How to screen for at-risk alcohol use in transplant patients? From instrument selection to implementation of the AUDIT-C

Background Given that drinking >2-3 units of alcohol daily might already have adverse health effects, regular screening of at-risk drinking is warranted. We aimed to select and pilot a short instrument to accurately screen for at-risk drinking in transplant patients. Methodology and results Five consecutive steps were completed: A comprehensive literature review identified 24 possible self-report instruments (step 1). These instruments were scored on six yes/no criteria (ie, length, concept measured, diagnostic accuracy, population, manual available, cost) (step 2). Four nurses piloted three instruments with the highest score and were interviewed on their experiences with using the AUDIT-C, TWEAK, and Five Shot. The AUDIT-C was the easiest to use and score, and items were clear. Cognitive debriefings with 16 patients were conducted to verify clarity of instructions and items, and suggestions were incorporated into a modified version of the AUDIT-C (step 4). A convenience sample of 130 Dutch-speaking heart transplant patients completed the modified AUDIT-C during a scheduled visit (Step 5), revealing that 27.6% of patients showed at-risk drinking. Conclusion The AUDIT-C might be a suitable instrument to identify at-risk drinking in routine post-transplant follow-up. Further validation, however, is indicated.

Automated summary

By conducting literature review, scoring, nursing pilot testing, cognitive debriefings with patients, a modified AUDIT-C was found to be suitable for identifying at-risk drinking in heart transplant patients, with further validation needed.