Alcohol and Alcoholism Advance Access originally published online on March 16, 2009
Alcohol and Alcoholism 2009 44(4):398-402; doi:10.1093/alcalc/agp011
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Validation of the Bayesian Alcoholism Test Compared to Single Biomarkers in Detecting Harmful Drinking
1 Informatics Institute, University of Amsterdam (UvA), Amsterdam, The Netherlands
2 Department of Psychiatry, St. Lucas Andreas Hospital, Amsterdam, The Netherlands
3 Drug Health Services, Royal Prince Alfred Hospital, Sydney, Australia
4 Faculty of Medicine, University of Sydney, Sydney, Australia
5 Department of Physiology, Academic Medical Centre, Amsterdam, The Netherlands
6 Department of Pharmacology, University of Colorado, School of Medicine, Anschutz Medical Center, Aurora, CO, USA
* Corresponding author: A. Korzec, Sint Lucas Andreas Ziekenhuis, Post Box 9423, 1006 AE Amsterdam, The Netherlands. Tel: +31-20-5108562; Fax: +31-20-6126431; E-mail: skorzec{at}science.uva.nl and a.korzec{at}slaz.nl
Received 25 August 2008; first review notified 10 October 2008; in revised form 6 January 2009; accepted 13 February 2009; advance access publication 16 March 2009
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Abstract |
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Aims: Conventional tests for alcohol dependence often fail to detect hazardous and harmful alcohol use (HHAU) accurately. We previously validated the Bayesian Alcoholism Test (BAT) for the detection of HHAU among males. This uses 15 biochemical and clinical variables, including questionnaire data to calculate the probability of harmful (>80 g alcohol/day), hazardous (40–80 g/day) and ‘moderate’ (<40 g/day) drinking. Here we investigate the BAT's diagnostic performance when more limited clinical data are available. Methods: The WHO/ISBRA Collaborative Project recruited subjects from the general community and alcohol dependence treatment services. We analysed data from male drinkers: 318 alcohol dependent, 220 heavy and 712 moderate drinkers. Drinking was assessed using the Alcohol-Use Disorders and Associated Disabilities Interview Schedule. Eight of 15 markers used in the original BAT could be extracted from the WHO/ISBRA dataset. Results: Comparing harmful to moderate drinkers, the area under the ROC curve for BAT (0.90) was significantly higher than that for CDT (0.82), GGT (0.77) and AST (0.76). Comparing hazardous to moderate drinkers, the area under the ROC curve for BAT (0.78) was significantly higher than that for AST (0.65) but not significantly higher than that for CDT (0.71) and GGT (0.70). For all 1250 subjects, the amount consumed correlated significantly better with BAT (0.65) than with CDT (0.52), GGT (0.44) or AST (0.40) alone. Conclusions: The BAT is more accurate than commonly used single biological markers in detecting harmful alcohol use, even when only half the input requirements are available. Computerized record keeping increases the practicality of use of algorithms in the detection of harmful drinking.