What is the Paddington Alcohol Test?

Introduction

The Paddington alcohol test (PAT) was first published in the Journal of Accident and Emergency Medicine in 1996.

Background

It was designed to identify alcohol-related problems amongst those attending accident and emergency departments. It concords well with the Alcohol Use Disorders Identification Test (AUDIT) questionnaire but is administered in a fifth of the time.

When 40-70% of the patients in an accident and emergency department (AED) are there because of alcohol-related issues, it is useful for the staff of the AED to determine which of them are hazardous drinkers so that they can treat the underlying cause and offer brief advice which may reduce the health impact of alcohol for that patient. In accident and emergency departments it is also important to triage incoming patients as quickly as possible, to reduce staff size and cost. In one study, it took an average of 73 seconds to administer the AUDIT questionnaire but only 20 seconds for the PAT.

The working version of the PAT is reviewed at St Mary’s Hospital based on feedback from frontline doctors in the emergency department (A&E). There is also a modified version in use for an English multi-site programme research (Screening and Intervention Programme for Sensible Drinking, SIPS).

The latest version of the PAT is available on the UK Department of Health website, the Alcohol Learning Centre (now part of Public Health England).

On This Day … 08 August

People (Births)

  • 1879 – Bob Smith, American physician and surgeon, co-founded Alcoholics Anonymous (d. 1950).

Bob Smith

Robert Holbrook Smith (08 August 1879 to 16 November 1950), also known as Dr. Bob, was an American physician and surgeon who founded Alcoholics Anonymous with Bill Wilson (more commonly known as Bill W.).

Smith began drinking at college attending Dartmouth College in Hanover, New Hampshire. Early on he noticed that he could recover from drinking bouts quicker and easier than his classmates and that he never had headaches, which caused him to believe he was an alcoholic from the time he began drinking. Smith was a member of Kappa Kappa Kappa fraternity at Dartmouth. After graduation in 1902, he worked for three years selling hardware in Boston, Chicago, and Montreal and continued drinking heavily. He then returned to school to study medicine at the University of Michigan. By this time drinking had begun to affect him to the point where he began missing classes. His drinking caused him to leave school, but he returned and passed his examinations for his sophomore year. He transferred to Rush Medical College, but his alcoholism worsened to the point that his father was summoned to try to halt his downward trajectory. But his drinking increased and after a dismal showing during final examinations, the university required that he remain for two extra quarters and remain sober during that time as a condition of graduating.

After graduation, Smith became a hospital intern, and for two years he was able to stay busy enough to refrain from heavy drinking. He married Anne Robinson Ripley on 25 January 1915, and opened up his own office in Akron, Ohio, specialising in colorectal surgery and returned to heavy drinking. Recognising his problem, he checked himself into more than a dozen hospitals and sanitariums in an effort to stop his drinking. He was encouraged by the passage of Prohibition in 1919, but soon discovered that the exemption for medicinal alcohol, and bootleggers, could supply more than enough to continue his excessive drinking. For the next 17 years his life revolved around how to subvert his wife’s efforts to stop his drinking and obtain the alcohol he craved while trying to hold together a medical practice in order to support his family and his drinking.

Meeting Bill Wilson

In January 1933, Anne Smith attended a lecture by Frank Buchman, the founder of the Oxford Group. For the next two years he and Smith attended local meetings of the group in an effort to solve his alcoholism, but recovery eluded him until he met Bill Wilson on 12 May 1935. Wilson was an alcoholic who had learned how to stay sober, thus far only for some limited amounts of time, through the Oxford Group in New York, and was close to discovering long-term sobriety by helping other alcoholics. Wilson was in Akron on business that had proven unsuccessful and he was in fear of relapsing. Recognising the danger, he made inquiries about any local alcoholics he could talk to and was referred to Smith by Henrietta Seiberling, one of the leaders of the Akron Oxford Group. After talking to Wilson, Smith stopped drinking and invited Wilson to stay at his home. He relapsed almost a month later while attending a professional convention in Atlantic City. Returning to Akron on 09 June, he was given a few drinks by Wilson to avoid delirium tremens. He drank one beer the next morning to settle his nerves so he could perform an operation, which proved to be the last alcoholic drink he would ever have. The date, 10 June 1935, is celebrated as the anniversary of the founding of Alcoholics Anonymous.

Final Years

Smith was called the “Prince of Twelfth Steppers” by Wilson because he helped more than 5000 alcoholics before his death. He was able to stay sober from 10 June 1935, until his death in 1950 from colon cancer. He is buried at the Mount Peace Cemetery in Akron, Ohio.

What is the Alcohol Use Disorders Identification Test?

Introduction

The Alcohol Use Disorders Identification Test (AUDIT) is a ten-item questionnaire approved by the World Health Organisation (WHO) to screen patients for hazardous (risky) and harmful alcohol consumption.

Background

It was developed from a WHO multi-country collaborative study, the items being selected for the AUDIT being the best performing of approximately 150 items including in the original survey. It is widely used as a summary measure of alcohol use and related problems. It has application in primary health care, medical clinics, and hospital units and performs well in these settings. Using different cut-off points, it can also screen for Alcohol Use Disorder (DSM-5) and Alcohol Dependence. Guidelines for the use of the AUDIT have been published by WHO and are available in several languages. It has become a widely used instrument and has been translated into approximately fifty languages.

The AUDIT consists of ten questions, all of which ask explicitly about alcohol:

  • Questions 1 to 3 ask about consumption of alcohol (frequency, quantity or typical drinking occasions, and consumption likely to cause impairment);
  • Possible dependence on alcohol (Questions 4 to 6); and
  • Harmful alcohol use, including concern expressed by others (Questions 7 to 10).

Each question is scored between 0 and 4 depending on the response and so the total score ranges between 0 and 40. Based on responses in the original WHO multi-centre study a score of 8 or more is the threshold for identifying hazardous or harmful alcohol consumption with a score of 15 or more indicating likely alcohol dependence, and 20 or more indicating likely severe dependence and harm. Using the cut-off point of 8, its performance in the original collaborative WHO study indicated a sensitivity of 92% and a specificity of 94% for the diagnoses of hazardous and harmful alcohol consumption.

The AUDIT was designed to be used internationally, and was derived from a WHO collaborative study drawing patients from six countries, representing different regions of the world and different political and economic systems. More than 300 studies have been undertaken to examine its usefulness and validity in various settings. Multiple studies have found that the AUDIT is a reliable and valid measure in identifying alcohol abuse, hazardous consumption and harmful alcohol use (consumption leading to actual harm) and it has also been found to be a valid indicator for severity of alcohol dependence. There is some evidence that the AUDIT works in adolescents and young adults; it appears less accurate in older adults. It appears well-suited for use with college students, and also with women and members of minority groups. There has also been significant evidence for its use in the trauma patient population to screen for possible alcohol use disorders. In the trauma patient population, AUDIT has been shown to be more effective at identifying possible alcohol abuse than physician judgement and the blood alcohol content (BAC) test.

A shorter version of the Alcohol Use Disorders Identification Test (AUDIT-C) has been created for rapid use, and is composed of the first 3-question of the full length AUDIT pertaining specifically to quantity of alcohol consumed. It is appropriate for screening for problem drinking in a doctor’s office.

On This Day … 10 June

Events

  • 1935 – Dr. Robert Smith takes his last drink, and Alcoholics Anonymous is founded in Akron, Ohio, United States, by him and Bill Wilson.

Dr. Robert Smith

Robert Holbrook Smith (08 August 1879 to 16 November 1950), also known as Dr. Bob, was an American physician and surgeon who founded Alcoholics Anonymous with Bill Wilson (more commonly known as Bill W.).

Family and Early Life

Smith was born in St. Johnsbury, Vermont, where he was raised, to Susan A. (Holbrook) and Walter Perrin Smith. His parents took him to religious services four times a week, and in response he determined he would never attend religious services when he grew up. He graduated from St Johnsbury Academy in 1898, having met his future wife Anne Robinson Ripley at a dance there.

Education, Marriage, Work, and Alcoholism

Smith began drinking at college attending Dartmouth College in Hanover, New Hampshire. Early on he noticed that he could recover from drinking bouts quicker and easier than his classmates and that he never had headaches, which caused him to believe he was an alcoholic from the time he began drinking. Smith was a member of Kappa Kappa Kappa fraternity at Dartmouth. After graduation in 1902, he worked for three years selling hardware in Boston, Chicago, and Montreal and continued drinking heavily. He then returned to school to study medicine at the University of Michigan. By this time drinking had begun to affect him to the point where he began missing classes. His drinking caused him to leave school, but he returned and passed his examinations for his sophomore year. He transferred to Rush Medical College, but his alcoholism worsened to the point that his father was summoned to try to halt his downward trajectory. But his drinking increased and after a dismal showing during final examinations, the university required that he remain for two extra quarters and remain sober during that time as a condition of graduating.

After graduation, Smith became a hospital intern, and for two years he was able to stay busy enough to refrain from heavy drinking. He married Anne Robinson Ripley on January 25, 1915, and opened up his own office in Akron, Ohio, specialising in colorectal surgery and returned to heavy drinking. Recognising his problem, he checked himself into more than a dozen hospitals and sanitariums in an effort to stop his drinking. He was encouraged by the passage of Prohibition in 1919, but soon discovered that the exemption for medicinal alcohol, and bootleggers, could supply more than enough to continue his excessive drinking. For the next 17 years his life revolved around how to subvert his wife’s efforts to stop his drinking and obtain the alcohol he craved while trying to hold together a medical practice in order to support his family and his drinking.

Meeting Bill Wilson

In January 1933, Anne Smith attended a lecture by Frank Buchman, the founder of the Oxford Group. For the next two years she and Smith attended local meetings of the group in an effort to solve his alcoholism, but recovery eluded him until he met Bill Wilson on 12 May 1935. Wilson was an alcoholic who had learned how to stay sober, thus far only for some limited amounts of time, through the Oxford Group in New York, and was close to discovering long-term sobriety by helping other alcoholics. Wilson was in Akron on business that had proven unsuccessful and he was in fear of relapsing. Recognising the danger, he made inquiries about any local alcoholics he could talk to and was referred to Smith by Henrietta Seiberling, one of the leaders of the Akron Oxford Group. After talking to Wilson, Smith stopped drinking and invited Wilson to stay at his home. He relapsed almost a month later while attending a professional convention in Atlantic City. Returning to Akron on 09 June, he was given a few drinks by Wilson to avoid delirium tremens. He drank one beer the next morning to settle his nerves so he could perform an operation, which proved to be the last alcoholic drink he would ever have. The date, 10 June 1935, is celebrated as the anniversary of the founding of Alcoholics Anonymous.

Final Years

Smith was called the “Prince of Twelfth Steppers” by Wilson because he helped more than 5000 alcoholics before his death. He was able to stay sober from 10 June 1935, until his death in 1950 from colon cancer. He is buried at the Mount Peace Cemetery in Akron, Ohio.

Alcoholics Anonymous

Alcoholics Anonymous (AA) is an international mutual aid fellowship with the stated purpose of enabling its members to “stay sober and help other alcoholics achieve sobriety.” AA is nonprofessional, non-denominational, self-supporting, and apolitical. Its only membership requirement is a desire to stop drinking. The AA programme of recovery is set forth in the Twelve Steps.

AA was founded in 1935 in Akron, Ohio, when one alcoholic, Bill Wilson, talked to another alcoholic, Bob Smith, about the nature of alcoholism and a possible solution. With the help of other early members, the book Alcoholics Anonymous: The Story of How More Than One Hundred Men Have Recovered From Alcoholism was written in 1939. Its title became the name of the organisation and is today commonly referred to as “The Big Book”. AA’s initial Twelve Traditions were introduced in 1946 to help the fellowship be stable and unified while disengaged from “outside issues” and influences.

The Traditions recommend that members remain anonymous in public media, altruistically help other alcoholics, and that AA groups avoid official affiliations with other organisations. They also advise against dogma and coercive hierarchies. Subsequent fellowships such as Narcotics Anonymous have adapted the Twelve Steps and the Twelve Traditions to their respective primary purposes.

AA membership has since spread internationally “across diverse cultures holding different beliefs and values”, including geopolitical areas resistant to grassroots movements. As of 2016, close to two million people worldwide are estimated to be members of AA.

Age at First Drink & Severity of Alcohol Dependence in Military Personnel

Research Paper Title

Age at first drink and severity of alcohol dependence.

Background

Early age at first drink (AFD) has been linked to early onset and increased severity of alcohol dependence in various studies. Few Indian studies on AFD have shown a negative correlation between AFD and severity of alcohol dependence. The study aimed to explore this relationship in patients with alcohol dependence syndrome (ADS) diagnosed using ICD-10 criteria.

Methods

One hundred fifty-one consecutive patients freshly diagnosed with ADS were included in the study, which was conducted at the psychiatry unit of a tertiary care, multispecialty hospital. The Addiction Severity Index (ASI) was used to assess severity of alcohol dependence.

Results

Mean AFD was 24.85 years (range = 13-40 years). Median ASI score was 36 (range = 21 to 57). The study yielded a weak negative correlation (ρ = -.105) between AFD and ASI, which was statistically not significant.

Conclusions

The researchers found no correlation between AFD and severity of alcohol dependence at detection in Indian Armed Forces personnel, which is contrary to what has been reported worldwide and in previous Indian studies. Delayed initiation of alcohol use among those enrolling in the Indian Armed Forces and early detection of alcohol dependence within the military environment are possible explanations.

Reference

Chatterjee, K., Dwivedi, A.K. & Singh, R. (2021) Age at first drink and severity of alcohol dependence. Medical Journal, Armed Forces India. 77(1), pp.70-74. doi: 10.1016/j.mjafi.2019.05.003. Epub 2019 Oct 16.