Associations between the Brief Assessment of Alcohol Demand Questionnaire and Alcohol Use Disorder Severity in UK Samples of Student and Community Drinkers, 2019-2020

Value-based choice and compulsion theories of addiction offer distinct explanations for the persistence of alcohol use despite harms. Choice theory argues that problematic drinkers ascribe such high value to alcohol that costs are outweighed, whereas compulsion theory argues that problematic drinkers discount costs in decision making. The current study evaluated these predictions by testing whether alcohol use disorder (AUD) symptom severity (indexed by the AUDIT) was more strongly associated with the intensity item (maximum alcohol consumption if free, indexing alcohol value) compared to the breakpoint item (maximum expenditure on a single drink, indexing sensitivity to monetary costs) of the Brief Assessment of Alcohol Demand (BAAD) questionnaire, in student (n = 579) and community (n = 120) drinkers. The community sample showed greater AUD than the student sample (p = .004). In both samples, AUD severity correlated with intensity (students, r = 0.63; community, r = 0.47), but not with breakpoint (students, r = -0.01; community, r = 0.12). Similarly, multiple regression analyses indicated that AUD severity was independently associated with intensity (student, ΔR2 < 0.20, p < .001; community, ΔR2 = 0.09, p = .001) but not breakpoint (student, ΔR2 = 0.003, p = .118; community ΔR2 = 0.01, p = .294). There was no difference between samples in the strength of these associations. The value ascribed to alcohol may play a more important role in AUD severity than discounting of alcohol-associated costs (compulsivity), and there is no apparent difference between student and community drinkers in the contribution of these two mechanisms. Assessments: Data were collated across a number of experiments and in all cases questionnaires were delivered at baseline and followed the same order. Demographic measures (age and gender) were collected. AUD severity was assessed using the ten-item Alcohol Use Disorders Identification Test (AUDIT) (Babor et al. 2001). The AUDIT total score ranges from 0-40, and can be divided into categories: low-risk (0–7), hazardous (8–15), harmful (16–19) and possibly dependent (20–40). Cronbach’s alpha for the AUDIT was .78 in the student and .81 in the community sample. The AUDIT has two subscales, measuring alcohol consumption and alcohol-related consequences (Doyle et al. 2007). Value and cost insensitivity constructs were measured with the Brief Assessment of Alcohol Demand (BAAD) questionnaire (Owens et al. 2015). The BAAD has three items. The first item indexes intensity of demand (‘If drinks were free, how many would you have in a single session?’), with possible responses ranging from 0 to 10+ drinks in increments of 1. The second item indexes Omax (‘What is the maximum total amount you would spend on drinks for yourself in a single session?’), with responses ranging from £0 to £40 in £4 increments. The final item indexes breakpoint (‘What is the maximum you would pay for a single drink?’) with responses ranging from £0 to £20 in £2 increments.