The association between changes in AUDIT-C scores and acute mental healthcare utilization over the next year in a primary care population

Background

Unhealthy alcohol use (UAU) is common in primary care populations and can significantly impact mental health. Screening for UAU within primary care is increasingly used for point-in-time identification of UAU, but it is less clear whether changes in alcohol screening scores effectively capture changes in alcohol-related risk.

Methods

This retrospective cohort study used data from adult primary care patients in a Northwest US health system who had completed two AUDIT-C screens 11–24 months apart (T1, T2). Scores were grouped into five categories from no use to very high-risk UAU. Generalized estimating equation models tested whether changes in AUDIT-C categories from T1 to T2 were associated with changes in risk for nonaddiction mental health acute care utilization (emergency department or hospital admission) over 1 year after T1 and T2.

Results

Of 165,101 patients (61% female; mean age 55), mental health acute care utilization risks were 0.9% after T1 and 0.8% after T2. Compared to those with stable drinking (T1 utilization 0.8%, T2 0.8%), mental health acute care utilization risk decreased for patients with a one-level decrease (T1 1.1%, T2 0.9%, p < 0.01) or greater than or equal to two-level decrease (T1 2.5%, T2 1.4%, p < 0.001). Increases in AUDIT-C categories were not associated with increased risk of mental health acute care utilization.

Conclusions

Changes in AUDIT-C score categories over time, particularly decreases, may reflect real changes in an important risk of UAU. Changes in alcohol screening scores may offer clinicians, health systems, and researchers meaningful information about changes in health risk.