Alcohol use

Alcohol Use Disorders Identification Test (AUDIT)

The World Health Organization (WHO) developed the 10-item AUDIT (Information sheet 22, Questionnaire 19) (Barbor et al., 2001; Saunders et al., 1993). The instrument covers three fields, i.e. alcohol abuse, dependence and pathological consumption. What differentiates it from the CAGE questionnaire (see below) is that the AUDIT can detect less severe forms of alcohol-related problem behaviours (Bradley et al., 1998; Dhalla and Kopec, 2007). This instrument is criticized for certain aspects, such as the uneven distribution of the items in the total score, e.g. three items explain 90% of the total score, and to identify individuals as at-risk consumers when they often consume alcohol but do not display any problematic signs (Bernards et al., 2007). Moreover, it tends to underestimate alcohol dependence among women (Bradley et al., 1998). Its clinical use is still recommended to conduct screening but it would be less appropriate in population-based studies to assess the proportions of at-risk individuals with the threshold recommended when it was designed (Bernards et al., 2007). To circumvent this problem, some studies have developed sub-indicators (Information sheet 22) (Bernards et al., 2007).

CAGE Questionnaire

The CAGE questionnaire1 (or the DETA in French) identifies individuals experiencing alcohol-related problems, i.e. alcohol abuse or dependence (Information sheet 23, Questionnaire 20) (Ewing, 1984). The four-item instrument is short, easy to administer and simple to compile. It is used mainly in clinical practice and has good psychometric properties (Dhalla and Kopec, 2007). However, it is subject to criticism. It predicts the prevalence of disorders over an entire lifetime, which makes it impossible to distinguish between present and past problems. Furthermore, its results for women and adolescents are unsatisfactory (Bradley et al., 1998; Dhalla and Kopec, 2007; Knight et al., 2003). It does not allow for clinical screening of less severe forms of problem behaviours (Dhalla and Kopec, 2007). What is more, it does not appear to be an effective screening instrument in the total population. This instrument was used in a Québec survey in 1992 and validity testing confirmed that it does not allow for the identification of individuals whose alcohol use is excessive (Bisson, Nadeau, and Demers, 1999).

The CAGE-AID version jointly screens alcohol- and drug -related problems. It contains the same four items as the CAGE instrument but each item must be answered taking into account alcohol and drug use. Accordingly, it is impossible to determine through the score whether the problem is caused by drugs or alcohol. Neither this version nor the first one is recommended in the context of post-disaster surveillance.

Detection of Alcohol and Drug Problems in Adolescents (DEP-ADO)

The DEP-ADO is an instrument developed in Québec that assesses alcohol and drug use among adolescents (12 to 17 years of age) and screens problematic use. It was developed mainly for interveners but is also used in population-based surveys (RISQ, 2016). However, the 27-item instrument is relatively long and covers alcohol and drugs (Information sheet 24). It measures the consumption of at least seven categories of drugs over the past 12 months, alcohol abuse on a given occasion, and the adverse consequences associated with their consumption. In Québec, it has been used in the QHSHSS (Table 3). The instrument has acceptable psychometric properties. Some 80% of young people are classified correctly according to the DEP-ADO (Landry et al., 2005; Lécallier et al., 2012). It is regularly updated. Consequently, the questionnaire is not included in this toolkit but is readily available online on the Recherche et intervention sur les substances psychoactives – Québec website (RISQ, 2016).

Other questions related to alcohol use

Since the instruments recommended appear to be less effective to evaluate a difference in alcohol use before and after an event, it can be useful to use questions related to alcohol use already presented in the population-based surveys, even if the instruments are not standardized.

The “Alcohol use” module of the Canadian Community Health Survey (CCHS) measures frequency of consumption (at least one drink and four or five drinks on a given occasion) during the 12 previous months. Another section of the questionnaire ascertains the number of drinks each day over the previous week (Questionnaire 21) (Statistics Canada, 2018). This module is available in several cycles, which facilitates pre- and post -event comparisons (Table 4).

A more direct way to measure alcohol use is to ask the respondent if his alcohol use has increased, decreased or remained stabled after the disaster. A sample formulation to evaluate this behaviour is available in Questionnaire 21.

  1. CAGE is an acronym that includes several words in the questionnaire: Cut down, Annoyed, Guilty and Eye-opener.