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Predictors of Treatment Referral After AUDIT-C Screening for Heavy Drinking

Naps, Michelle S., MD*,†; Maass, Daniel, MD*; Kranzler, Henry R., MD*,†; Smith, Rachel V., PhD; Ingram, Erin, BA; Oslin, David W., MD*,†

Addictive Disorders & Their Treatment: September 2018 - Volume 17 - Issue 3 - p 124–133
doi: 10.1097/ADT.0000000000000134
Original Articles

Objectives: The Veterans Health Administration has implemented annual screening for heavy drinking during primary care encounters using the 3-item Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaire and made specialized services available to patients with alcohol use disorders (AUDs). We sought to identify the factors that influence whether a patient who has an elevated AUDIT-C score receives appropriate care in the context of an integrated mental health services program. We focused on higher AUDIT-C scores, as these are seen in individuals who are most likely to have a moderate-to-severe AUD and more severe alcohol-related consequences.

Methods: Utilizing electronic health record data, we conducted a 4-year retrospective study of veterans at high-risk for an AUD, based upon an AUDIT-C score ≥8 recorded during a primary care encounter at a Veterans Affairs Medical Center and its community-based outpatient clinics.

Results: In multivariate analysis, the predictors of treatment referral were younger age, being nonwhite, higher AUDIT-C score, and main campus location. Among patients referred for treatment, younger age and being white were associated with an increased likelihood of completing a pretreatment assessment.

Conclusions: Efforts to increase the consistency of treatment referrals, according to established clinical guidelines, could enhance the effectiveness of AUDIT-C screening during primary care visits. Subgroups of patients who may benefit from such efforts include individuals with high-risk but submaximal AUDIT-C scores, older patients, and patients who are seen at community-based outpatient clinics.

*Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA

Veterans Integrated Service Network 4, Mental Illness Research, Education, and Clinical Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA

Supported by the VISN 4 Mental Illness Research, Education, and Clinical Center (MIRECC) and the Office of Academic Affiliations, Advanced Fellowship Program in Mental Illness Research and Treatment, Department of Veterans Affairs.

The views expressed in the article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the US Government.

H.R.K.: has been an Advisory Board Member, Consultant, or CME speaker for Indivior and Lundbeck. He is also a member of the American Society of Clinical Psychopharmacology’s Alcohol Clinical Trials Initiative (ACTIVE), which was supported in the last 3 years by AbbVie, Alkermes, Ethypharm, Indivior, Lilly, Lundbeck, Otsuka, Pfizer, Arbor, and Amygdala Neurosciences. The remaining authors declare that they have nothing to disclose.

Reprints: David W. Oslin, MD, University of Pennsylvania, Treatment Research Center, 3900 Chestnut Street, Philadelphia, PA 19104 (e-mail:

Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.

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