In Korea, students often go through a very tough and stressful process preparing for college entrance exams and tend to feel free when they enter university. Entering university has multiple implications in that students are legally allowed to drink alcohol and are susceptible to alcohol-related situations. Korean college students are likely to lapse into heavy drinking, and 25% experience alcohol use disorders [1].

It is crucial to note that problematic drinking habits in youth may heavily affect future drinking habits. Many previous studies have shown that drinking habits formed during college years continue even after graduation and are highly likely to develop into drinking problems [2,3]. In this regard, drinking problems among college students cannot be dismissed as a temporary individual problem and, furthermore, can be the starting point of social challenges.

In this sense, it is important to identify college students’ alcohol use disorders, and the World Health Organization recommends the Alcohol Use Disorder Identification Test (AUDIT) [4]. The AUDIT is an index consisting of 10 questions for measuring hazardous drinking, symptoms of alcoholic dependence, and harmful drinking [5-7]. The AUDITKorean revised version is a revised version of the AUDIT in which the concept of a standard drink is applied. The reliability and validity of the AUDIT-Korean revised version have already been proven by Kim et al. [8] The study by Lee et al. [1] on the usefulness of alcohol screening tests found that the AUDIT is more useful than the CAGE (cut down, annoyed, guilty feelings, eye opener) or the CUGE (cut down, under the influence, guilty feelings, eye opener) measure for university student groups.

The diagnostic and statistical manual of mental disorders (DSM), 5th edition was published in 2013 as a handbook for the diagnosis and statistics of mental disorders published by the American Psychiatric Association [9]. Compared with the DSM-IV, the DSM-5 incorporates alcohol dependence and abuse into one term: ‘alcohol use disorder.’ It also divides the severity of the disorder into three levels: mild, moderate, and severe. The question in the DSM-IV that asks whether there are legal problems due to alcohol drinking has been replaced in the DSM-5 with the question of whether one craves alcohol. This change suggests that the prevalence rate of alcohol use disorder in Koreans is expected to increase when considering the domestic environment, where satisfying a craving is easier because of lower alcohol prices and the relatively generous Korean practices for legal drinking compared to Western countries.

So far, there have been studies in Korea on the usefulness of the AUDIT-Korean revised version and the optimal cutoff point in screening alcohol use disorders based on the DSM-5 diagnosis for the general public but not yet for college students. This study, based on the DSM-5, aimed to confirm the usefulness of the AUDIT-Korean revised version and the appropriate optimal cutoff point for college students who have different drinking habits than the general public.

In Korea, there have been studies on the usefulness of the AUDIT-Korean revised version and the optimal cutoff point in screening alcohol use disorders based on diagnosis criteria of the DSM-5 for the general public but not specifically for college students. This study intended to confirm the usefulness of the AUDIT-Korean revised version and the optimal cutoff point in screening alcohol use disorders based on the diagnosis criteria of the DSM-5 among college students, who have different drinking habits than the general public.

Closer proximity of the area under the ROC curve with 1 indicates high usefulness of the test. In this respect, this study confirmed the AUDIT-Korean revised version as a screening tool for alcohol use disorders based on the diagnosis criteria of the DSM-5 as the area under the ROC curve was 0.768 for male and 0.883 for female participants. In research of Hagman [13], the calculation of the area under the ROC curve for the AUDIT based on the diagnostic criteria of the DSM-5 among college students in the United States showed values similar to this study: 0.810 for male and 0.727 for female participants. In similar research by Kokotailo et al. [14] on American college students, the areas under the ROC curve for male and female participants were 0.872 and 0.791, respectively, which are also similar to the results in our study. However, in research conducted by Lee et al. [1], the value of the area under the ROC curve shows some different results—as high as 0.970 for male students and 0.989 for female students. In the interpretation of this difference, it should be noted that Lee et al. [1] used the diagnosis criteria of the DSM-IV whereas our study used the criteria of the DSM-5. Interpretation of these results suggests that the DSM-IV to DSM-5 test results showed that the accuracy of the test decreased from excellent to good. If similar studies are done in the future, the accuracy of the test should be checked and compared again.

This study showed that the optimal cutoff point for alcohol use disorder for male college students was 9. Research from Hagman [13] was consistent with our study, setting the threshold of the AUDIT cutoff point for male students at 9 for screening alcohol use disorders based on the DSM-5 among 251 American college students. Also, in research by Lee et al. [1], the DSM-IV TR was used to check the status of alcohol use disorders among Korean college students through diagnostic interviews, and it was confirmed that the standard cutoff point of the AUDIT for screening problem drinking among female students was 6 points, as seen in the present study. On the other hand, the 2004 research by Kokotailo et al. [14] on 302 American college students suggested that the standard cutoff point is 6 points regardless of gender. Differences in these studies may arise from certain changes in DSM diagnosis criteria and differences in ethnicity and culture.

Additionally, this research examined the positive frequency of each symptom in the DSM-5. As a result of the analysis of the frequency in the current research, items no. 1 (“Do you drink alcohol more or for longer periods than you intended?”) and no. 3 (“Do you spend a lot of time drinking alcohol and trying to overcome sickness or other side effects from drinking?”), both of which correspond to the impaired control category, showed the highest and 2nd highest frequency, respectively. The results show that the major cause of alcohol use disorders among college students is ‘impaired control,’ which may come from the cultural background in Korea that not refusing to drink is accepted as a virtue. It is anticipated that repetitive behavior of encouraging each other to drink and not refusing to do so leads to impaired control and binge drinking. There is a need for education to raise awareness of these inappropriate drinking habits as drinking behavior during college periods may determine drinking habits over a lifetime.

In our study, the proportion of binge drinking among students based on the NIAAA guidelines was 56.69% for male students and 34.12% for female students, comparatively higher than for heavy drinking. In a previous thesis studying drinking habits of college students, the proportion of binge drinkers, a drinking characteristic of Korean students, was as high as 82.2% (male 87.6%, female 33.5%) compared to the proportion of Canadian college students, which was 62.4% (male 66.9%, female 58.7%) [15,16]. Also, heavy episodic drinking was significantly higher in college students than in non-college students of the same age, so, once again, it is clear that college students have unique drinking habits [17]. However, the result of this study showed a lower proportion of binge drinking than previous studies. It is considered that college efforts to reduce drinking that induces frequent drinking accidents on university campuses lead to this result. So far, the research by Naimi et al. [18] on the US general public found that the frequency of binge drinking was 32.2% for adults aged 21 to 25, which was higher than for adults aged 35 to 54 (13.6%). The survey on drinking habits of adults in Korea also showed that the percentage of binge drinking in 20–29-year-olds was 24.3%, higher than in 30–39-year olds (21.3%) and 40–49-year-olds (16.8%) [19]. Considering that binge drinking is more common among younger adults than in any other age group, it is obvious that greater efforts are needed to reduce binge drinking in youth.

From a sociodemographic perspective, female students in the patient group were significantly more likely than the control group to have problem drinkers among family members. The research by Chun and Sohn [15] on college students also showed similar results that students who have problem drinkers in their families are more likely to have alcohol use disorders than those who do not. The study also showed that, among the US students, the chance of having an alcohol use disorder was 1.38 times higher for those who have heavy drinkers in their families than those who do not [20]. Furthermore, research by Chun and Sohn [15] revealed that the chance of having an alcohol use disorder can be influenced by participation in club activities and living conditions, contradicting the results of this research. It is considered that this reflects the recent trend in which forced drinking is less common in club gatherings.

Our study is limited in that it used a certain group of students in a certain university in a certain area, making it difficult to generalize the results to all college students. Despite its limitations, the study can be meaningful in that it determined an optimal cutoff point of the AUDIT in screening alcohol use disorders based on the DSM-5 and examined the drinking habits of college students.