A Deep Dive into the Alcohol Use Disorder Identification Test (AUDIT)

Alcohol use is pretty ubiquitous in the US, but there is always a threshold that tips people’s relationship with alcohol into worrisome territory. To help assess where that threshold is for a client, the Alcohol Use Disorder Identification Test (AUDIT) might be the tool you need.

We’ll go over a detailed overview of the AUDIT, explaining its purpose, uses, and the insights it offers to both clinicians and clients, as well research supporting the AUDIT's effectiveness, answer common questions, and suggest other assessments that can enhance your practice.

What is the Alcohol Use Disorder Identification Test (AUDIT)?

‍The Alcohol Use Disorders Identification Test (AUDIT) was developed by the World Health Organization (WHO) to identify people who may have hazardous or harmful patterns of alcohol consumption or who may be at risk for alcohol use disorders (AUDs). Its 10 questions inquire about the three key domains of: alcohol intake; potential dependence on alcohol; and experience of alcohol-related harm. Respondents rate each domain using the responses provided. For example, for questions inquiring about how often they use alcohol according to the descriptions listed (e.g., “How often do you have six or more drinks on one occasion?”) available responses range on a scale from “Never” to “Daily or almost daily.”

What AUDIT measures

The AUDIT measures the full range of alcohol misuse, from risky drinking to behaviors associated with alcohol dependence, helping clinicians decide on the appropriate level of intervention for each client. It evaluates consumption patterns, drinking behaviors, and related consequences, providing a thorough assessment of an individual's relationship with alcohol.

When Do You Use the Alcohol Use Disorder Identification Test (AUDIT)?

The AUDIT serves as a flexible tool in various clinical settings to screen for alcohol misuse and guide treatment decisions. It’s also worth mentioning that the AUDIT has extremely strong credentials as an international instrument. Here are some important considerations for when to use the AUDIT:

Treatment Focus Areas

• Alcohol use disorders: The primary function of the AUDIT is to identify individuals with alcohol use disorders, including alcohol abuse and dependence.
• Risky drinking behaviors: It also helps detect patterns of risky drinking that might not yet qualify as an alcohol use disorder but still require attention.

Age Groups

• Adults: The AUDIT is designed for use with adults aged 18 and older.
• Adolescents: The AUDIT has been validated for use with adolescents ages 14 to 17. 

Related Diagnoses

• Substance use disorders: Alcohol misuse often occurs alongside other substance use disorders, making the AUDIT a useful tool in comprehensive substance abuse assessments.
• Mental health conditions: Alcohol misuse often links to various mental health conditions, such as depression and anxiety disorders and can fall under the radar when co-occurring symptoms present as more severe. Clinicians should consider using the AUDIT as part of a broader mental health evaluation.

Suggested Frequency of Use

• Initial assessment: Administer the AUDIT during the initial assessment phase to establish a baseline understanding of the client's alcohol use.
• Periodic re-assessment: Re-administer it periodically throughout treatment to monitor progress and adjust interventions as needed, typically every 3-6 months or based on clinical judgment.

What Do You Learn from the Alcohol Use Disorder Identification Test (AUDIT)?

‍The AUDIT offers important insights into a person's drinking habits and potential alcohol-related issues. Here's what the AUDIT scores can reveal:

• Risk level: The total score reflects the risk level associated with the individual's drinking habits..
• Consumption patterns: Questions 1-3 focus on alcohol consumption, providing details about how often and how much the person drinks.
• Dependence symptoms: Questions 4-6 address symptoms related to alcohol dependence, such as difficulty controlling drinking, drinking in the morning, and a growing focus on alcohol.
• Harmful alcohol use: Questions 7-10 evaluate the presence of alcohol-related harm, including feelings of guilt after drinking, blackouts, alcohol-related injuries, and concerns from others about drinking.

When you administer the AUDIT over time, you gather valuable data to track changes in a person's drinking habits and related consequences. This allows you to:

• Monitor progress: Regular use of the AUDIT helps assess how well interventions work and track improvements or setbacks in the client's alcohol use.
• Identify trends: Reviewing AUDIT scores over time helps you spot patterns or trends in the client's drinking behavior, which can guide treatment decisions and strategies to prevent relapse.
• Evaluate treatment outcomes: Comparing AUDIT scores before, during, and after treatment helps measure the overall impact of interventions on the client's alcohol use and related issues.
• Adjust treatment plans: The insights from tracking AUDIT scores over time allow you to make informed adjustments to treatment plans, tailoring interventions to the client's specific needs and progress.

Research and Evidence behind the Alcohol Use Disorder Identification Test (AUDIT)

‍The AUDIT has a rich history and a strong foundation of research supporting its effectiveness as a screening tool for alcohol misuse. Here's a closer look at how the AUDIT was developed and the evidence supporting its use:

History and Creation

The AUDIT was developed as part of a six-country World Health Organization (WHO) collaborative project as a screening instrument for harmful alcohol consumption. The WHO worked with an international group of addiction researchers, including Dr. John Saunders and Dr. Thomas Babor, to create a simple, effective screening tool that could be used in various settings and cultures throughout the world.

Strength of Research and Evidence

Studies have consistently validated the AUDIT's effectiveness in detecting alcohol misuse across different populations and settings:

• Diverse populations: Research indicates that the AUDIT is a valid and reliable screening tool for alcohol misuse in a broad range of populations throughout the world., such as 
• Wide Variety of Settings: The AUDIT was developed for use in a multitude of settings, including with primary care patients, emergency department visitors, and the general public.
• Cross-cultural applicability: Studies demonstrate the AUDIT's effectiveness in different countries and cultures, suggesting it works well universally. It is currently available in approximately 40 languages.
• Comparison to other tools: The AUDIT has been found to perform as well as or better than other alcohol screening tools, like the CAGE questionnaire and the Michigan Alcoholism Screening Test (MAST).
• Predictive validity: Higher AUDIT scores are linked to an increased risk of alcohol-related problems, highlighting the tool's ability to predict such issues.

Limitations of the AUDIT

While the AUDIT is widely used and well-validated, it's important to acknowledge its limitations:

• Self-report bias: Like any self-report measure, the AUDIT depends on individuals providing honest and accurate responses about their drinking habits. Due to the inherent shameful nature of substance abuse, reporting may not always be accurate 
• Lack of specificity: The AUDIT may not always distinguish between individuals with alcohol dependence and those with less severe alcohol misuse.
• Need for further assessment: A positive screen on the AUDIT suggests the need for additional evaluation and does not provide a definitive diagnosis of an alcohol use disorder.

Frequently Asked Questions (FAQ)

When should I use the AUDIT?
The AUDIT can be given as part of an initial assessment or when alcohol use concerns first arise for clients to check for potential alcohol misuse. For clients with alcohol use disorder or behaviors as a focus of treatment it can also be administered periodically throughout treatment to monitor progress and guide interventions. Typically, the AUDIT is used as a screening measure (typically yearly); although it can be used more frequently (e.g., monthly) during treatment as clinically indicated.

How do I interpret the AUDIT scores?
The total score on the AUDIT can range from 0 to 40. The following cut-off scores indicate the risk level associated with an individual's drinking habits:

• Scores of 0-7 indicate low risk consumption
• Scores of 8-14 suggest hazardous or harmful alcohol use
• Scores of 15 or more indicate high-risk drinking or likelihood of alcohol dependence (moderate-severe alcohol use disorder).

Can the AUDIT be used in different settings?
Yes, the AUDIT can be used in various settings, including primary care, mental health clinics, and community health centers. Its brevity and ease of administration make it a versatile tool for screening alcohol misuse across diverse populations.

Is the AUDIT suitable for all age groups?
The AUDIT is validated for use with individuals  aged 14 and older. 

How does the AUDIT compare to other alcohol screening tools?
Research shows that the AUDIT performs as well as or better than other commonly used alcohol screening tools, such as the CAGE questionnaire and the Michigan Alcoholism Screening Test (MAST). The AUDIT's comprehensive nature and ability to detect a wide range of alcohol misuse make it a preferred choice for many clinicians.

Other Assessments Similar to Alcohol Use Disorder Identification Test (AUDIT) to Consider

‍While the AUDIT is a popular tool for screening alcohol misuse, several other assessments can provide useful insights into an individual's drinking habits and related issues. Here are a few to think about:

• Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST): Developed by the World Health Organization, the ASSIST screens for risky or harmful use of alcohol and other substances. It's a comprehensive tool that assesses multiple substances in one go.
• Tobacco, Alcohol, Prescription medication, and other Substance use Tool (TAPS-2): The TAPS-2 categorizes substance use into risk levels, playing a crucial role in determining the need for further clinical evaluation and intervention based on the severity of use identified during the screening process.

Each of these assessments offers unique advantages and can complement the AUDIT to create a thorough evaluation of an individual's alcohol use and related issues. The choice of which additional assessments to use depends on factors such as the specific population, setting, and treatment goals.