Primary Care
AUDIT-C (Alcohol Use)
Screen for hazardous drinking.
Education and reference only. Not a substitute for clinical judgement, local policy or product labelling. Always verify before clinical use. Values are calculated in your browser and never stored.
Background
AUDIT-C is a brief alcohol screening tool comprising the first three consumption questions of the full ten-item Alcohol Use Disorders Identification Test, developed for the World Health Organization. The three items ask about frequency of drinking, the typical quantity per drinking day and the frequency of heavy episodic (six or more drinks) drinking. Each is scored 0–4, giving a total of 0–12. It is widely used in primary care and other settings as a quick way to detect hazardous or harmful drinking.
Interpreting the result
A higher score indicates a greater likelihood of hazardous drinking or an alcohol use disorder. Commonly used bands are 0–4 lower risk, 5–7 increasing risk and 8–12 higher risk or possible dependence, although some services use a positive-screen cut-off of 4 or more in men and 3 or more in women. A positive screen should prompt a fuller assessment, often the complete AUDIT, and brief intervention where appropriate. The score quantifies consumption-related risk rather than diagnosing dependence.
Advice
A score ≥5 suggests increasing or higher-risk drinking (some use ≥4 men / ≥3 women as a positive screen). Consider a full AUDIT and brief intervention.
Worked example
A patient drinks two to three times a week (2), typically five to six drinks per occasion (2) and has six or more drinks weekly (3). The AUDIT-C total is 7, in the increasing-risk band, warranting a fuller alcohol assessment and brief advice.
Pearls / pitfalls
- A "drink" refers to a standard unit, which varies by country — clarify what a unit means to avoid under- or over-estimating intake.
- Different services use different cut-offs; many treat 5 or more as positive, while others apply lower sex-specific thresholds (4 in men, 3 in women).
- A positive AUDIT-C is a screen, not a diagnosis — follow up with the full AUDIT and assess for dependence and withdrawal risk.
- Self-reported intake is often underestimated, so a low score does not entirely exclude harmful drinking.
Evidence & validation
Derived from the WHO AUDIT and validated by Bush et al. (1998) as an effective brief screen; it is recommended within NICE guidance and used across UK primary care and the Identification and Brief Advice (IBA) programme.
Frequently asked questions
What AUDIT-C score is positive?
A total of 5 or more is commonly treated as a positive screen for increasing-risk drinking, though some services use 4 or more in men and 3 or more in women. A positive result should prompt a fuller assessment.
How does AUDIT-C differ from the full AUDIT?
AUDIT-C uses only the first three consumption questions, whereas the full AUDIT adds seven items on dependence and alcohol-related harm. AUDIT-C is quicker for routine screening; the full tool gives a more complete picture.
What counts as a drink?
It refers to a standard drink or unit of alcohol, but the amount varies between countries. Clarify the local definition with the patient so quantities are scored consistently.
Does a positive screen mean alcohol dependence?
No — it indicates a higher likelihood of hazardous or harmful drinking and warrants further assessment. Dependence is established through a fuller evaluation, not by AUDIT-C alone.
What should follow a positive screen?
A positive screen should lead to brief intervention or advice and, where indicated, the full AUDIT and assessment for dependence and withdrawal risk. Onward referral may be appropriate for higher scores.
References
- Bush K, Kivlahan DR, McDonell MB, et al. The AUDIT alcohol consumption questions (AUDIT-C). Arch Intern Med. 1998;158(16):1789–1795.
- NICE PH24: Alcohol-use disorders: prevention. 2010.
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