An alternative alcohol use disorder screening tool in South Africa within set criteria

Abstract

The Recall, Caution, Acting out, Excessive, Difficulty, Anxiety, Stress (RCAEDAS) screening tool was developed and validated to address limitations of existing alcohol use disorder screening instruments, particularly for diverse populations such as those in South Africa. We assessed the validity and reliability of the RCAEDAS using a cross-sectional design with 900 adult alcohol consumers across South Africa. Exploratory and confirmatory factor analyses supported a unidimensional structure with high internal consistency (Cronbach’s α = 0.83). The tool demonstrated excellent model fit (Comparative Fit Index (CFI) = 1.00, Tucker–Lewis Index (TLI) = 1.00, Root Mean Square Error of Approximation (RMSEA) = 0.00, Standardised Root Mean Square Residual (SRMR) = 0.00) and strong factor loadings, indicating good construct validity. Structural equation modelling revealed complex relationships between symptoms, with difficulty in daily functioning emerging as the strongest indicator of possible alcohol use disorder, followed equally by excessive drinking, anxiety and stress. The RCAEDAS showed high specificity (100%) and moderate sensitivity (45.7%) in identifying potential alcohol problems. Its focus on psychological impacts, behavioural changes and memory issues provides a more comprehensive assessment than existing tools that primarily emphasise consumption patterns. The strong psychometric properties and culturally sensitive approach of RCAEDAS suggest it may be a valuable addition to alcohol screening practices in South Africa and potentially other diverse populations, enabling earlier detection and intervention for alcohol use disorders.

Significance:

This study significantly contributes to addressing alcohol use disorders in South Africa. The RCAEDAS screening tool, developed and validated, offers a culturally sensitive and efficient method for identifying individuals at risk. Its strong psychometric properties and comprehensive symptom coverage make it valuable in clinical and research settings. The tool’s brevity addresses the need for time-efficient screening in diverse populations. Insights from structural equation modelling deepen our understanding of the complex interrelationships between alcohol use disorder symptoms. This research provides a foundation for more targeted intervention strategies, potentially enhancing the management of alcohol-related health issues in South Africa and similar contexts.