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Journal Article


Vickers Smith R, Kranzler HR, Justice AC, Tate JP. Alcohol Clin. Exp. Res. 2019; 43(3): 465-472.


Yale University School of Medicine, New Haven, CT, 06510.


(Copyright © 2019, John Wiley and Sons)






BACKGROUND: A variety of measures have been developed to screen for hazardous or harmful drinking. The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) is one of the screening measures recommended by the U.S. Preventive Services Task Force. Annual administration of the AUDIT-C to all primary care patients is required by the U.S. Veterans Affairs Health System. The availability of data from the repeated administration of this instrument over time in a large patient population provides an opportunity to evaluate the utility of the AUDIT-C for identifying distinct drinking groups.

METHODS: Using data from the Million Veteran Program cohort, we modeled group-based drinking trajectories using 2,833,189 AUDIT-C scores from 495,178 Veterans across an average 6-year time period. We also calculated patients' age-adjusted mean AUDIT-C scores to compare to the drinking trajectories. Finally, we extracted data on selected clinical diagnoses from the EHR and assessed their associations with the drinking trajectories.

RESULTS: Of the trajectory models, the four-group model demonstrated the best fit to the data. AUDIT-C trajectories were highly correlated with the age-adjusted mean AUDIT-C scores (rs=0.94). Those with an alcohol use disorder diagnosis had 10 times the odds of being in the highest trajectory group (consistently hazardous/harmful) compared to the lowest drinking trajectory group (infrequent). Those with hepatitis C, PTSD, liver cirrhosis, and delirium had 10%, 7%, 21%, and 34%, respectively, higher odds of being classified in the highest drinking trajectory group vs. the lowest drinking trajectory group.

CONCLUSION: Trajectories and age-adjusted mean scores are potentially useful approaches to optimize the information provided by the AUDIT-C. In contrast to trajectories, age-adjusted mean AUDIT-C scores also have clinical relevance for real-time identification of individuals for whom an intervention may be warranted. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.

Language: en


alcohol use disorder; electronic health record data; group-based trajectory modeling; hazardous drinking


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