AUDIT-C Alcohol Use

AUDIT-C criteria

The AUDIT-C is one of the most popular alcohol screening methods. It consists of a simple, easy to administer questionnaire that addresses the following criteria:

■ Frequency of consumption of alcoholic drinks in the past year;

■ Number of drinks per day during the past year;

■ Frequency of consumption of six or more drinks on one occasion;

■ Not being able to stop drinking;

■ Failing expectations because of drinking;

■ Consumption of alcoholic drinks in the morning;

■ Feelings of guilt and remorse;

■ Not being able to remember the night before;

■ Injuries occurring during drinking;

■ Concern from peers.

AUDIT-C score interpretation

According to the above, questions 1, 2 and 3 focus on alcohol consumption. Each of the answers is awarded a number of points. If only these three questions are applied, the score ranges from 0 to 12.

Scores of 4 in women and 5 in men are the threshold for higher drinking risk and likelihood of alcohol consumption to have further consequences.

Questions 4 to 6 address alcohol dependence while questions 7 to 10 address alcohol related problems. When these 7 questions are applied, the threshold for alcohol misuse is at 7 points for women and 8 points for men.

Overall scores below 7 are only deemed to require alcohol education, scores between 8 and 19 should receive advice, counselling and in some cases treatment.

Some clinicians, when applying the whole scale, consider a threshold of 20 to indicate alcohol associated risks and dependence but the AUDIT-C is not specifically designed to screen for dependence.

The following table summarizes the above score interpretations:

About the original study

The Alcohol Use Disorders Identification Test (AUDIT) has been developed from a six-country WHO collaborative project. It was aimed to become a screening instrument for hazardous and harmful alcohol consumption.

From the results of the study:

■ Among those diagnosed with harmful alcohol use, 92% had an AUDIT score of 8 or more;

■ In the cohort of patients that didn’t present hazardous consumption. 94% had a score of less than 8.

The AUDIT-C is different from blood alcohol tests which are determining levels of alcohol in the system (after a certain amount of time has lapsed).

Alcoholism signs and withdrawal symptoms

From risky drinking to severe alcohol dependence, alcohol misuse has associated mortality and morbidity. Common signs include the inability to control or give up drinking, an increase in quantity in time, decrease in life quality because of drinking or presence of withdrawal symptoms.

Hazardous drinking patterns are often associated with the following conditions:

■ Hypertension;

■ Congestive heart failure (CHF);

■ Increased stroke risk;

■ Liver disease;

■ Malignancy;

■ Depression.

Alcohol withdrawal symptoms can vary in intensity, depending on alcohol misuse, quantity, period of time and other personal factors. Some of the common symptoms include: headaches, sweating, fever, nausea, anxiety, restlessness or shaking.

Drinking limits

The National Institutes for Health (NIH) published consumption limits that state:

■ For men: no more than 14 drinks a week and no more than 4 drinks at once;

■ For women: no more than 7 drinks a week and no more than 3 drinks at once.

Here are some examples of what a drink is considered: 12 ounces of beer, 5 ounces of wine, 1.5 ounces of hard liquor.

Original sources

1. Fleming MF, Barry KL, MacDonald R. The alcohol use disorders identification test (AUDIT) in a college sample. Int J Addict. 1991; 26(11):1173-85.

2. 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--II. Addiction. 1993; 88(6):791-804.

Other references

1. Bohn MJ, Babor TF, Kranzler HR. The Alcohol Use Disorders Identification Test (AUDIT): validation of a screening instrument for use in medical settings. J Stud Alcohol. 1995; 56(4):423-32.

2. Frank D, DeBenedetti AF, Volk RJ, Williams EC, Kivlahan DR, Bradley KA. Effectiveness of the AUDIT-C as a screening test for alcohol misuse in three race/ethnic groups. J Gen Intern Med. 2008; 23(6):781-7.