Alcohol Use Disorders Identification Test (AUDIT)

Foundational Context

The AUDIT was originally developed as part of a WHO initiative to improve early identification of risky alcohol use in primary care settings. Saunders et al. (1993) conducted international field testing across multiple countries, resulting in a tool that performs reliably regardless of cultural context. The AUDIT remains one of the most extensively validated alcohol screening measures worldwide.

Unlike earlier tools focused solely on dependence, the AUDIT was intentionally designed to detect hazardous and harmful drinking, capturing risk long before severe consequences appear. The official WHO 2nd edition manual (Babor et al., 2001) remains the standard reference for scoring, interpretation, and brief intervention recommendations.

What the Assessment Measures

The AUDIT evaluates alcohol use across three clinically meaningful domains, though its scoring remains a single total score:

The assessment measures:

• Alcohol consumption (frequency, quantity, heavy-drinking episodes)
• Symptoms of dependence (impaired control, morning drinking, craving patterns)
• Alcohol-related problems (injuries, guilt, blackouts, external concern)

These domains help clinicians rapidly identify the level of risk and the urgency of intervention.

Interpretation Guidelines

The AUDIT uses a total score (0–40) to categorize drinking risk. These thresholds come directly from WHO guidelines and are widely used in clinical practice.

AUDIT Score Interpretation (WHO Standard):

• 0–7: Low Risk Typical drinking patterns with low likelihood of harm. Preventive advice may still be appropriate.
• 8–15: Hazardous Drinking Increased risk of harm; brief intervention recommended.
• 16–19: Harmful Drinking Evidence of harmful alcohol use; structured counseling strongly recommended.
• 20+: Possible Dependence / High Risk High likelihood of dependence; requires comprehensive assessment and potential referral to specialized services.

Interpretation Notes:

• These ranges are validated, not estimated.
• The AUDIT is a screening tool; diagnosis requires clinical interview and functional assessment.
• Cultural drinking norms and gender differences may influence score patterns.
• Scores can change meaningfully during treatment, making the AUDIT suitable for monitoring progress.

Psychometric Properties

Reliability

• Strong internal consistency (often α > .80 across samples)
• Stable test–retest reliability
• Reliable across different cultures and languages due to WHO multi-country validation

Validity

• Excellent sensitivity and specificity for hazardous and harmful drinking
• Strong convergent validity with biochemical markers and other alcohol-use scales
• Demonstrated ability to identify cases in primary care populations (Saunders et al., 1993)
• Predictive validity for health, injury, and social consequences

The AUDIT is considered one of the most robust alcohol-use screening tools available internationally.

Administration Considerations

• Can be completed via paper, digital form, or structured interview
• Works well in primary care, emergency departments, mental health, and workplace settings
• Clear, brief wording supports use with diverse populations
• Should be administered in a private, non-judgmental context to reduce social desirability bias
• Clinicians should follow WHO brief-intervention guidance for moderate and high scores

Limitations

• Screening tool only; does not diagnose alcohol use disorder
• Self-report may underestimate consumption due to stigma or recall issues
• Cultural drinking norms may influence responses
• Does not directly measure withdrawal symptoms
• Requires follow-up assessment for individuals with high-risk scores