Alcohol Use Disorders Identification Test - C (AUDIT-C)

Purpose and Use

The Alcohol Use Disorders Identification Test - C (AUDIT-C) is a 3-item screening tool that is a shortened version of the 10-item AUDIT tool developed by the World Health Organization (WHO) to assess alcohol consumption, drinking behaviors, and alcohol-related problems. The primary purpose of the 10-item AUDIT is to help identify individuals with hazardous or harmful patterns of alcohol consumption, as well as those with potential alcohol dependence. According to auditscreen.org, briefer versions of the AUDIT have been shown to be convenient and effective instruments for diagnosing  alcohol use disorders in the a primary care setting. A 'standard drink' is defined as containing approximately 14 grams of pure alcohol (e.g., 12 oz of beer, 5 oz of wine, or 1.5 oz of spirits).

To diagnose an alcohol use disorder (AUD), further evaluation is warranted. The AUDIT-C is more effective in detecting heavy drinking and can help distinguish active and past problem drinking better than other screening questionnaires, such as the 4-item CAGE questionnaire.

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Summary 
 

The Alcohol Use Disorder Identification Test (AUDIT) implemented in this evaluation is a modified, shortened version of the 10-question AUDIT assessment. The modified version is a 3-question alcohol screening tool (AUDIT-C) that assists in identifying persons who may have an active alcohol use disorder (AUD). 

Scoring

Answers are assigned points (except for sex). The sum of these points (12 points possible) from three alcohol assessment questions determines the score and risk. If the first question about alcohol consumption is "never" then the remaining two questions will be skipped.

• Normal alcohol consumption (females <3)
• Normal alcohol consumption (males <4)
• Risk for alcohol misuse (female ≥ 3)
• Risk for alcohol misuse (male ≥ 4)
• Risk for possible liver damage (Score ≥ 5)
• Healthcare practitioner note: Confirm accuracy - Review patient's alcohol intake over the past months
  • When points are only from Questions 1, they are often drinking below the AUDIT-C cutoff. 
    • Question 1: How often did you have a drink containing alcohol in the past year?
    • Clarify with patient by reviewing alcohol intake over the past few months.

Practitioner Next Steps

If you suspect the patient is minimizing their alcohol use, or if the patient's score is near the cutoff, consider utilizing a more comprehensive screening tool to understand the nature and extent of alcohol use.

Comprehensive validated tests for further assessment include:

• Michigan Alcoholism Screening Test (MAST)
• Alcohol Use Disorders Identification Test (AUDIT)

When screening results are positive, consider assessing the patient for alcohol withdrawal syndrome. 

• In any potential setting where access to alcohol may be limited, monitor for signs or symptoms of withdrawals, even in patients who do not screen positive for alcohol misuse. 
• The Clinical Institute Withdrawal Assessment for Alcohol Scale, Revised (CIWA-Ar) is a 10-item questionnaire that assess the signs, symptoms and severity of alcohol withdrawal to guide outpatient treatment.

Primary Reference: Babor, T.F., Higgins-Biddle, J.C., Saunders, J.B., & Monteiro, M.G. (2001). AUDIT: The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Care (2nd ed.). World Health Organization.

Limitations

The AUDIT is a screening tool and not a substitute for a comprehensive diagnostic assessment by a qualified healthcare professional. Its accuracy depends on the patient's honest self-reporting, which may be influenced by recall bias or a reluctance to disclose heavy drinking. The definition of a 'standard drink' can also vary by country, which may require clarification for the user.

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• Answer up to 3 questions about your alcohol use over the past year.
• Choose the answer that is most accurate for you.
• Your total score and risk level will be calculated and displayed after you answer all questions.
• Please discuss these results with a healthcare provider. This tool is for screening, not for diagnosis.