A group of scientists under the auspices of WHO, which included Bulat Idrisov, an employee of the Laboratory for Analysis of Population Health Indicators and Digitalization of Health Care at the Moscow Institute of Physics and Technology, conducted a study on the potential of using the AUDIT test for alcohol use disorders. The test has been modified for assessment in Russia. The results obtained can significantly transform the system of medical care, change the cost of diagnostics, transferring it to the mode of telemedicine consultations and expand the coverage.
The research results are published in the bulletin of the World Health Organization (WHO). In 2018, WHO launched an initiative to help reduce the impact of alcohol abuse across countries. Five strategies have been proposed, one of which is the Alcohol Use Disorders Identification Test (AUDIT). This technique has been tested in Russia and has shown good prospects for implementation in primary health care.
AUDIT is an easy-to-use 10-item questionnaire that has been successfully used in other countries for a long time. It allows you to identify alcohol dependence and concomitant diseases. However, the introduction of this tool into practice required some adaptation to take into account Russian specifics. As a result of the research, an adapted Russian version of the RUS-AUDIT questionnaire was proposed.
According to one of the authors of the study, Bulat Idrisov, in public health, it is important to have accurate and effective measuring instruments in order to adequately assess the scale of the problem. The AUDIT test is a tool that allows you to identify risky alcohol consumption in the early stages.
The need to make changes to the test was related to the peculiarities of national alcohol consumption and terminology: it required clarity in the concepts of “regular drinking” and “one-time alcohol use” to assess the cases of episodic alcohol consumption in large quantities.
The Russian version of the test additionally includes a table in which respondents must indicate the type and amount of alcohol consumed; “One-time use” from the standard questionnaire in the Russian version has been replaced by “within 24 hours”, which makes it possible to record long-term binges. The version of the test used in the study additionally contained three questions related to excessive drinking in the past three months: the highest amount of alcohol consumed, the frequency of hangovers, and the frequency of falling asleep in clothes.
The experiment involved 21 primary health care centers (urban and rural) from nine regions of Russia. Of each, about 200 people participated. The questionnaires traditionally used to diagnose alcohol use disorders are complex and contain several dozen questions and take time and concentration to complete. AUDIT-based questionnaires, with comparable results, can reduce time and effort.
According to the survey results, the alcohol consumption situation falls into one of four categories: hazardous alcohol consumption (according to WHO and the European Medicines Agency, the threshold values for this category are over 20 g / day for women and 40 g / day for men); problematic alcohol use (causing health problems with family objections, breakdown in relationships, financial hardship, assaults and injuries to others while drunk, problems with the police, reduced hours of work and rest).
And also: harmful use of alcohol (harmful to health: both physical, as in the case of alcoholic hepatitis, and psychological, as in the case of depression that develops with prolonged binge drinking; this is a real medical diagnosis); alcohol dependence (in the presence of a strong desire to consume alcohol without the possibility of self-control; it is also an official diagnosis).
When introducing RUS-AUDIT, it is important to correctly determine in which cases the patient should be transferred to a specialized system for treating alcoholism and drug addiction. According to Russian law, specialized treatment is provided free of charge, but after a diagnosis is made, patients are monitored for a long time, they are deprived of the opportunity to work in a number of professions, as well as part of their rights (to drive a vehicle, and so on).
They may be subject to social stigma and discrimination because of their status. Thus, formal registration is often a punishment, fear of which becomes an obstacle to seeking help. This practice should be reviewed in order to create a safe and high quality screening and health care system. The main goal of the implementation of RUS-AUDIT is to reorganize the drug treatment system with an emphasis on early detection of dangerous inclinations and early intervention, which will allow not to lead to severe disorders and unpleasant social consequences.
“Validation of the AUDIT test is an important step towards reducing alcohol-related harm in Russia. This study helps to assess the risky consumption of alcohol,”concludes Bulat Idrisov. The researchers' plans are not to be satisfied with what has already been achieved.
“We want to carry out a series of studies that continue the topics raised, and we hope that WHO will support us in this initiative. We plan to involve the talented youth of the FBMF in research. I think this publication will not be the last,”says Stanislav Otstavnov, head of the laboratory for analysis of population health indicators and digitalization of healthcare at the Moscow Institute of Physics and Technology.