Standardised alcohol screening in primary health care services targeting Aboriginal and Torres Strait Islander peoples in Australia

Introduction and aims: Aboriginal and Torres Strait Islander Community Controlled Health Services (ACCHSs)

around Australia have been asked to standardise screening for unhealthy drinking. Accordingly, screening with the

3-item AUDIT-C (Alcohol Use Disorders Identifcation Test—Consumption) tool has become a national key performance

indicator. Here we provide an overview of suitability of AUDIT-C and other brief alcohol screening tools for use

in ACCHSs.

Methods: All peer-reviewed literature providing original data on validity, acceptability or feasibility of alcohol screening

tools among Indigenous Australians was reviewed. Narrative synthesis was used to identify themes and integrate

results.

Results: Three screening tools—full AUDIT, AUDIT-3 (third question of AUDIT) and CAGE (Cut-down, Annoyed, Guilty

and Eye-opener) have been validated against other consumption measures, and found to correspond well. Short

forms of AUDIT have also been found to compare well with full AUDIT, and were preferred by primary care staf. Help

was often required with converting consumption into standard drinks. Researchers commented that AUDIT and its

short forms prompted refection on drinking. Another tool, the Indigenous Risk Impact Screen (IRIS), jointly screens

for alcohol, drug and mental health risk, but is relatively long (13 items). IRIS has been validated against dependence

scales. AUDIT, IRIS and CAGE have a greater focus on dependence than on hazardous or harmful consumption.

Discussion and conclusions: Detection of unhealthy drinking before harms occur is a goal of screening, so AUDIT-C

ofers advantages over tools like IRIS or CAGE which focus on dependence. AUDIT-C’s brevity suits integration with

general health screening. Further research is needed on facilitating implementation of systematic alcohol screening

into Indigenous primary healthcare