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Alcohol Use Disorders Identification Test

CONTENTS

CONTENTS

Assessment Rating

A - Psychometrics Well-Demonstrated

Developer: John B. Saunders, MD, and the World Health Organization

A
See entire scale

Assessment Rating

A - Psychometrics Well-Demonstrated

Developer: John B. Saunders, MD, and the World Health Organization

A
See entire scale

Description / Purpose

The 10-item AUDIT (Alcohol Use Disorders Identification Test) is a simple and effective method of screening for unhealthy alcohol use, defined as risky or hazardous consumption, or any alcohol use disorder. It enquires about the three key domains of:

1. Alcohol intake

2. Potential dependence on alcohol

3. Experience of alcohol-related harm

Many of the AUDIT™ questions reflect the fundamental relationship between people and alcohol, including its liability to cause dependence (addiction) and a range of harmful consequences. The three domains can be scored individually but it is most usual to compute the score for the AUDIT as a whole.

Target Population: Adults

Administer Time: 2 minutes

Completed By: Self-report

Available Modalities: Pen and paper; Online

Scoring Information: The AUDIT has 10 questions and the possible responses to each question are scored 0, 1, 2, 3, or 4, with the exception of questions 9 and 10, which have possible responses of 0, 2, and 4.The range of possible scores is from 0 to 40, where 0 indicates an abstainer who has never had any problems from alcohol. A score of 1 to 7 suggests low-risk consumption according to World Health Organization (WHO) guidelines. Scores from 8 to 14 suggest hazardous or harmful alcohol consumption, and a score of 15 or more indicates the likelihood of alcohol dependence (moderate-severe alcohol use disorder).

Training Requirements: None required. A training manual is available.

Availability: The AUDIT is copyrighted, but the test and manual are free and available widely on the internet.Manual Citation: Babor, T. F., Higgins-Biddle, J. C., Saunders, J. B., and Monteiro, M. (2001). AUDIT The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Care (2nd ed.). Geneva: World Health Organization.

Description / Purpose

The 10-item AUDIT (Alcohol Use Disorders Identification Test) is a simple and effective method of screening for unhealthy alcohol use, defined as risky or hazardous consumption, or any alcohol use disorder. It enquires about the three key domains of:

1. Alcohol intake

2. Potential dependence on alcohol

3. Experience of alcohol-related harm

Many of the AUDIT™ questions reflect the fundamental relationship between people and alcohol, including its liability to cause dependence (addiction) and a range of harmful consequences. The three domains can be scored individually but it is most usual to compute the score for the AUDIT as a whole.

Target Population: Adults

Administer Time: 2 minutes

Completed By: Self-report

Available Modalities: Pen and paper; Online

Scoring Information: The AUDIT has 10 questions and the possible responses to each question are scored 0, 1, 2, 3, or 4, with the exception of questions 9 and 10, which have possible responses of 0, 2, and 4.The range of possible scores is from 0 to 40, where 0 indicates an abstainer who has never had any problems from alcohol. A score of 1 to 7 suggests low-risk consumption according to World Health Organization (WHO) guidelines. Scores from 8 to 14 suggest hazardous or harmful alcohol consumption, and a score of 15 or more indicates the likelihood of alcohol dependence (moderate-severe alcohol use disorder).

Training Requirements: None required. A training manual is available.

Availability: The AUDIT is copyrighted, but the test and manual are free and available widely on the internet.Manual Citation: Babor, T. F., Higgins-Biddle, J. C., Saunders, J. B., and Monteiro, M. (2001). AUDIT The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Care (2nd ed.). Geneva: World Health Organization.

Contact Information

John B Saunders

Contact Information

John B Saunders

Summary of Relevant Psychometric Research
This tool has received the Measurement Tools Rating of A – Psychometrics Well-Demonstrated based on the published, peer-reviewed research available. The tool must have 2 or more published, peer-reviewed studies that have established the measure’s psychometrics (e.g., reliability and validity, sensitivity and specificity, etc.). Please see the Measurement Tools Rating Scale for more information.
View All Research Articles

  • Saunders, J. B., Aasland, O. G., Babor, T. F., de la Fuente, J. R., & Grant, M. (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction, 88(6), 791–804. https://doi.org/10.1111/j.1360-0443.1993.tb02093.x

    Number of participants: 1888 persons attending representative primary health care facilities in Australia, Bulgaria, Kenya, Mexico, Norway and the USA.

    Summary:

    Among those diagnosed as having hazardous or harmful alcohol use, 92% had an AUDIT score of 8 or more, and 94% of those with non-hazardous consumption had a score of less than 8.The sensitivity of AUDIT for hazardous alcohol consumption ranged from 95% to 100%, for abnormal drinking behavior from 93% to 100%, for the alcohol dependence syndrome it was 100%, and for "alcohol problems in the last year" it ranged from 91% to 100%. The overall sensitivity for hazardous and harmful alcohol use was 87% to 96%, with an overall value of 92%. The corresponding specificity was 81% to 98%, with an overall value of 94%. The validity of AUDIT was then determined among the external reference groups of known alcoholics and non-drinkers. Of the alcoholics, 99% had a score of 8 or more, 98% had a score of 10 or more and when those who were currently abstinent were excluded, all scored 10 or more. Only three of 678 non-drinkers (0.5%) had a score of 8 or more.

  • Conigrave, K. M., Hall, W. D., & Saunders, J. B. (1995). The AUDIT questionnaire: choosing a cut-off score. Addiction, 90(10), 1349–1356. https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1360-0443.1995.901013496.x

    Number of participants: 330 Ambulatory care patients in Sydney, Australia

    Summary:

    This longitudinal study examined the AUDIT™ performance in predicting alcohol-related harm over the full range of its scores using receiver operating characteristic analyses. Subjects were interviewed using a detailed assessment schedule which included the AUDIT questions. After 2-3 years, subjects were reviewed, and their experience of alcohol-related medical and social harm assessed by interview and perusal of medical records. AUDIT was a good predictor of both alcohol-related social and medical problems. Cut-off points of 7-8 maximized discrimination in the prediction of trauma and hypertension. Higher cut-offs (12 and 22) provided better discrimination in the prediction of alcohol-related social problems and of liver disease or gastrointestinal bleeding, but high specificity was offset by reduced sensitivity. We conclude that the recommended cut-off score of eight is a reasonable approximation to the optimal for a variety of endpoints.

  • Conigrave, K. M., Saunders, J. B., & Reznik, R. B. (1995). Predictive capacity of the AUDIT questionnaire for alcohol related harm. Addiction, 90(11), 1479–1485. https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1360-0443.1995.901114796.x

    Number of participants: 330 Ambulatory care patients in Sydney, Australia

    Summary:

    The study examined the AUDIT™ ability to predict alcohol–related illness and social problems, hospital admission and mortality over a 2–3–year period. At initial interview, subjects were assessed using a detailed interview including the AUDIT questions and laboratory tests. After 2–3 years, subjects were reassessed and their experience of alcohol–related harm determined. Of those who scored eight or more on AUDIT at initial interview, 61 % experienced alcohol–related social problems compared with 10% of those with lower scores (p < 0.0001); they also had a significantly greater experience of alcohol–related medical disorders and hospitalization. AUDIT score was a better predictor of social problems and of hypertension than laboratory markers.

  • Bohn, M. J., Babor, T. F., & Kranzler, H. R. (1995). The Alcohol Use Disorders Identification Test (AUDIT): Validation of a screening instrument for use in medical settings. Journal of Studies on Alcohol, 56(4), 423–432. https://doi.org/10.15288/jsa.1995.56.423

    Number of participants: 65 known alcoholics and 187 general medical patients in the United States

    Summary:

    This study examined the concurrent, construct, and discriminant validity of the Alcohol Use Disorders Identification Test (AUDIT). Results showed that AUDIT scores correlated significantly with scores on the MAST and MacAndrew alcoholism screening tests, and with ALAT, ASAT, GGT and MCV levels, which reflect recent heavy drinking. AUDIT scores were correlated with measures of alcoholism vulnerability (e.g., familial alcoholism and sociopathy), and with somatic and affective consequences of drinking. Receiver operating characteristic and discriminant function analyses indicated that the AUDIT Core and Clinical instruments were sensitive and specific in discriminating alcoholics from medical patients, most of whom were nonalcoholics. The AUDIT Core was superior to the MAST and the AUDIT Clinical in discriminating hazardous drinkers from nonhazardous drinkers. It was also superior to the AUDIT Clinical in discriminating harmful from non-harmful drinkers.

  • de Meneses-Gaya, C., Zuardi, A. W., Loureiro, S. R., & Crippa, J. A. S. (2009). Alcohol Use Disorders Identification Test (AUDIT): An updated systematic review of psychometric properties. Psychology & Neuroscience, 2(1), 83–97. https://doi.org/10.3922/j.psns.2009.1.12

    Number of participants: Not applicable – systematic review

    Population:

    • Race/Ethnicity — Not applicable – systematic review

    Summary:

    This systematic review examined 47 articles published between 2002 and 2009 that evaluated the AUDIT in different countries and in diverse health and community contexts, involving adolescent, adult, and elderly samples. The studies confirmed the validity and efficiency of the AUDIT in the identification of harmful use, abuse, and dependence of alcohol, both in the original version and in modified ones. The possibility of using brief and efficient versions is of great value, since certain health contexts demand faster assessment. The results also showed that the reduced versions have satisfactory psychometric qualities, sometimes with sensitivity values higher than those of the AUDIT itself. The studies analyzed confirm the efficiency of the AUDIT both in its original, reduced, and language-adapted versions in different contexts and cultures.

Summary of Relevant Psychometric Research

This tool has received the Measurement Tools Rating of A – Psychometrics Well-Demonstrated based on the published, peer-reviewed research available. The tool must have 2 or more published, peer-reviewed studies that have established the measure’s psychometrics (e.g., reliability and validity, sensitivity and specificity, etc.). Please see the Measurement Tools Rating Scale for more information.
View All Research Articles

  • Saunders, J. B., Aasland, O. G., Babor, T. F., de la Fuente, J. R., & Grant, M. (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction, 88(6), 791–804. https://doi.org/10.1111/j.1360-0443.1993.tb02093.x

    Number of participants: 1888 persons attending representative primary health care facilities in Australia, Bulgaria, Kenya, Mexico, Norway and the USA.

    Summary:

    Among those diagnosed as having hazardous or harmful alcohol use, 92% had an AUDIT score of 8 or more, and 94% of those with non-hazardous consumption had a score of less than 8.The sensitivity of AUDIT for hazardous alcohol consumption ranged from 95% to 100%, for abnormal drinking behavior from 93% to 100%, for the alcohol dependence syndrome it was 100%, and for "alcohol problems in the last year" it ranged from 91% to 100%. The overall sensitivity for hazardous and harmful alcohol use was 87% to 96%, with an overall value of 92%. The corresponding specificity was 81% to 98%, with an overall value of 94%. The validity of AUDIT was then determined among the external reference groups of known alcoholics and non-drinkers. Of the alcoholics, 99% had a score of 8 or more, 98% had a score of 10 or more and when those who were currently abstinent were excluded, all scored 10 or more. Only three of 678 non-drinkers (0.5%) had a score of 8 or more.

  • Conigrave, K. M., Hall, W. D., & Saunders, J. B. (1995). The AUDIT questionnaire: choosing a cut-off score. Addiction, 90(10), 1349–1356. https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1360-0443.1995.901013496.x

    Number of participants: 330 Ambulatory care patients in Sydney, Australia

    Summary:

    This longitudinal study examined the AUDIT™ performance in predicting alcohol-related harm over the full range of its scores using receiver operating characteristic analyses. Subjects were interviewed using a detailed assessment schedule which included the AUDIT questions. After 2-3 years, subjects were reviewed, and their experience of alcohol-related medical and social harm assessed by interview and perusal of medical records. AUDIT was a good predictor of both alcohol-related social and medical problems. Cut-off points of 7-8 maximized discrimination in the prediction of trauma and hypertension. Higher cut-offs (12 and 22) provided better discrimination in the prediction of alcohol-related social problems and of liver disease or gastrointestinal bleeding, but high specificity was offset by reduced sensitivity. We conclude that the recommended cut-off score of eight is a reasonable approximation to the optimal for a variety of endpoints.

  • Conigrave, K. M., Saunders, J. B., & Reznik, R. B. (1995). Predictive capacity of the AUDIT questionnaire for alcohol related harm. Addiction, 90(11), 1479–1485. https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1360-0443.1995.901114796.x

    Number of participants: 330 Ambulatory care patients in Sydney, Australia

    Summary:

    The study examined the AUDIT™ ability to predict alcohol–related illness and social problems, hospital admission and mortality over a 2–3–year period. At initial interview, subjects were assessed using a detailed interview including the AUDIT questions and laboratory tests. After 2–3 years, subjects were reassessed and their experience of alcohol–related harm determined. Of those who scored eight or more on AUDIT at initial interview, 61 % experienced alcohol–related social problems compared with 10% of those with lower scores (p < 0.0001); they also had a significantly greater experience of alcohol–related medical disorders and hospitalization. AUDIT score was a better predictor of social problems and of hypertension than laboratory markers.

  • Bohn, M. J., Babor, T. F., & Kranzler, H. R. (1995). The Alcohol Use Disorders Identification Test (AUDIT): Validation of a screening instrument for use in medical settings. Journal of Studies on Alcohol, 56(4), 423–432. https://doi.org/10.15288/jsa.1995.56.423

    Number of participants: 65 known alcoholics and 187 general medical patients in the United States

    Summary:

    This study examined the concurrent, construct, and discriminant validity of the Alcohol Use Disorders Identification Test (AUDIT). Results showed that AUDIT scores correlated significantly with scores on the MAST and MacAndrew alcoholism screening tests, and with ALAT, ASAT, GGT and MCV levels, which reflect recent heavy drinking. AUDIT scores were correlated with measures of alcoholism vulnerability (e.g., familial alcoholism and sociopathy), and with somatic and affective consequences of drinking. Receiver operating characteristic and discriminant function analyses indicated that the AUDIT Core and Clinical instruments were sensitive and specific in discriminating alcoholics from medical patients, most of whom were nonalcoholics. The AUDIT Core was superior to the MAST and the AUDIT Clinical in discriminating hazardous drinkers from nonhazardous drinkers. It was also superior to the AUDIT Clinical in discriminating harmful from non-harmful drinkers.

  • de Meneses-Gaya, C., Zuardi, A. W., Loureiro, S. R., & Crippa, J. A. S. (2009). Alcohol Use Disorders Identification Test (AUDIT): An updated systematic review of psychometric properties. Psychology & Neuroscience, 2(1), 83–97. https://doi.org/10.3922/j.psns.2009.1.12

    Number of participants: Not applicable – systematic review

    Population:

    • Race/Ethnicity — Not applicable – systematic review

    Summary:

    This systematic review examined 47 articles published between 2002 and 2009 that evaluated the AUDIT in different countries and in diverse health and community contexts, involving adolescent, adult, and elderly samples. The studies confirmed the validity and efficiency of the AUDIT in the identification of harmful use, abuse, and dependence of alcohol, both in the original version and in modified ones. The possibility of using brief and efficient versions is of great value, since certain health contexts demand faster assessment. The results also showed that the reduced versions have satisfactory psychometric qualities, sometimes with sensitivity values higher than those of the AUDIT itself. The studies analyzed confirm the efficiency of the AUDIT both in its original, reduced, and language-adapted versions in different contexts and cultures.