The AUDIT Questionnaire: A Comprehensive Screening Tool for Alcohol Use Disorders
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 patterns with high sensitivity and specificity. 1, 2
Structure and Content of AUDIT
The AUDIT questionnaire consists of 10 questions that cover three key domains:
- Alcohol consumption patterns (questions 1-3): Assesses frequency of drinking, typical quantity consumed, and frequency of heavy drinking episodes 1
- Alcohol dependence symptoms (questions 4-6): Evaluates inability to stop drinking once started, failure to meet expectations due to drinking, and morning drinking 1, 3
- Harmful consequences of drinking (questions 7-10): Measures guilt after drinking, blackouts, injuries related to drinking, and concerns expressed by others 1
Each question is scored from 0 to 4 points, with a maximum possible total score of 40 points 2.
Scoring and Interpretation
The AUDIT uses the following scoring thresholds:
- Score of 8 or higher for men up to age 60: Indicates hazardous or harmful drinking 1
- Score of 4 or higher for women, adolescents, or men over age 60: Indicates hazardous or harmful drinking 1
- Score of 20 or higher: Suggests alcohol dependence requiring further diagnostic evaluation 3
Among those diagnosed with hazardous or harmful alcohol use, 92% had an AUDIT score of 8 or more, while 94% of those with non-hazardous consumption had a score below 8 2.
Clinical Applications
AUDIT is valuable in clinical settings for:
- Early detection of hazardous and harmful drinking patterns before physical dependence or severe consequences develop 2, 4
- Predicting future alcohol-related problems - higher scores correlate with increased risk of both social and medical problems over time 4, 5
- Guiding appropriate interventions based on risk level 3, 6
Advantages Over Other Screening Tools
AUDIT offers several advantages compared to other alcohol screening instruments:
- Cross-cultural validation through development in a six-country WHO collaborative project 2
- Higher sensitivity for detecting hazardous drinking compared to the CAGE questionnaire, which focuses more on dependence 1
- Focus on recent drinking patterns rather than lifetime behaviors, making it more relevant for current risk assessment 1
Shortened Versions
For time-constrained clinical settings, shortened versions have been developed:
- AUDIT-C: Uses only the first three questions about consumption patterns while maintaining good sensitivity and specificity 1, 7
- AUDIT-3: In some settings, only the third question about binge drinking is used as an initial screen 1
Common Pitfalls to Avoid
When using the AUDIT questionnaire, clinicians should be aware of these potential pitfalls:
- Focusing only on alcohol consumption without considering functional impairment and consequences 3
- Overreacting to low scores by recommending unnecessary interventions 6
- Underreacting to moderate scores by failing to provide appropriate education and intervention 6
- Not distinguishing between different risk levels that require different intervention approaches 3, 6
The AUDIT questionnaire remains a gold standard for alcohol screening in primary care and other clinical settings due to its comprehensive nature and strong predictive validity 8, 4.