Practical assessment of DSM-5 alcohol use disorder criteria in routine care: High test-retest reliability of an Alcohol Symptom Checklist

Kevin A Hallgren; Theresa E Matson; Malia Oliver; Ryan M Caldeiro; Daniel R Kivlahan; Katharine A Bradley

doi:10.1111/acer.14778

Practical assessment of DSM-5 alcohol use disorder criteria in routine care: High test-retest reliability of an Alcohol Symptom Checklist

Alcohol Clin Exp Res. 2022 Mar;46(3):458-467. doi: 10.1111/acer.14778.

Authors

Kevin A Hallgren^{1

2

3}, Theresa E Matson^{2

3

4}, Malia Oliver², Ryan M Caldeiro⁵, Daniel R Kivlahan⁴, Katharine A Bradley^{2

3

6}

Affiliations

¹ Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA.
² Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA.
³ Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA.
⁴ Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Veteran Affairs Puget Sound HealthCare System, Seattle, Washington, USA.
⁵ Mental Health and Wellness, Kaiser Permanente of Washington, Renton, Washington, USA.
⁶ Department of Medicine, University of Washington, Seattle, Washington, USA.

Abstract

Background: Alcohol use disorder (AUD) is underdiagnosed and undertreated in medical settings, in part due to a lack of AUD assessment instruments that are reliable and practical for use in routine care. This study evaluates the test-retest reliability of a patient-report Alcohol Symptom Checklist questionnaire when it is used in routine care, including primary care and mental health specialty settings.

Methods: We performed a pragmatic test-retest reliability study using electronic health record (EHR) data from Kaiser Permanente Washington, an integrated health system in Washington state. The sample included 454 patients who reported high-risk drinking on a behavioral health screen and completed two Alcohol Symptom Checklists 1 to 21 days apart. Subgroups of these patients who completed both checklists in primary care (n = 271) or mental health settings (n = 79) were also examined. The primary measure was an Alcohol Symptom Checklist on which patients self-reported whether they experienced each of the 11 AUD criteria within the past year, as defined by the Diagnostic and Statistical Manual of Mental Disorders-5^th edition (DSM-5).

Results: Alcohol Symptom Checklists completed in routine care and documented in EHRs had excellent test-retest reliability for measuring AUD criterion counts (ICC = 0.79, 95% CI: 0.76 to 0.82). Test-retest reliability estimates were also high and not significantly different for the subsamples of patients who completed both checklists in primary care (ICC = 0.82, 95% CI: 0.77 to 0.85) or mental health settings (ICC = 0.74, 95% CI: 0.62 to 0.83). Test-retest reliability was not moderated by having a past two-year AUD diagnosis, nor by the age or sex of the patient completing it.

Conclusions: Alcohol Symptom Checklists can reliably and pragmatically assess AUD criteria in routine care among patients who screen positive for high-risk drinking. The Alcohol Symptom Checklist may be a valuable tool in supporting AUD-related care and monitoring AUD criteria longitudinally in routine primary care and mental health settings.

Keywords: alcohol use disorder; assessment; measurement-based care; primary care; symptom checklist.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Alcohol Drinking / psychology
Alcoholism* / diagnosis
Checklist
Diagnostic and Statistical Manual of Mental Disorders
Humans
Reproducibility of Results

Abstract

Publication types

MeSH terms

Grants and funding