Understanding and Assessing the Impact of Alcoholism on Quality of Life: A Systematic Review of the Content Validity of Instruments Used to Assess Health-Related Quality of Life in Alcoholism.

Alcoholism has the potential to impact on the quality of life (QOL) of an 'alcoholic,' their family, and friends in both the short and long term. Consequently, increasing significance has been placed on understanding health issues from the patient's perspective, evaluating the patient's subjective experience of his/her symptoms (as well as any treatment), and the impact of these on his/her QOL.The objective of this review was to identify and evaluate the content validity of measures used to assess health-related QOL (HR-QOL) in alcoholism (alcohol abuse and alcohol dependence).Systematic searches of Scopus (1990-2007) were conducted using terms synonymous with alcoholism combined with terms associated with measuring HR-QOL. A total of 618 abstracts were identified, detailing the use of 16 generic patient-reported outcome measures to assess HR-QOL in alcoholism. Upon further examination of item content, seven measured generic health status and nine assessed generic QOL or life satisfaction (with varying definitional criteria and domain focus).The SF-36 and EQ-5D, in particular, have been used widely, but were misinterpreted frequently as measures of HR-QOL rather than health status. One alcohol-specific measure was identified: the AlQoL 9, a scale that some have claimed to epitomize alcohol-related QOL. However, the AlQoL 9 was developed by reducing the SF-36 (French version) to the nine items most relevant to alcoholism. The methodology for determining the relevance of the existing items of the SF-36 was comprehensive but the adapted measure does not include assessment of additional concepts (such as sleep and social isolation) of particular importance for alcohol-related QOL.There is a lack of research and assessment of HR-QOL in alcoholism and alcohol abuse, and our assessment of the content validity of existing measures used to date suggests that many are likely to be inadequate. Given the insufficiencies of generic measures and the limited applicability of the AlQoL 9, there is a need for an alcoholism-specific QOL measure that focuses on the domains that are most salient to people with such problems. Individuals need to be given the opportunity to determine the extent to which their QOL is impaired by alcoholism based upon their own criteria for what constitutes good HR-QOL. Only then will we be able to assess the full impact of alcoholism (and its treatment) on QOL.