Outcome Measure

Alcohol Use Disorder Identification Test

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What it measures?

The AUDIT identifies risky or harmful alcohol consumption, as well as alcohol dependence or abuse.
Items 1-3 measure the amount and frequency of alcohol intake.
Items 4-6 assess alcohol dependence
Items 7-10 identify problems related to alcohol consumption.

Who is it for?

Adults aged 18 years and older.

Instrument Quality

Among 40 existing alcohol scales, a systematic review used COSMIN criteria to rank the AUDIT in the top three instruments (the other two were the SADD and ADS; Ohtani et al., 2023). The mean COSMIN score of overall quality reflecting measurement property and methodological quality was 6.3. However none the of the 40 scales had moderate to high evidence for all nine psychometric properties considered by COSMIN.

Structure

10 items
5-point Likert scale (although questions nine and ten are scored 0, 2 or 4 only)
Reflecting on the past year, respondents are asked how frequently (e.g. 0 = “Never”; 4 = “4+ times a week”) each statement has applied to them (e.g. “How often do you have six or more standard drinks on one occasion?”)

Scoring instructions

Sum responses to all 10 items to form the full-scale. Some versions of the AUDT have two additional questions (items 11 and 12). These two items do not contribute towards the full-scale score.
The AUDIT-C, which measures only alcohol consumption can also be calculated by summing responses to the first three items.

Subscale	Item number
Full-scale (AUDIT)	1,2,3,4,5,6,7,8,9,10

Score Interpretation

What higher scores mean?

More hazardous or harmful alcohol consumption. Greater likelihood of meeting criteria for Alcohol Use Disorder.

Identifying risk

A patient may be at risk if they endorse any of the following ‘red flag’ items. Further risk assessment should be undertaken.

Item number	Item content
9	Have you or someone else been injured because of your drinking?

How to assess symptom severity & change?

Description	Score Range
Low-risk use	0
Hazardous use	8
Alcohol use disorder	>=6	Provisional Diagnosis
Harmful use	16
High risk use/dependence	20
Maximum	40

Severity ranges

Research by Babor and colleagues (2001) compared AUDIT scores with diagnostic data reflecting low, medium and high degrees of alcohol dependence. WHO guidelines suggest the following: * Scores between 8 and 15 are most appropriate for simple advice focused on the reduction of hazardous drinking. * Scores between 16 and 19 suggest brief counselling and continued monitoring. * Scores of 20 or above warrant further diagnostic evaluation for alcohol dependence.

Provisional diagnosis

A large number of studies have reported a cutoff score of 8 as optimal for identifying alcohol dependence or an alcohol use disorder, determined against DSM/ICD criteria and standardised measures—such as Composite International Diagnostic Interview (CIDI; World Health Organization, 1993), Structured Clinical Interview for DSM-IV (SCID-IV) and others (for a review, see Reinert & Allen, 2002). In predicting alcohol use disorders, dependence or heavy drinking, the median sensitivity across multiple studies was reported to be 0.86 and the median specificity was 0.89. Several more recent studies have also found that a cutoff score of 6 or 7 was optimal for identifying alcohol use disorders (see Babor & Robaina, 2016 for a review). It has been emphasised that the standard cutoff score of 8 may be too high females—for whom a score of 5 or 6 may be more appropriate. There is also evidence that the AUDIT may not be a particularly accurate screening instrument among the elderly (Babor & Robaina, 2016; Reinert & Allen, 2002). Given the state of research, we have taken a conservative approach to the identification of alcohol use disorder status, therefore selecting a cutoff value of 6.

Reliable change and clinically significant improvement

Wampold et al (2001) conducted a meta analysis of psychotherapy outcome studies and noted that the average improvement was reflected in an effect size (ES) of .80. Because a change of 1 SD corresponds to an ES of 1.0, and .80 is considered to be a large ES, Wise (2004) concludes that a change of 1 SD is a defensible indicator of clinically significant change.

Mean

Sample	Mean	Comments
Clinical	11.7	Given that the value of 8 has consistently been identified as a reliable cutoff for problematic substance use, we have employed the values reported by Cunningham and colleagues (2012) who examined Canadians from the general population with an AUDIT score greater than or equal to 8 (N = 2757). The mean AUDIT score for this sample was 11.7. * Note: clinical means on the AUDIT vary between countries, cultures and client populations. The selected clinical mean and standard deviation values are intended only to provide an approximation of clinical norms. You should select appropriate clinical mean and standard deviation values for your client population.
Normative	4.2	Given that the value of 8 has consistently been identified as a reliable cutoff for problematic substance use, we have employed the values reported by Cunningham and colleagues (2012) who examined Canadians from the general population with an AUDIT score less than 8 (N = 11, 252). The mean AUDIT score for this sample was 4.2. This value is comparable to other nationally-representative studies in Australia, and other English-speaking countries (Lundin, Hallgren, Balliu & Forsell, 2015; O’Brien, Callinan, Livingston, Doyle & Dietze, 2020).

Standard Deviation

Sample	Mean	Comments
Clinical	4.6	Given that the value of 8 has consistently been identified as a reliable cutoff for problematic substance use, we have employed the values reported by Cunningham and colleagues (2012) who examined Canadians from the general population with an AUDIT score greater than or equal to 8 (N = 2757). The mean AUDIT score for this sample was 11.7. * Note: clinical means on the AUDIT vary between countries, cultures and client populations. The selected clinical mean and standard deviation values are intended only to provide an approximation of clinical norms. You should select appropriate clinical mean and standard deviation values for your client population.
Normative	1.5	Given that the value of 8 has consistently been identified as a reliable cutoff for problematic substance use, we have employed the values reported by Cunningham and colleagues (2012) who examined Canadians from the general population with an AUDIT score less than 8 (N = 11, 252). The mean AUDIT score for this sample was 4.2. This value is comparable to other nationally-representative studies in Australia, and other English-speaking countries (Lundin, Hallgren, Balliu & Forsell, 2015; O’Brien, Callinan, Livingston, Doyle & Dietze, 2020).

Reliability

Value	Comments
0.84	Selin (2003) examined test-retest reliability (intraclass correlation coefficient) over an 1-month interval, using a general population sample (N = 457).

Instrument developers

Saunders, J. B., Aasland, O. G., Amundsen, A., & Grant, M. (1993). Alcohol consumption and related problems among primary health care patients: WHO collaborative project on early detection of persons with harmful alcohol consumption—I. Addiction, 88(3), 349-362.
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

Refrences

* Babor, T. F., & Robaina, K. (2016). The Alcohol Use Disorders Identification Test (AUDIT): A review of graded severity algorithms and national adaptations. * Babor, T. F., Higgins-Biddle, J. C., Saunders, J. B., Monteiro, M. G., & World Health Organization. (2001). AUDIT: the alcohol use disorders identification test: guidelines for use in primary health care (No. WHO/MSD/MSB/01.6 a). World Health Organization. * Cunningham, J. A., Neighbors, C., Wild, T. C., & Humphreys, K. (2012). Normative misperceptions about alcohol use in a general population sample of problem drinkers from a large metropolitan city. Alcohol and Alcoholism, 47(1), 63-66 * 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), 8. * Lundin, A., Hallgren, M., Balliu, N., & Forsell, Y. (2015). The use of alcohol use disorders identification test (AUDIT) in detecting alcohol use disorder and risk drinking in the general population: validation of AUDIT using schedules for clinical assessment in neuropsychiatry. Alcoholism: Clinical and Experimental Research, 39(1), 158-165. * O'Brien, H., Callinan, S., Livingston, M., Doyle, J. S., & Dietze, P. M. (2020). Population patterns in alcohol use disorders identification test (AUDIT) scores in the Australian population; 2007–2016. Australian and New Zealand journal of public health, 44(6), 462-467. * Ohtani, Y., Ueno, F., Kimura, M., Matsushita, S., Mimura, M., & Uchida, H. (2023). Highly endorsed screening and assessment scales for alcohol problems: A systematic review. Neuropsychopharmacology Reports * Selin, K. H. (2003). Test‐retest reliability of the alcohol use disorder identification test in a general population sample. Alcoholism: Clinical and experimental research, 27(9), 1428-1435 * World Health Organization. (2001). The alcohol use disorders identification test: guidelines for use in primary care. Geneva: World Health Organization

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