Home / Resources / Psychological Measures / AUDIT
Alcohol Use Disorders Identification Test:
Scoring and Interpretation
The Alcohol Use Disorders Identification Test (AUDIT) is a ten-item World Health Organization screening instrument for hazardous and harmful alcohol use, scored from 0 to 40 once each answer has been converted with the WHO key (Saunders et al., 1993). Covered here: AUDIT scoring with the 0, 2 and 4 values on the last two items, the four WHO zones as action levels rather than diagnoses, the separate AUDIT-C total, syntax that computes both scores, and an example write-up.
What the AUDIT Measures
The AUDIT is a ten-item screening instrument developed by the World Health Organization to identify hazardous and harmful patterns of alcohol use. It covers alcohol consumption, symptoms of dependence and alcohol-related harms, and it is intended to guide assessment and prevention, not to establish an alcohol use disorder diagnosis by itself (Saunders et al., 1993).
The AUDIT is used in US public-health research, primary-care investigations and behavioral intervention trials. Its ten-item format allows a summed screening score from 0 to 40, and its early cross-national validation and later WHO scoring guidance give an interpretable framework while leaving room for contextual clinical judgment. In practice, totals go wrong when the last two items are scored on the wrong metric, and conclusions go wrong when the risk zones are treated as diagnostic categories.
Structure of the AUDIT
- Items: ten questions grouped conceptually as consumption (1 to 3), dependence-related experience (4 to 6) and alcohol-related consequences (7 to 10).
- Item scoring: each answer must be converted with the WHO key. Items 9 and 10 take the values 0, 2 and 4 rather than five sequential values.
- Subscales: the three domains are conceptual groupings. The standard output is one total.
- Reverse-scored items: none after official item scoring.
- Total: one summed score from 0 to 40.
- Short form: the AUDIT-C comprises items 1 to 3 and has a 0 to 12 total. It is a separate screening score with its own cut-offs (commonly 4 or more for men and 3 or more for women in US primary-care validation; Bush et al., 1998; Bradley et al., 2007).
The instrument itself is available from the World Health Organization (AUDIT Guidelines for Use in Primary Care, 2001).
How to Score the AUDIT
- Verify that audit1 to audit10 already hold valid WHO item scores. Items 1 to 8 generally permit 0 to 4, whereas items 9 and 10 are scored 0, 2 or 4.
- Sum all ten scored items to obtain audit_total (0 to 40). Where a short score is appropriate, the AUDIT-C is the sum of items 1 to 3 (0 to 12).
- The example requires all items. Respondents who report no drinking may follow WHO-defined skip patterns, which should be implemented from the manual and not treated as unexplained missing values. Document how skips were scored.
* All items already scored by WHO response key, including 9 & 10 as 0/2/4.
COMPUTE audit_total=SUM.10(audit1, audit2, audit3, audit4, audit5, audit6, audit7, audit8, audit9, audit10).
COMPUTE audit_c=SUM.3(audit1, audit2, audit3).
EXECUTE.# Pre-score using the WHO item-specific key; questions 9 and 10 use 0/2/4.
cols <- paste0("audit",1:10)
data$audit_total <- rowSums(data[cols],na.rm=FALSE)
data$audit_c <- rowSums(data[paste0("audit",1:3)],na.rm=FALSE)Interpreting AUDIT Scores
| Score band | Interpretation |
|---|---|
| 0 to 7 | Zone I: alcohol education |
| 8 to 15 | Zone II: simple advice |
| 16 to 19 | Zone III: simple advice plus brief counseling and continued monitoring |
| 20 to 40 | Zone IV: referral to a specialist for diagnostic evaluation and treatment |
Source: WHO, AUDIT Guidelines for Use in Primary Care, 2nd ed. (Babor et al., 2001).
Higher scores indicate greater alcohol-related risk. In the multinational development study of Saunders et al. (1993), 92% of those classified as hazardous or harmful drinkers scored 8 or more, while 94% of those without hazardous consumption scored below 8. These development-study proportions are not a universal pair of sensitivity and specificity estimates for US clinical or community screening. The WHO manual notes that a lower cut-off (for example, 7) may be considered for women and for people over 65, and that country-specific standard-drink definitions affect items 2 and 3.
AUDIT scores screen for consumption-related harm and possible dependence, not for a definitive diagnosis. Standard-drink definitions vary across jurisdictions, so US studies should use an explicitly defined US standard drink and culturally appropriate administration.
Psychometric Properties
| Property | Published finding | Source |
|---|---|---|
| Original development sample | 1,888 primary-care respondents in six countries; item selection from a larger assessment schedule | Saunders et al. (1993) |
| Screening discrimination | 92% of hazardous or harmful drinkers scored 8 or more; 94% of non-hazardous drinkers scored below 8 | Saunders et al. (1993) |
| Content validity | Assesses consumption, dependence-related symptoms and alcohol harms | Saunders et al. (1993); Babor et al. (2001) |
| Internal consistency | A review of 2002 to 2006 studies reported a median α of about .83 across samples | Reinert & Allen (2007) |
| Short form | The AUDIT-C comprises questions 1 to 3 with different cut-offs | WHO AUDIT framework |
These are source-specific results and cannot be assumed to hold as reliability or accuracy estimates in a new sample.
Using the AUDIT in a Study
The AUDIT may be analyzed as a continuous 0 to 40 score in risk-factor studies, after careful assessment of skewness, the large share of zeros and overdispersion, using an approach such as Multiple Linear Regression only when the residual diagnostics support it. It may instead be dichotomized at a validated screening threshold when the aim is to estimate a screening proportion, a binary outcome that Logistic Regression models. In evaluation studies, report the chosen cut-off and whether consumption and harms were measured in the same period.
The domains are designed to cover different clinical aspects of alcohol risk. Examine internal consistency where relevant, for instance with Reliability Analysis (Cronbach’s Alpha), but recognize that a heterogeneous multi-domain screening measure may not behave like a unidimensional trait questionnaire. For diagnostic accuracy, use an independently established alcohol use disorder criterion, not the AUDIT threshold itself, and summarize the trade-off across thresholds with ROC Curve Analysis.
Related field: Public Health
Reporting the AUDIT
Alcohol-related risk was assessed with the ten-item World Health Organization Alcohol Use Disorders Identification Test (AUDIT; Saunders et al., 1993). Each item was scored using the WHO key (including 0, 2 and 4 coding for items 9 and 10) and summed to yield a total from 0 to 40. We analyzed [AUDIT total/AUDIT screening status at 8 or more] as [outcome/predictor]; missing responses and prescribed skip patterns were managed according to [study procedure].
References
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. https://www.who.int/publications/i/item/WHO-MSD-MSB-01.6a
Bradley, K. A., DeBenedetti, A. F., Volk, R. J., Williams, E. C., Frank, D., & Kivlahan, D. R. (2007). AUDIT-C as a brief screen for alcohol misuse in primary care. Alcoholism: Clinical and Experimental Research, 31(7), 1208-1217. https://doi.org/10.1111/j.1530-0277.2007.00403.x
Bush, K., Kivlahan, D. R., McDonell, M. B., Fihn, S. D., & Bradley, K. A. (1998). The AUDIT alcohol consumption questions (AUDIT-C): An effective brief screening test for problem drinking. Archives of Internal Medicine, 158(16), 1789-1795. https://doi.org/10.1001/archinte.158.16.1789
Reinert, D. F., & Allen, J. P. (2007). The Alcohol Use Disorders Identification Test: An update of research findings. Alcoholism: Clinical and Experimental Research, 31(2), 185-199. https://doi.org/10.1111/j.1530-0277.2006.00295.x
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
Frequently Asked Questions
What is the AUDIT score range?
Ten scored items sum to a total from 0 through 40. This holds only when every item has first been converted with the WHO key.
Does an AUDIT score of 20 mean alcohol dependence?
No. WHO identifies a score of 20 or more as a trigger for further evaluation for possible dependence, which is a referral recommendation and not a diagnosis.
Are items 9 and 10 coded 0 to 4?
They have three possible scored values, 0, 2 and 4. Do not recode them as 0, 1 and 2, because that would understate the total.
Is the AUDIT-C scored the same way?
It uses only the first three consumption items (0 to 12) and has different screening thresholds from the full AUDIT, so the two scores should be reported separately.
NEXT STEP
Need AUDIT Totals Scored
Against the WHO Key?
OnlineSPSS is a statistical consultancy for researchers. Share your design and dataset, and a statistically trained Research Coordinator reviews it. The scope and one fixed project fee are confirmed before work begins.
No Commitment Required
Strictly Confidential
Fixed Project Fee
In-House PhD-Level Statisticians
Same-Day Response
Serving Researchers Since 2014