The Russian translations of the Alcohol Use Disorders Identification Test (AUDIT): A document analysis and discussion of implementation challenges

Aims: To analyze existing Russian translations of the Alcohol Use Disorders Identification Test (AUDIT) and their applicability in Russian-language populations. Method: Document analysis of different Russian-language versions of the AUDIT and its shorter versions as identified in a systematic search. Findings: A total of 122 Russian translations of the AUDIT or its shorter versions from Russia and other countries were included in the document analysis, 61 of which were unique versions. Across the translations, a series of inconsistencies was identified, most of which related to the first three consumption items and the concept of a standard drink. The identified problems appeared to have been caused by difficulties in adapting the tool to local drinking patterns and local beverage volumes. None of the analyzed sources mentioned systematic translation procedures according to a predetermined protocol. Conclusions: Despite the fact that the AUDIT was developed as a standardized screening tool almost 30 years ago, there is still no official translation into the Russian language according to the commonly used procedures for the translation and adaptation of instruments. A systematic translation and validation appears to be urgently needed in order to have an internationally comparable AUDIT for research and clinical purposes in Russian-speaking populations. IJADR International Journal of Alcohol and Drug Research The Official Journal of the Kettil Bruun Society for Social and Epidemiological Research on Alcohol The Russian translations of the Alcohol Use Disorders Identification Test (AUDIT) 21 –––––– IJADR 9(1) –––––– Introduction Despite the recent downward trend in total alcohol consumption, the Russian Federation is still considered to be one of the heaviest-drinking countries in Europe and worldwide (World Health Organization, 2018). The local drinking patterns of irregular heavy episodic drinking and its detrimental effects on health, most importantly cardiovascular mortality, appear to have shaped the observed trends in mortality and life expectancy in Russia for the past decades (Nemtsov, Neufeld, & Rehm, 2019; World Health Organization Regional Office for Europe, 2019). In order to reduce alcohol-attributable burden, alcohol use disorders (AUDs), as well as per capita alcohol consumption at a population level, Russia has introduced various alcohol control measures in the past, such as higher alcohol pricing and restrictions on sale hours and advertisement (Khaltourina & Korotayev, 2015; Kolosnitsyna, Sitdikov, & Khorkina, 2014; Nemtsov et al., 2019; Neufeld & Rehm, 2013), as well as specific measures against the use of unrecorded alcohol (i.e. alcohol which is consumed but not taxed as an alcoholic beverage; Neufeld & Rehm, 2018a, 2018b). In 2016, with the help of the WHO European Region, the Russian Ministry of Health launched an initiative to implement screening and brief interventions (known as SBI) for alcohol problems in the primary health care (PHC) setting (World Health Organization Regional Office for Europe, 2017). SBI is an evidence-based practice used to identify, reduce, and prevent problematic use and abuse of alcohol and illicit drugs (including substance use disorders) (Babor & Higgins-Biddle, 2001). Its goal is to identify individuals with potential or already manifested alcohol problems and motivate them to change their drinking behaviors at the PHC level, which is more accessible than specialized treatment settings. The implementation of the SBI program within the Russian health-care system poses various specific challenges at the country level (Bunova et al., 2017; B.E. Gornyi, Kalinina, & Bojcov, 2015; B.E. Gornyi, Kutumova, & Kalinina, 2016), which are not unique when compared to the experiences of other countries which have implemented similar models (Anderson et al., 2017; Barry et al., 2004; Johnson, Jackson, Guillaume, Meier, & Goyder, 2010). The availability of a quick, effective and reliable screening tool as part of the SBI program is a crucial cornerstone of the strategy’s success since primary care physicians are not likely to use instruments that require special training or extra time during the medical interview, or in the recording of patients’ accounts of their medical histories. The Alcohol Use Disorders Identification Test (AUDIT) was developed by the WHO in the 1980s as the main instrument of the SBI program (Babor & Higgins-Biddle, 2001). It was validated in PHC facilities in six countries over four continents (Saunders, Aasland, Amundsen, & Grant, 1993; Saunders, Aasland, Babor, de la Fuente, & Grant, 1993). The AUDIT has established itself as an effective instrument in screening for hazardous and harmful alcohol consumption, which have been defined by the WHO as: (a) a pattern of alcohol use that increases the risk of harmful consequences for the user and (b) a pattern of use that is causing damage to health respectively (World Health Organization, 2019). However, the operationalizations of these definitions have been different in different countries, usually because of socalled “low risk drinking guidelines” (Furtwaengler & de Visser, 2013) specific to each country. To the best of our knowledge, there is no such definition in the Russian Federation besides the harmful use diagnosis of F10.1 in the Russian version of the ICD-10, which is only ever used in the diagnostic procedures of the highly specialized addiction services, the so-called “narcology” medical specialty —a sub-discipline of psychiatry. As for PHC facilities, “the risk of harmful use of alcohol” is addressed as one of several risk factors within the standard prophylactic medical examination, the so-called “dispanserization” effort available to the population in Russia (Garant.ru, 2019). Dispanserization is a comprehensive population-based health screening program used in the Russian Federation for the early detection and prevention of chronic noncommunicable diseases as well as risk factors for their development. Rooted in the Soviet Semashko model of healthcare, with a focus on preventive services and health promotion within publicly owned polyclinics (the major providers of PHC in the case of Russia), dispanserization is routinely carried out covering the entire population and consists of a pre-screening and an in-depth consultation with respective specialists should any issues be detected. Dispanserization is carried out every three years for adults between 21 and 40 years and can be carried out every year starting from the age of 40. At the same time, Russian adults are eligible for the so called “professional examination” every year, which is a shorter health check-up (Sheiman, Shishkin, & Shevsky, 2018). However, there is no operational definition for the “risk of harmful alcohol use” within the legislative documents regulating these two processes. According to the existing law, the risks are assessed “according to the results of a survey (questionnaire)” and are coded as ICD-10 code Z72.1 (i.e., “Problems related to lifestyle: alcohol use”). The specific details for how the assessment is to be carried out are defined elsewhere, namely in the guidelines from the National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Health. For alcohol, the most recent guidelines provide a Russian translation of the AUDIT with sex-specific cut-off values for hazardous and harmful alcohol use, which were copied from a Russian medical journal (Boytsov et al., 2017; Degtyareva, Kuznetsova, Plavinsky, & Barinova, 2012). The hazardous and harmful alcohol use, however, are not defined within the AUDIT tool itself. Considering that the AUDIT has not been validated for the Russian Federation, the lack of widely recognized and accepted definitions of hazardous and harmful alcohol use poses serious challenges for its implementation. However, the Ministry of Health has recently initiated a large-scale validation study of the AUDIT for use in the Russian Federation, also in response to the concerns expressed by some narcologists that the AUDIT would not adequately 22 Anna Bunova et al. –––––– IJADR 9(1) –––––– capture the specific drinking patterns in Russian-language populations (Rehm et al., 2020; Neufeld et al., 2021a). Over 60 Russian-language translations of the AUDIT were identified worldwide as a result of the first step of this validation effort (Neufeld et al., 2021b). The present contribution is part of this validation effort and provides a document analysis of the various translations of the AUDIT used in Russia and Russian-speaking populations in other countries. It discusses the reasons for the discrepancies found between the various translations and the resulting implementation challenges for both the AUDIT and the SBI