ALCOHOL USE AMONG SWEDES AND A PSYCHOMETRIC EVALUATION OF THE ALCOHOL USE DISORDERS IDENTIFICATION TEST
Abstract
The Alcohol Use Disorders Identification Test (AUDIT) was completed by 997 persons randomly selected from the general Swedish population (80% response rate). Eighteen per cent of the men and 5% of the women had hazardous or harmful alcohol use according to the > or =8 score criterion. AUDIT scores decreased with increasing age in both genders. Women are more sensitive to alcohol than men and when the cut-off score was set to > or =6, the female prevalence of hazardous or harmful alcohol use increased to nearly 11%. The 'binge drinking' question explained half of the total AUDIT variance and is thus the best item indicator of hazardous or harmful alcohol use in the test. Confirmatory and exploratory factor analyses revealed two AUDIT basic factors, the first three items defining a 'hazardous consumption' factor and the other seven items an 'alcohol-related problems' factor. Both the internal and test- retest reliability of the Swedish version of AUDIT were satisfactory. A table for converting raw scores to non-normalized T-scores for each combination of gender and three age intervals is presented.
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The basis for the female predilection in alcohol-induced nasal symptoms is not well understood.
“but the basis for this predilection is not well understood.168-170”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [170]
The Introduction discusses sex differences in blood-alcohol levels and alcohol-related harm, while the Discussion and Results address drinking patterns and AUDIT scores. Searches for female predilection and alcohol-induced nasal symptoms found no passage about nasal symptoms or why they might be more common in women. (LLM, conf=0.74)
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“Principal component extraction with Varimax rotation yielded two factors explaining 73.8p of the total variance. With this solution, however, items 1, 4 and 8 loaded on both factors. An oblique rotation eliminated multiple loading for item 4. According to this solution, the two factors showed a correlation of 0.44 (n…”
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“AUDIT is a 10-item self-report screening questionnaire of alcohol drinking habits developed by WHO and validated in various cultural settings (Reinert and Allen, 2002), including Sweden, and for populations of patients with psychosis (Dawe et al., 2000; Bergman and Kallmen, 2002).”
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“Cumulative AUDIT scores reflect two distinct constructs: one measuring alcohol consumption and another measuring alcohol-related problems; thus, AUDIT scores may conflate multiple genetic signals (Bergman & Källmén 2002; Shevlin & Smith 2007).”
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“A study in Switzerland (Bergman and Kallman, 2002), analyzed the possible motives or factors which influence women to drink less when they binge drink, which is inserted into the risky or dangerous use of alcohol group.”
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“In a psychometric evaluation, the Swedish version of the AUDIT showed a satisfactory internal and test–retest reliability (Bergman and Källmen, 2002; Selin, 2003).”
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“%) examined by Silvermark et al. HADS scores were slightly higher as compared with Swedish normative data (Lisspers et al., 1997; age 50–59), whereas the AUDIT (M¼ 1.8) scores were lower (Bergman & Källmén, 2002).”
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“Previous studies in general population samples from different countries consistently identified a two factor structure with one factor measuring alcohol consumption and the other factor measuring alcohol-related problems [Bergman and Kallmen, 2002; Lima et al., 2005; Shevlin and Smith, 2007].”
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“In order to highlight these non-linear associations we grouped the full range of alcohol consumption in 6 categories including that of abstinence or excessive drinking, as follows:(a) Regarding the total AUDIT scores we derived 6 groups of increasing severity defined using the 25th, 50th, 75th, 90th and 95th percentil…”
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“More than five glasses for men and four for women at the same occasion is regarded as harmful drinking (Bergman and Källmén, 2002), so-called binge drinking, with an increased risk for violence and injuries as well as mental and somatic effects (Brewer and Swahn, 2005).”
BackgroundPositive versus negative mental health in emerging adulthood: a national cross-sectional survey
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“We used three questions from the Swedish version of the Alcohol Use Disorders Identification Test [38] as a measure of risky alcohol consumption.”
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“A score of between 6 and 13 for women and between 8 and 15 for men is considered hazardous use [31]; a score of between 14 and 19 for women, and between 16 and 19 for men is considered harmful use.”
Extensive undertreatment of osteoporosis in older Swedish women
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“…from results for clinical samples, finding a two-factor structure of the AUDIT in general population samples replicates many previous studies (Bergman and Kallmen, 2002; Chung et al., 2002; Doyle et al., 2007; Karno et al., 2000; Kelly and Donovan, 2001; Lima et al., 2005; Maisto et al.,…”
BackgroundResultInfluentialADHD in adult psychiatry. Minimum rates and clinical presentation in general psychiatry outpatients
Nylander, L., Holmqvist, M., Gustafson, L., & Gillberg, C. (2008) · Nordic Journal of Psychiatry · doi:10.1080/08039480802416323 · Cited by 60 · see citing works
“The AUDIT measures degree of alcohol dependence and was completed by all 30 patients with scores ranging from 0 to 21, where 8 is commonly used as cut-off for problem drinking in men, and 6 in women (37, 38).”
BackgroundMethodAndersson, C. R., Johnsson, K., Berglund, M., & Öjehagen, A. (2007) · Alcohol and Alcoholism · doi:10.1093/alcalc/agm008 · Cited by 60 · see citing works
“82 (Bergman and Källmen, 2002), and in this study this internal consistency score was 0.”
BackgroundEffects of acute alcohol consumption on executive cognitive functioning in naturalistic settings
Lyvers, M., & Tobias‐Webb, J. (2010) · Addictive Behaviors · doi:10.1016/j.addbeh.2010.06.022 · Cited by 59 · see citing works
“The measure has good to excellent temporal stability with testretest reliabilities for general population samples ranging from r =.87 over a one week time period (Rubin et al., 2006) to r =0.93 and 0.95 over a one month time period (Bergman & Källmén, 2002; Dybek et al., 2006).”
MethodInfluentialChildhood sexual abuse and substance abuse: A gender paradox?
Tonmyr, L., & Shields, M. E. (2016) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2016.11.004 · Cited by 59 · see citing works
“…involving three items and a second measuring symptoms of alcohol dependence involving seven items related to problem consequences from drinking (Bergman & Kallmen, 2002; Lima et al., 2005; Maisto, Conigliaro, McNeil, Kraemer, & Kelley, 2000; Peng, Wilsnack, Kristjanson, Benson, & Wilsnack,…”
Increased cortical porosity in women with hip fracture
Sundh, D., Nilsson, A. G., Nilsson, M., Johansson, L., Mellström, D., & Lorentzon, M. (2017) · Journal of Internal Medicine · doi:10.1111/joim.12587 · Cited by 59 · see citing works
Larsson, B. A. M., Johansson, L., Johansson, H., Axelsson, K. F., Harvey, N. C., Vandenput, L., Magnusson, P., McCloskey, E. V., Liu, E., Kanis, J. А., et al. (2020) · Osteoporosis International · doi:10.1007/s00198-020-05681-w · Cited by 57 · see citing works
Gajecki, M., Andersson, C. R., Rosendahl, I. K., Sinadinovic, K., Fredriksson, M., & Berman, A. H. (2017) · International Journal of Behavioral Medicine · doi:10.1007/s12529-016-9629-9 · Cited by 57 · see citing works
“sessment in study B, 6 weeks prior to the invitation to participate in the current trial, were indicative of hazardous drinking [20, 28].”
BackgroundDurbeej, N., Berman, A. H., Gumpert, C. H., Palmstierna, T., Kristiansson, M., & Alm, C. (2010) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2010.07.007 · Cited by 50 · see citing works
Mathiesen, E. F., Nome, S., Eisemann, M. R., & Richter, J. (2012) · Quality of Life Research · doi:10.1007/s11136-011-0080-8 · Cited by 54 · see citing works
Wetterborg, D., Dehlbom, P., Långström, N., Andersson, G., Fruzzetti, A. E., & Enebrink, P. (2018) · Journal of Personality Disorders · doi:10.1521/pedi_2018_32_379 · Cited by 53 · see citing works
Revising the Cannabis Use Disorders Identification Test (CUDIT) by means of Item Response Theory
Annaheim, B., Scotto, T. J., & Gmel, G. E. (2010) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.308 · Cited by 52 · see citing works
“Empirical evidence points to mostly two-factor (drinking behaviour and adverse consequences, e.g. Bergman and Källmén, 2002; Kim et al., 2008; Shields et al., 2004), but also onefactor (Carey et al., 2003) and four-factor models (frequency, quantity of use, binge-drinking and problems: Gmel et al.,…”
BackgroundPersonality traits and mental health of severe drunk drivers in Sweden
Hubicka, B., Källmén, H., Hiltunen, A. J., & Bergman, H. (2009) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-009-0111-8 · Cited by 52 · see citing works
Self-citationNicholls, J., Staiger, P., Williams, J. S., Richardson, B., & Kambouropoulos, N. (2014) · Psychiatry Research · doi:10.1016/j.psychres.2014.08.040 · Cited by 47 · see citing works
“Firstly, if, as researchers have previously contended, social anxiety precedes the onset substance misuse (Lipsitz and Schneier, 2000; Buckner et al., 2008), it is possible that those who fit the approachmotivated social anxiety subtype are at greater risk of developing co-occurring substance use owing to specific vul…”
BackgroundBrendryen, H., Johansen, A., Nesvåg, S., Kok, G., & Duckert, F. (2013) · JMIR Research Protocols · doi:10.2196/resprot.2371 · Cited by 48 · see citing works
“However, in Sweden, a comparable nation with regard to alcohol consumption, the prevalence of at-risk drinking has been reported as 18% for men and 5% for women [36].”
Alcohol Use and Hazardous Drinking among Medical Specialists
Joos, L., Glazemakers, I., & Dom, G. (2013) · European Addiction Research · doi:10.1159/000341993 · Cited by 50 · see citing works
von der Pahlen, B., Santtila, P. O., Witting, K., Varjonen, M., Jern, P., Johansson, A., & Sandnabba, N. K. (2008) · Journal of Studies on Alcohol and Drugs · doi:10.15288/jsad.2008.69.616 · Cited by 51 · see citing works
Johansson, M., Sinadinovic, K., Gajecki, M., Lindner, P., Berman, A. H., Hermansson, U., & Andréasson, S. (2020) · Addiction · doi:10.1111/add.15270 · Cited by 52 · see citing works
“AUDIT is a 10‐item instrument that has been validated in Swedish and via computer [31,32].”
MethodStåhlbrandt, H., Andersson, C. R., Johnsson, K., Tollison, S. J., Berglund, M., & Larimer, M. E. (2008) · Alcohol and Alcoholism · doi:10.1093/alcalc/agn055 · Cited by 50 · see citing works
“In the USA, ∼63% of the population are current drinkers (NIAAA, 2004), compared to ∼87% in Sweden (Bergman and Källmén, 2002).”
BackgroundLyvers, M., Duff, H., Basch, V., & Edwards, M. S. (2012) · Addictive Behaviors · doi:10.1016/j.addbeh.2012.03.028 · Cited by 49 · see citing works
“Temporal stability is also high ranging from r=.87 over one week (Rubin et al., 2006) to r=.93 and .95 over four weeks (Bergman & Källmén, 2002; Dybek et al., 2006).”
BackgroundKonstenius, M., Larsson, H., Lundholm, L., Philips, B., van de Glind, G., Jayaram-Lindström, N., & Franck, J. (2015) · Journal of Attention Disorders · doi:10.1177/1087054712451126 · Cited by 40 · see citing works
“Alcohol consumption was measured using the Swedish version of the Alcohol Use Disorder Identification Test (AUDIT; Bergman & Kallmen, 2002; Saunders, Aasland, Babor, de la Fuente, & Grant, 1993).”
MethodIntimate partner violence and help-seeking – a cross-sectional study of women in Sweden
Dufort, M., Gumpert, C. H., & Stenbacka, M. (2013) · BMC Public Health · doi:10.1186/1471-2458-13-866 · Cited by 47 · see citing works
“95) [38].”
Is Pregnancy the Time to Change Alcohol Consumption Habits in France?
de Chazeron, I., Llorca, P., Ughetto, S., Vendittelli, F., Boussiron, D., Sapin, V., Coudoré, F., & Lemery, D. J. (2008) · Alcoholism Clinical and Experimental Research · doi:10.1111/j.1530-0277.2008.00646.x · Cited by 47 · see citing works
“In reference to the AUDIT cut-off of 6 for detecting hazardous or harmful alcohol for nonpregnant women (Bergman and Kallmen, 2002), 9 individuals (2.1”
BackgroundInfluentialEberhard, S., Nordstrom, G., Höglund, P., & Öjehagen, A. (2009) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-009-0023-7 · Cited by 47 · see citing works
Internet-based assessment and self-monitoring of problematic alcohol and drug use
Sinadinovic, K., Berman, A. H., Hasson, D., & Wennberg, P. (2010) · Addictive Behaviors · doi:10.1016/j.addbeh.2009.12.021 · Cited by 46 · see citing works
Vissoci, J. R. N., Hertz, J., El-Gabri, D., Andrade Do Nascimento, J. R., Pestillo De Oliveira, L., Mmbaga, B. T., Mvungi, M., & Staton, C. A. (2018) · Alcohol and Alcoholism · doi:10.1093/alcalc/agx058 · Cited by 40 · see citing works
“However, multiple previous psychometric analyses have shown that AUDIT’s internal structure is most consistent with a 2D model (Bergman and Kallmen, 2002; Cook et al., 2011).”
MethodBerman, A. H., Forsberg, L., Durbeej, N., Källmén, H., & Hermansson, U. (2010) · Substance Use & Misuse · doi:10.3109/10826080903452488 · Cited by 45 · see citing works
“Alcohol use was measured using the 10-item self-report Alcohol Use Disorders Identification Test (AUDIT; Bergman and Källmén, 2002;”
MethodNaltrexone in compulsive sexual behavior disorder: a feasibility study of twenty men
Savard, J., Öberg, K. G., Chatzittofis, A., Dhejne, C., Arver, S., & Jokinen, J. (2020) · The Journal of Sexual Medicine · doi:10.1016/j.jsxm.2020.04.318 · Cited by 45 · see citing works
Alcohol habits in Sweden during 1997–2005 measured with the AUDIT
Källmén, H., Wennberg, P., Berman, A. H., & Bergman, H. (2007) · Nordic Journal of Psychiatry · doi:10.1080/08039480701773303 · Cited by 44 · see citing works
“The Swedish version of the test has been described earlier by Bergman & Källmén (6).”
MethodInfluentialSelf-citationStress and hazardous alcohol use: Associations with early dropout from university
Andersson, C., Johnsson, K. O., Berglund, M., & Öjehagen, A. (2009) · Scandinavian Journal of Public Health · doi:10.1177/1403494809344359 · Cited by 43 · see citing works
Disinhibition and reward sensitivity in relation to alcohol consumption by university undergraduates
Lyvers, M., Czerczyk, C., Girardi, A. M., & Lodge, P. (2009) · Addiction Research & Theory · doi:10.3109/16066350802404158 · Cited by 43 · see citing works
“Recent studies have shown that the AUDIT demonstrates construct, discriminate, and concurrent validity (Bergman and Kallmen 2002; Shields and Caruso 2004).”
BackgroundMaroti, D., Lumley, M. A., Schubiner, H., Lilliengren, P., Bileviciute-Ljungar, I., Ljótsson, B., & Johansson, R. (2022) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2022.111068 · Cited by 40 · see citing works
Johansson, M., Berman, A. H., Sinadinovic, K., Lindner, P., Hermansson, U., & Andréasson, S. (2021) · Journal of Medical Internet Research · doi:10.2196/29666 · Cited by 46 · see citing works
“AUDIT [38] is a 10-item instrument that covers both alcohol consumption and problems and has been validated in Swedish and via the computer [51,52].”
Alcohol intoxicated eyewitnesses' memory of intimate partner violence
Karlén, M. H., af Hjelmsäter, E. R., Fahlke, C., Granhag, P. A., & Gordh, A. S. (2014) · Psychology Crime and Law · doi:10.1080/1068316x.2014.951644 · Cited by 40 · see citing works
“This is likely to stem from a gender-specific reaction to this alcohol dose, since women have a relatively greater vulnerability to short-term as well as to long-term effects of alcohol (Andreano & Cahill, 2009; Bergman & Källmén, 2002; Mumenthaler, Taylor, O’Hara, & Yesevage, 1999).”
BackgroundWeb-Based Self-Help for Problematic Alcohol Use: a Large Naturalistic Study
Johansson, M., Sinadinovic, K., Hammarberg, A., Sundström, C., Hermansson, U., Andréasson, S., & Berman, A. H. (2016) · International Journal of Behavioral Medicine · doi:10.1007/s12529-016-9618-z · Cited by 42 · see citing works
“They were then directed to a screening page where they were required to indicate their gender and age and fill in Web-based Swedish versions of the Alcohol Use Identification Test (AUDIT [22]) and the first question of the Drug Use Disorders Identification Test (DUDIT [23]); registrants who scored >0 filled in all 11…”
MethodAlcohol-induced upper airway symptoms: prevalence and co-morbidity
Nihlen, U., Greiff, L. J., Nyberg, P., Persson, C. G. A., & Andersson, M. (2005) · Respiratory Medicine · doi:10.1016/j.rmed.2004.11.010 · Cited by 39 · see citing works
Möhring, A., Krause, K., Guertler, D., Bischof, G., Hapke, U., Freyer‐Adam, J., Baumann, S., Batra, A., Rumpf, H., Ulbricht, S., et al. (2018) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2018.05.002 · Cited by 39 · see citing works
Lyvers, M., Onuoha, R., Thorberg, F. A., & Samios, C. (2011) · Addictive Behaviors · doi:10.1016/j.addbeh.2011.10.012 · Cited by 39 · see citing works
Lätth, J., Landgren, V., McMahan, A., Sparre, C., Eriksson, J., Malki, K., Söderquist, E., Öberg, K. G., Rozental, A., Andersson, G., et al. (2022) · Internet Interventions · doi:10.1016/j.invent.2022.100590 · Cited by 38 · see citing works
“b Positive screening results on the Alcohol Use Disorder Identification Test (AUDIT) (8+ out of 40 points) (Bergman and Källmén, 2002) or the Drug Use Disorder Identification Test (DUDIT) (3+ out of 44 points) (Hildebrand, 2015).”
MethodAndersson, C. R. (2015) · European Addiction Research · doi:10.1159/000381017 · Cited by 38 · see citing works
Ahlberg, R., Skårberg, K., Brus, O., & Kjellin, L. (2016) · Substance Abuse Treatment Prevention and Policy · doi:10.1186/s13011-016-0068-z · Cited by 38 · see citing works
“Cases with missing values for up to three BAI items, one ISI item, two AUDIT items and two DUDIT items were included in the analyses.”
MethodInfluentialJohanson, S., & Bejerholm, U. (2017) · Disability and Rehabilitation · doi:10.1080/09638288.2016.1211758 · Cited by 37 · see citing works
“Test-retest and internal reliability are satisfactory.[55] The Swedish version of Adult Attention Deficit and Hyperactivity Disorder Self Report Scales (ASRS) [56] was administered to screen for attention and hyperactivity symptoms.”
MethodLindhe, N., Bengtsson, A., Byggeth, E., Engström, J., Lundin, M., Ludvigsson, M., Aminoff, V., Berg, M., & Andersson, G. (2023) · Behaviour Research and Therapy · doi:10.1016/j.brat.2023.104438 · Cited by 40 · see citing works
“However, the cut-off score of 15 has been found to give the highest positive predictive value (Bergman & K ¨ allm ´ en, 2002).”
Källmén, H., Elgán, T. H., Wennberg, P., & Berman, A. H. (2019) · Nordic Journal of Psychiatry · doi:10.1080/08039488.2019.1642382 · Cited by 37 · see citing works
“Respondents were sent an invitation letter in the spring of 2018 and a postal questionnaire consisting of the Swedish version of the 10-item AUDIT [5,15] and an authorized Swedish translation of the 13-item brief DSM-5 selfreport diagnostic assessment screener [2].”
MethodSinadinovic, K., Wennberg, P., & Berman, A. H. (2010) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2010.09.004 · Cited by 36 · see citing works
Åhlin, J., Hallgren, M. Å., Öjehagen, A., Källmén, H., & Forsell, Y. (2015) · BMC Public Health · doi:10.1186/s12889-015-1837-8 · Cited by 36 · see citing works
“three-factor scale consisting of consumption, dependence and harms [18, 19].”
Long-Term Treatment Outcome in Adult Male Prisoners With Attention-Deficit/Hyperactivity Disorder
Ginsberg, Y., Långström, N., Larsson, H., & Lindefors, N. (2015) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0000000000000395 · Cited by 36 · see citing works
Källmén, H., Wennberg, P., Leifman, H., Bergman, H., & Berman, A. H. (2010) · European Addiction Research · doi:10.1159/000322068 · Cited by 35 · see citing works
Self-citationHildebrand, M., & Noteborn, M. G. C. (2015) · Substance Use & Misuse · doi:10.3109/10826084.2014.998238 · Cited by 35 · see citing works
“Interestingly, this two-factor solution is not entirely similar to that generally identified in (a variety of) adult samples (AlMarri et al., 2009; Bergman & Källmén, 2002; Karno et al., 2000; Maisto et al., 2000; Mathew et al., 2010; Shevlin & Smith, 2007; Shields, Guttmannova, & Caruso, 2004;…”
ResultNilsson, A., Magnusson, K., Carlbring, P., Andersson, G., & Hellner, C. (2020) · Addiction · doi:10.1111/add.14900 · Cited by 34 · see citing works
Shayesteh, A., Boman, J., Janlert, U., Brulin, C., & Nylander, E. (2016) · The Journal of Dermatology · doi:10.1111/1346-8138.13291 · Cited by 34 · see citing works
Skårberg, K. (2009) · Örebro University Library (Örebro University) · Cited by 34 · see citing works
Schmidt, M., Ekstrand, J., & Tops, A. B. (2018) · Issues in Mental Health Nursing · doi:10.1080/01612840.2018.1481471 · Cited by 33 · see citing works
Helverschou, S. B., Brunvold, A. R., & Arnevik, E. A. (2019) · Substance Abuse Research and Treatment · doi:10.1177/1178221819843291 · Cited by 33 · see citing works
- Authors
- Bergman, H.
- Affiliations
- Karolinska University Hospital (SE)
- Corresponding author
- Bergman, H.
- Venue
- Alcohol and Alcoholism
- Publisher
- Oxford University Press (OUP)
- Published
- 2002-05-01
- Volume
- 37
- Issue
- 3
- Pages
- 245-251
- ISSN
- 0735-0414 (ISSN-L)
- 1464-3502
- OpenAlex
- W1995146706
- Cited by
- 345
- References
- 34
- Citations by year
- 2026: 5 · 2025: 14 · 2024: 10 · 2023: 15 · 2022: 17 · 2021: 14 · 2020: 13 · 2019: 15 · 2018: 12 · 2017: 16 · 2016: 23 · 2015: 23 · 2014: 20 · 2013: 17 · 2012: 19
- FWCI
- 3.01
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Alcohol and Alcoholism (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Karolinska Institutet
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Keywords
- Alcohol Use Disorders Identification Test, auditing, alcoholism, hazardous drinking, binge drinking, alcohol-related problems, psychometric validation, factor structure, test-retest reliability, gender differences, age differences, Swedish population, screening tool
- MeSH terms
- Adolescent, Adult, Aged, Alcohol Drinking, Analysis of Variance, Female, Humans, Male, Middle Aged, Psychometrics, Surveys and Questionnaires, Sweden, Alcohol-Related Disorders
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