What 10‑item screening tool can be used to assess alcohol use disorder in an adult patient?

AUDIT (Alcohol Use Disorders Identification Test)

The AUDIT is the 10-item screening tool used to assess alcohol use disorder in adults, developed by the World Health Organization and validated across multiple international settings. 1

Structure and Content

The AUDIT consists of 10 questions organized into three domains 1:

• Questions 1-3: Assess alcohol consumption (quantity and frequency) 1
• Questions 4-6: Evaluate alcohol dependence symptoms 1
• Questions 7-10: Screen for alcohol-related problems and harm 1

Each question is scored from 0 to 4 points, yielding a maximum total score of 40 1

Scoring Thresholds

A score of ≥8 for men under age 60 indicates hazardous or harmful alcohol use requiring intervention. 1

A score of ≥4 for women, adolescents, or men over age 60 is considered a positive screening test. 1

Higher cut-off scores indicate more severe problems 1:

• Score ≥12: Suggests alcohol dependence 1
• Score ≥19: Indicates alcohol dependency requiring referral to specialized alcohol services 2

Clinical Performance

The AUDIT demonstrates excellent diagnostic accuracy 3, 4:

• 92% of patients with hazardous or harmful alcohol use score ≥8 3
• 94% of those with non-hazardous consumption score <8 3
• Sensitivity of 0.887 for alcohol dependence and 0.860 for any alcohol use disorder 5
• Superior to biomarkers like GGT in predicting alcohol-related social problems and hypertension 6

Why AUDIT is the Gold Standard

AUDIT remains the gold standard screening tool because it was developed through a six-country WHO collaborative project specifically for primary care settings and has proven sensitivity and specificity across diverse populations. 1

The AUDIT outperforms alternatives 1:

• More comprehensive than CAGE, which focuses only on consequences rather than consumption patterns 1
• Better than biomarkers (GGT, MCV, CDT) which have lower sensitivity and specificity 1
• More reliable than quantity-frequency questionnaires alone for detecting risky drinking 1

Practical Implementation

Administer the full 10-item AUDIT systematically to all adult patients during routine examinations, when prescribing medications that interact with alcohol, or during emergency department visits. 1

The AUDIT-C (first 3 questions only) can serve as a brief prescreen 1:

• Score >4 for men or >3 for women on AUDIT-C warrants completion of the full 10-item AUDIT 1
• AUDIT-C is particularly useful in busy clinical settings for initial screening 1

Critical Pitfalls to Avoid

Do not rely on biomarkers like GGT alone for alcohol screening—they have significantly lower sensitivity (73% for GGT vs 92% for AUDIT) and miss many patients with hazardous drinking. 1, 2

Do not assume a low AUDIT score excludes all alcohol-related harm—the tool screens for current patterns but may miss past consequences or recent changes in drinking behavior. 6, 7

In patients with cirrhosis, AUDIT maintains its validity while biomarkers like GGT lose specificity, as GGT elevates in advanced liver disease regardless of alcohol consumption. 2

Predictive Value for Clinical Outcomes

AUDIT scores predict future alcohol-related harm over 2-3 years, with 61% of those scoring ≥8 experiencing alcohol-related social problems compared to only 10% of those with lower scores. 6

The AUDIT also predicts 6, 7:

• Alcohol-related medical disorders and hospitalization 6
• Trauma and hypertension (optimal cut-off 7-8) 7
• Liver disease and gastrointestinal bleeding (higher cut-offs 12-22) 7
• Increased all-cause mortality risk 1