., de la Fuente, J. R., & Grant, M. (development, 1993); Babor, T. F., Higgins-Biddle, J. C., Saunders, J. B., & Monteiro, M. G. (manual, 2001); World Health Organization2001

この理論に基づくテスト

AUDIT: the World Health Organization alcohol use test

Ten questions, a score from 0 to 40, and the four risk zones the World Health Organization publishes for its own alcohol test.

詳しく見る →

実践的応用

AUDIT is used in primary care, emergency departments and occupational health to identify risky drinking early enough for brief intervention to work, and in population surveys to estimate risk distribution. Its four published risk zones map to graded responses: education, brief advice, brief counselling with monitoring, or referral for diagnostic evaluation. Read individually, it locates a drinking pattern on a risk continuum; it does not diagnose an alcohol use disorder, which requires clinical assessment.

測定方法

Ten self-report items across consumption, dependence and harm domains, summed 0 to 40 and read against four published risk zones; screening only, with no diagnostic inference.

批評と制限事項

All alcohol screening depends on self-reported consumption, which is systematically underreported, and underreporting increases exactly where stakes are highest — employment, driving, custody contexts. The conventional cutoff of 8 performs differently by sex, with evidence supporting a lower threshold for women, and by age; a single universal threshold sacrifices accuracy for simplicity. Drinking patterns and standard-drink definitions vary enough across countries that consumption items are not strictly comparable internationally. AUDIT-C, being consumption-only, misses harm and dependence indicators entirely.

主要文献

Saunders, J. B., Aasland, O. G., Babor, T. F., de la Fuente, J. R. & Grant, M.. (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption, II. 10.1111/j.1360-0443.1993.tb02093.x
Babor, T. F., Higgins-Biddle, J. C., Saunders, J. B. & Monteiro, M. G.. (2001). AUDIT: The Alcohol Use Disorders Identification Test, Guidelines for Use in Primary Care, 2nd edition.
Bush, K., Kivlahan, D. R., McDonell, M. B., Fihn, S. D. & Bradley, K. A.. (1998). The AUDIT alcohol consumption questions (AUDIT-C): An effective brief screening test for problem drinking. 10.1001/archinte.158.16.1789