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(Open Calc) Alcohol Use Disorders Identification Test (AUDIT)

Background

• Screening for excessive alcohol consumption
  • Identifies hazardous and harmful alcohol use, and possible dependence
  • Focuses on recent alcohol use
  • Very good sensitivity, specificity, and reliability
• Developed by World Health Organization (WHO) for international use
  • Validated on primary healthcare pts in 6 countries
• Designed for healthcare practitioners in various settings, but can be self-administered

Definitions

• Hazardous drinking (questions 1-3)
  • Pattern of alcohol consumption that increases risk of harmful consequences for user or others
• Harmful use (questions 4-6)
  • Alcohol consumption that results in consequences to physical and mental health, or social consequences
• Alcohol dependence (questions 7-10)
  • Cluster of behavioral, cognitive, and physiological phenomena that develops after repeated alcohol uses
  • Usually includes
    • Desire for alcohol
    • Impaired control over its use
    • Persistent drinking despite harmful consequences
    • Higher priority given to drinking than to other activities or obligations
    • Increased alcohol tolerance
    • Physical withdrawal reaction when use is discontinued

Instructions

• Inform pt of questionnaire
• Encourage pt to answer questions even if alcohol use is not socially sanctioned for them (eg, minors, observant Muslims)
• Read questions as written
• Explain what is meant by "alcoholic beverages" by using local examples of beer, wine, vodka, etc
  • Code answers in terms of "standard drinks" (approx 13 g pure EtOH, ie, 1 bottle of beer, 1 glass of wine, 1 shot of spirits)
• Most low-risk pts will not need to answer all questions
  • If pt responds to question 1 that no drinking has occurred during last year, may skip to questions 9-10
  • If pt scores 0 on questions 2 and 3, may skip to questions 9-10

Interpretation

• Recommended cutoff: 8 points
  • May use lower cutoff (7 points) in pts > 65 yo
• 8 - 15 points: at risk
  • Require simple advice focused on reduction of hazardous drinking
• 16 - 19 points: medium risk
  • Brief counseling and continued monitoring
• 20 or more points: high risk
  • Further diagnostic eval for alcohol dependence
• Score above 0 on questions 2 or 3 indicates hazardous consumption
• Score above 0 on questions 4-6 (esp weekly or daily Sx) imply alcohol dependence
• Score above 0 on questions 7-10 indicates that alcohol-related harm is already present

Scoring Instructions

1. How often do you have a drink containing alcohol?
   • Never (0 points) - SKIP TO QUESTIONS 9-19
   • Monthly or less (1 point)
   • 2-4 times/ month (2 points)
   • 2-3 times/ week (3 points)
   • 4 or more times/ week (4 points)
2. How many drinks containing alcohol do you have on a typical day when you are drinking?
   • 1 or 2 (0 points)
   • 3 or 4 (1 point)
   • 5 or 6 (2 points)
   • 7, 8, or 9 (3 points)
   • 10 or more (4 points)
3. How often do you have six or more drinks on one occasion?
   • Never (0 points)
   • Less than monthly (1 point)
   • Monthly (2 points)
   • Weekly (3 points)
   • Daily or almost daily (4 points)
   • SKIP TO QUESTIONS 9 AND 10 IF TOTAL SCORE FOR QUESTIONS 2 AND 3 IS 0
4. How often during the last year have you found that you were not able to stop drinking once you had started?
   • Never (0 points)
   • Less than monthly (1 point)
   • Monthly (2 points)
   • Weekly (3 points)
   • Daily or almost daily (4 points)
5. How often during the last year have you failed to do what was normally expected from you because of your drinking?
   • Never (0 points)
   • Less than monthly (1 point)
   • Monthly (2 points)
   • Weekly (3 points)
   • Daily or almost daily (4 points)
6. How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?
   • Never (0 points)
   • Less than monthly (1 point)
   • Monthly (2 points)
   • Weekly (3 points)
   • Daily or almost daily (4 points)
7. How often during the last year have you had a feeling of guilt or remorse after drinking?
   • Never (0 points)
   • Less than monthly (1 point)
   • Monthly (2 points)
   • Weekly (3 points)
   • Daily or almost daily (4 points)
8. How often during the last year have you been unable to remember what happened the night before because you had been drinking?
   • Never (0 points)
   • Less than monthly (1 point)
   • Monthly (2 points)
   • Weekly (3 points)
   • Daily or almost daily (4 points)
9. Have you or someone else been injured as a result of your drinking?
   • No (0 points)
   • Yes, but not in the last year (2 points)
   • Yes, during the last year (4 points)
10. Has a relative or friend or a doctor or another health worker been concerned about your drinking or suggested you cut down?
    • No (0 points)
    • Yes, but not in the last year (2 points)
    • Yes, during the last year (4 points)

References

1. Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption. Addiction 1993; 88:791-804.
2. Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG. AUDIT The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Health Care, Second Edition. WHO/MSD/MSB/01.6a, World Health Organization, Geneva, 2001.