What is the AUDIT (Alcohol Use Disorders Identification Test) score?

The AUDIT Score: A Comprehensive Alcohol Screening Tool

The AUDIT (Alcohol Use Disorders Identification Test) is a 10-item questionnaire developed by the World Health Organization to screen for hazardous and harmful alcohol consumption, with scores of 8+ for men up to age 60 or 4+ for women, adolescents, and older men indicating potential alcohol use disorder. 1, 2

Structure and Scoring of AUDIT

The AUDIT questionnaire consists of 10 questions covering three domains:

1. Alcohol Consumption (Questions 1-3)

   • Frequency of drinking
   • Typical quantity consumed
   • Frequency of heavy drinking episodes

2. Drinking Behavior/Dependence (Questions 4-6)

   • Impaired control over drinking
   • Increased importance of drinking
   • Morning drinking

3. Alcohol-Related Problems (Questions 7-10)

   • Guilt after drinking
   • Blackouts
   • Alcohol-related injuries
   • Others concerned about drinking

Each question is scored from 0-4 points, with a maximum possible score of 40 points. 1

Interpretation of AUDIT Scores

The interpretation of AUDIT scores follows these thresholds:

• 8+ points for men up to age 60: Indicates hazardous or harmful alcohol consumption 1
• 4+ points for women, adolescents, or men over 60: Indicates hazardous or harmful alcohol consumption 1, 2

More detailed interpretation:

• 0-7: Low-risk drinking or abstinence
• 8-15: Hazardous drinking pattern
• 16-19: Harmful alcohol use
• 20+: Possible alcohol dependence requiring further diagnostic evaluation 1, 3

Clinical Utility

The AUDIT has several advantages over other alcohol screening tools:

• High sensitivity and specificity: Among those with hazardous or harmful alcohol use, 92% had an AUDIT score of 8+, while 94% of those with non-hazardous consumption scored below 8 4

• Predictive value: AUDIT scores effectively predict:

  • Alcohol-related social problems (61% of those scoring 8+ experienced these vs. 10% of those scoring lower) 3
  • Alcohol-related medical disorders
  • Risk of hospitalization
  • Hypertension 3, 5

• Cross-cultural validity: Developed through a six-country WHO collaborative project, making it applicable across different cultural contexts 4

AUDIT Variants

• AUDIT-C: A shortened version using only the first three consumption questions, useful for rapid screening of risky drinking 1

• Single-Question Screening: The NIAAA recommends using question #3 alone ("How often do you have six or more drinks on one occasion?") as an initial screen, followed by the full AUDIT if positive 1

Clinical Application

When a patient screens positive on the AUDIT:

1. For scores 8-15: Brief intervention focusing on reducing hazardous drinking

2. For scores 16-19: Brief counseling plus continued monitoring

3. For scores 20+: Further diagnostic evaluation for alcohol dependence and potential referral for specialized treatment 2, 3

Common Pitfalls

• Relying solely on biomarkers: While laboratory tests like GGT and MCV can support diagnosis, the AUDIT is a better predictor of social problems and hypertension than laboratory markers 2, 3

• Using inappropriate cut-off scores: Using standard cut-offs without adjusting for gender and age can miss at-risk individuals 1

• Failure to follow up on positive screens: A positive AUDIT should prompt further assessment and appropriate intervention 2

The AUDIT provides clinicians with a standardized, validated tool to identify patients at risk for alcohol-related harm before significant health consequences develop, allowing for earlier intervention and potentially preventing progression to more severe alcohol use disorders.