Alcohol Use Disorders Identification Test (AUDIT)

The AUDIT is a 10-item questionnaire that screens for hazardous, harmful and dependent alcohol use. The three domains cover consumption, dependence symptoms, and alcohol related harm. Each item is scored from 0 to 4, giving a total from 0 to 40.

It is a screening tool, and a score identifies the level of risk. It does not diagnose alcohol dependence, which requires clinical assessment.

Usage. It is used in primary care, emergency departments, and in pregnancy and occupational health settings.

Indications. Screening for hazardous drinking in adults, assessment of alcohol related harm, and monitoring of change in use over time.

Preparation and technique. The patient completes the questionnaire in private, and the answers are reviewed with the clinician. A shorter version, the AUDIT-C, uses the consumption items alone.

Contraindications and precautions. Self-report underestimates consumption, and interpretation is cautious where the patient is intoxicated or has cognitive impairment.

Interpretation.

• Scores of 0 to 7 indicate low risk drinking.
• Scores of 8 to 15 indicate hazardous drinking.
• Scores of 16 to 19 indicate harmful drinking.
• Scores of 20 to 40 indicate probable alcohol dependence.

Causes of a raised score. Hazardous and harmful alcohol use, dependence, and co-existing mental health conditions.

Critical values and findings needing immediate action.

• A high score with withdrawal symptoms, such as tremor, sweats or hallucinations, requires urgent medical assessment.
• A high score with liver dysfunction or confusion requires prompt review.

Limitations and artefacts. Self-report underestimates consumption and is affected by stigma. The questionnaire does not identify the cause of harm, and it is interpreted with the clinical picture.

Follow up tests. Liver function tests, gamma glutamyl transferase, full blood count with mean cell volume, and screening for other substance use where indicated.

Special groups. Pregnancy is a context in which alcohol screening is particularly important, and results are interpreted with awareness of foetal risk. Older adults may be more sensitive to alcohol effects at lower quantities.