Alcohol Use Disorder Identification Test (AUDIT)

Abstract

The Alcohol Use Disorder Identification Test (AUDIT) is a highly utilized, 10-item screening instrument developed by the World Health Organization (WHO). Its primary function is to identify patterns of excessive, hazardous, and harmful alcohol consumption, as well as symptoms indicative of alcohol dependence. Designed specifically for use by General Practitioners and other professionals within the primary health care setting, the AUDIT is renowned for its brevity, ease of administration, and straightforward interpretation. It is applicable to adolescents and adults of all ages and can be administered as a self-report questionnaire or through a structured interview format, typically requiring only two to three minutes for completion.

Keywords

Alcohol Use Disorder Identification Test, AUDIT, Alcohol Use Disorder, Screening Tool, Primary Health Care, Hazardous Drinking, Alcohol Dependence, WHO.

Authors

The Alcohol Use Disorder Identification Test (AUDIT) was developed through a collaborative project initiated by the World Health Organization (WHO). Key figures involved in the development and subsequent guidelines include T. F. Babor, J. C. Higgins-Biddle, J. B. Saunders, and M. G. Monterio.

Purpose

The core purpose of the AUDIT is to provide a reliable and valid method for screening individuals for problematic alcohol use across diverse cultural settings. It serves as an early detection tool, enabling clinicians in primary care settings to quickly assess a patient’s drinking patterns and the associated risks. By identifying individuals exhibiting hazardous, harmful, or dependent drinking behaviors, the AUDIT facilitates timely intervention and referral.

Crucially, the AUDIT is intended as a screening instrument, not a definitive diagnostic tool. Its results are designed to guide clinical judgment, indicating the need for further, more comprehensive assessment, such as a formal clinical interview, to establish a formal diagnosis of Alcohol Use Disorder.

Construct

The AUDIT measures the construct of problematic alcohol consumption, encompassing a spectrum ranging from at-risk drinking to established alcohol dependence. The 10 items are structured to capture three distinct, yet related, conceptual domains of drinking behavior, aligning closely with criteria established by major international diagnostic systems like the ICD-10.

The three domains assessed by the item clusters are:

• Hazardous Alcohol Use: Items 1, 2, and 3 focus on the quantity and frequency of alcohol consumption, assessing consumption levels that increase the risk of adverse health outcomes.
• Dependence Symptoms: Items 4, 5, and 6 explore features typical of alcohol dependence, such as impaired control over drinking, increased priority given to drinking, and morning drinking (craving/withdrawal).
• Harmful Alcohol Use: Items 7, 8, 9, and 10 measure the negative consequences of drinking, including guilt, blackouts, injuries related to drinking, and concerns expressed by others.

Validity

The AUDIT has demonstrated excellent validity across numerous international studies, confirming its efficacy in distinguishing between non-problematic drinkers and those experiencing alcohol-related difficulties. Its development was closely tied to the definitions of alcohol dependence and harmful alcohol use outlined in the International Classification of Diseases, 10th Revision (ICD-10), ensuring strong criterion validity against established diagnostic standards.

In initial comparative studies conducted across six different countries, the AUDIT exhibited strong performance characteristics. Utilizing a conventional cut-off score of 8, the test achieved sensitivities consistently in the mid-.90s and specificities averaging in the .80s. This high level of sensitivity confirms its effectiveness in correctly identifying individuals who have problematic alcohol use, minimizing false negatives.

Reliability

Psychometric reviews have consistently supported the reliability and internal consistency of the AUDIT. A systematic review of psychometric properties conducted by Meneses-Gaya et al. (2009), which analyzed data across ten different studies, reported a mean Cronbach’s alpha of 0.80. This coefficient indicates good internal consistency, suggesting that the 10 items reliably measure the underlying construct of problematic alcohol use.

The stability of the instrument over time (test-retest reliability) is also generally considered high, reinforcing the AUDIT’s status as a robust and consistent measure suitable for clinical and research applications worldwide.

Factor Analysis

While the AUDIT is often utilized based on its unidimensional total score, factor analysis frequently supports the theoretical structure of three underlying factors: Consumption (Hazardous Use), Dependence, and Harmful Consequences. This three-factor structure reflects the distinct domains the test was designed to cover. However, depending on the population sampled (e.g., general population vs. clinical setting), research sometimes suggests a two-factor model (Consumption/Frequency and Adverse Consequences/Dependence) or even a single dominant factor representing overall alcohol problem severity. The three-domain structure remains the standard conceptual framework for interpreting individual item clusters and guiding brief interventions.

Instrument

Test Type: Screening Instrument; Self-Report Questionnaire or Structured Interview

Format: 10 multiple-choice items, primarily scored on a 0-4 point scale. Takes approximately 2-3 minutes to complete.

Language Available: Widely translated into numerous languages due to its international development by the WHO.

Population Group: General Population; Clinical samples, especially in Primary Health Care settings.

Age Group: Adolescents and Adults of all ages.

Population Details: Developed for use in diverse cultural contexts. Suitable for general medical and psychiatric patient populations where alcohol use screening is warranted.

Test Methodology: Total scores range from 0 to 40. Interpretation is based on cut-off points, which are considered tentative and subject to clinical judgment:

• Scores 8-15 indicate Hazardous Use.
• Scores 16-19 indicate Harmful Use.
• Scores 20 or greater indicate probable Alcohol Dependence.

Keywords

Screening, Alcohol Abuse, Dependence, Harmful Drinking, Hazardous Use, WHO, AUDIT, Primary Care, Psychometrics.

Authors

Author ORCID Identifier: N/A (Developed by WHO collaborative project)

Affiliation Email addresses: N/A

Correspondence Address: World Health Organization (WHO), Geneva, Switzerland.

Permissions & Fee and Test Year

The AUDIT is a public domain instrument developed by the World Health Organization and is free to use without requiring specific licensing fees or specialized training for administration. The original development and validation occurred in the late 1980s, culminating in the publication of comprehensive guidelines in the early 1990s and subsequent revisions (e.g., 2001).

The original PDF guidelines for the WHO collaborative project on identification and management of Alcohol-related problems in primary health care (Heather, 2006) can be accessed here: http://www.who.int/substance_abuse/publications/identification_management_alcoholproblems_phaseiv.pdf?ua=1

Reference’s

Babor, T. F., Higgins-Biddle, J. C., Saunders, J. B., & Monterio, M. G. (2001). AUDIT: The Alcohol Use Disorders Identification Test Guidelines for Use in Primary Care (second edition). Retrieved from http://www.who.int/substance_abuse/publications/audit/en/

Heather, N. (2006). WHO collaborative project on identification and management of Alcohol-related problems in primary health care. Retrieved from http://www.who.int/substance_abuse/publications/identification_management_alcoholproblems_phaseiv.pdf?ua=1

Menese-Gaya, C., Zuardi, A., Loureiro, S., & Crippa, J. (2009). Alcohol use disorders identification test (AUDIT): An updated systematic review of psychometric properties. Psychology & Neuroscience, 2(2), 83-97 DOI: 10.3922/j.psns.2009.1.12

Additional resource for clinical administration: Turning point have developed ‘The Adult AOD Screening and Assessment Instrument” Clinical Guide that lists instructions and advice for the AUDIT along with other AOD screening tools. The manual is available here: http://www.turningpoint.org.au/Treatment/Online-Self-Assessment.aspx

Items of the Alcohol Use Disorder Identification Test (AUDIT)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

Two examples of items on the AUDIT questionnaire are:

1. How often do you have a drink containing alcohol?

(0) Never [Skip to Qs 9-10] (1) Monthly or less (2) 2 to 4 times a month (3) 2 to 3 times a week (4) 4 or more times a week

9. Have you or someone else been injured as a result of your drinking?

(0) No (2) Yes, but not in the last year (4) Yes, during the last year