Alcohol Use Disorders Identification Test (AUDIT)

Instructions:

Because alcohol use can affect your health and can interfere with certain medications and treatments, it is important that we ask some questions about your use of alcohol. Please read the following questions and tap the box that best describes your answer to each question.

How often do you have a drink containing alcohol?
Never Monthly or less 2-4 times a month 2-3 times a week 4 or more times a week
How many drinks containing alcohol do you have on a typical day when you are drinking?
0	0 or 2
1	3 or 4
2	5 or 6
3	7 to 9
4	10 or more
		Never	Less than monthy	Monthly	Weekly	Daily or almost daily
How often do you have six or more drinks on one occasion ?		0	1	2	3	4
How often during the last year have you found that you were not able to stop drinking once you had started?		0	1	2	3	4
How often during the last year have you failed to do what was normally expected of you because of drinking?		0	1	2	3	4
How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session ?		0	1	2	3	4
How often during the last year have you had a feeling of guilt or remorse after drinking?		0	1	2	3	4
How often during the last year have you been unable to remember what happened the night before because of your drinking?		0	1	2	3	4
Have you or someone else been injured because of your drinking?
0	No
2	Yes, but not in the last year
4	Yes, during the last year

	Has a relative, friend, doctor, or other health care worker been concerned about your drinking or suggested you cut down?
	0 No 2 Yes, but not in the last year 4 Yes, during the last year

The AUDIT is a 12 question self-report screening questionnaire designed to measure harmful alcohol use. This includes the 10 standard questions of the AUDIT and this version includes 2 optional questions at the end to determine self-identified problem drinking and self-perceived difficulty in stopping drinking. The AUDIT is widely used and useful for routine screening in community health settings and was developed in conjunction with the World Health Organisation.

It is sensitive to three factors of problematic alcohol use:

• Hazardous health impacts
• Dependence symptoms
• Behavioural or social problems of use

The AUDIT differs from other self-report screening tests in that it was based on data collected from a large multinational sample, used a statistical rationale for item selection, emphasises identification of hazardous drinking rather than long-term dependence and adverse drinking consequences, and focuses primarily on symptoms occurring during the recent past rather than “ever”.

Validity

In the test development sample (Saunders et al, 1993), a cut-off value of 8 yielded sensitivities for various indices of problematic drinking that were in the mid 0.90s.

Subsequent research has evaluated the AUDIT against other measures of alcohol problems including data from comprehensive interviews. One such study (Bush, et al, 1998) found that among 477 participants who completed the AUDIT and were interviewed to determine significant alcohol related problems, a cutoff score of 8 had a sensitively (false negative) of 59% and a specificity (false positive) of 91%. That is, a score of 8 or more will only be sensitive to 59% of individuals who actually have drinking problems, and one can be 91% sure it is not a false positive.

Hays and Merz (1995) gave 832 individuals who were enrolled in drink driving treatment program in California the AUDIT and found that the average score was 8.6 (SD 6.9). This data is used to compute percentiles but given the positive skew should be interpreted with caution.

Interpretation

Total scores range from 0 to 40, with higher scores indicating greater likelihood of hazardous and harmful drinking. Scores are also presented as a percentile compared to a sample of individuals enrolled in a drink driving treatment program (Hays & Merz, 1995). A percentile of 50 indicates a typical score for someone with serious drinking related driving offences, with higher percentiles indicate high severity. Percentiles below 30 likely indicate no drinking problem.

Scoring is computed by adding scores (0 – 4) on questions 1 to 8, and questions 9 and 10 scored 0, 2, or 4 points. Questions 11 and 12 are not scored.

Risk levels are presented based upon the following total scores:

• 0 – 7: Low risk
• 8 – 15: Hazardous
• 16 – 19: Harmful
• 20+: High risk

Total scores of 8 or more are recommended as indicators of hazardous and harmful alcohol use. However, a score of 8 or more will only be sensitive to 59% of individuals who actually have drinking problems, (Bush et al, 1998). Therefore, scores should only be used as an indication of alcohol problems and not to definitively rule it out.

When looking at individual responses the questions can be conceptualised using the following three categories:

• Likelihood of hazardous health impacts (questions 1, 2 & 3)
• Dependence symptoms (questions 4, 5 & 6)
• Behavioural or social problems as a result of use (questions 7, 8, 9 & 10)
  These are also presented as standard scores (out of 10) so that the relative challenges faced in each of these categories can be compared.

A raw score above 4 (standard score 3.3) on the Dependence subscale indicates that the client may have alcohol dependency. If a client scores of 4 or more then it is recommended that further assessment be completed to determine if dependence is confirmed.

The last two questions help with managing self-beliefs about drinking problems and self-perceived difficulties in stopping or reducing drinking levels within the next 3 months.

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