AUDIT (Alcohol Use)

Background

The Alcohol Use Disorders Identification Test (AUDIT) is a 10-item questionnaire developed by the World Health Organization to screen for hazardous and harmful alcohol use and possible dependence. The first three items cover consumption (frequency, typical quantity and frequency of heavy episodic drinking), items 4–6 cover dependence symptoms, and items 7–10 cover alcohol-related harm. Each item scores 0–4, except the last two (items 9 and 10) which score 0, 2 or 4, giving a total out of 40. It is designed for use across diverse settings and populations.

Interpreting the result

A total of 0–7 indicates low-risk drinking. A score of 8–15 suggests hazardous drinking, while 16–19 indicates harmful drinking and warrants further assessment and brief intervention. A score of 20 or more suggests possible alcohol dependence and should prompt consideration of specialist referral and more detailed assessment. The bands guide the intensity of response, from simple feedback through to structured intervention.

Advice

≥8 suggests hazardous/harmful use; ≥16 warrants further assessment and brief intervention; ≥20 suggests possible dependence — consider specialist referral.

Worked example

A patient drinks 2–3 times a week (3), usually 5–6 drinks (2), and has ≥6 drinks weekly (3), with occasional guilt (1) and others suggesting they cut down in the last year (4). These items sum to 13, placing them in the hazardous-drinking band, where brief intervention is appropriate.

Pearls / pitfalls

• A widely used lower cut-off of 8 maximises sensitivity for hazardous use; some guidance applies a lower threshold (e.g. 7) in women and older adults.
• The shortened AUDIT-C (first three consumption items) is often used as a quick first-stage screen, with the full AUDIT used to confirm.
• Responses are self-reported and can be under-reported; a non-judgemental approach improves accuracy.
• The score screens for risk and possible dependence but does not diagnose a disorder; a high score should prompt fuller clinical assessment.

Evidence & validation

AUDIT was derived from a six-country WHO collaborative study (Saunders et al., 1993) and has been extensively validated; it is recommended by NICE and many national guidelines as a gold-standard alcohol screening instrument.

Frequently asked questions

References

1. Saunders JB, Aasland OG, Babor TF, et al. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project. Addiction. 1993;88(6):791–804.
2. Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG. AUDIT: The Alcohol Use Disorders Identification Test — Guidelines for Use in Primary Care. World Health Organization, 2nd ed. 2001.

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