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Use of Alcohol Use Disorder Identification Test in Primary Health Care

The Alcohol Use Disorder Identification Test (AUDIT) is among the most frequently used screening apparatus in primary health care (PHC). According to Neufeld et al. (2021), the integration of this instrument with referral to specialized treatment has made it into a more comprehensive program for people with harmful and hazardous alcohol use and at risk for alcohol use disorders (AUDs) or potential alcohol dependence. That is to say; in the ICD-10 or -11 it covers those people with unsafe drinking and alcohol dependence (Lange et al., 2019). The AUDIT has been adapted, modified, and translated into many languages for use in different countries. It follows official adaptation processes and authentication studies. The World Health Organization (WHO) developed the AUDIT as portion of a global collaborative study in 1982 (Babor & Robaina, 2016). Screening and Brief Interventions (SBIs) is used as part of the screening component in PHC for alcohol-related problems. However, the AUDIT instrument can be used in many other settings.

The AUDIT was designed for use by both health care practitioners and non-health professionals. It can be self-administered. Additionally, health professionals can read the questions aloud, and its administration can take about 2 minutes (SAMHSA, 2020). The AUDIT has a framework for intervention that helps those with unhealthy alcohol use t cease or reduce their consumption and thereby avoid alcohol’s harmful consequences. The main focus of the AUDIT test is identifying preliminary signs of mild dependence and hazardous drinking. Alcohol problems within the last year are detected using this instrument, and its rating stands at 92 percent effectiveness in detecting harmful or hazardous drinking.

The AUDIT test is used because of its cross-national standardization aspect and identification of hazardous and dangerous alcohol use and possible dependence. Furthermore, it is a flexible, rapid, and brief test designed for PHC workers and is consistent with ICD-10 definitions of harmful alcohol use and dependence (Lange et al., 2019). Lastly, it gives focus to current alcohol use. The pool of questions on the AUDIT was from patients’ medical history, demographic characteristics, use of alcohol and drugs, health complaints, and family history of alcohol problems. The basis of choosing the questions correlates with a daily intake of alcohol, frequency of consumption, and their ability to discriminate between hazardous and harmful drinkers (Verhoog et al., 2020). Choosing the items was based on clinical relevance, face validity, and the coverage of pertinent conceptual domains: alcohol dependence, alcohol use, and adverse drinking consequences. Gender suitability and cross-national generalizability were the special attention in the selection of items.

The AUDIT contains ten multiple-choice questions on frequency and quantity of drinking behavior, alcohol intake, and alcohol-related reactions or problems (Verhoog et al., 2020). Scoring of the responses is on a point system where a score of more than eight shows an alcohol problem. The effectiveness of the AUDIT has seen it identify serious drinking problems among non-pregnant women. Hazardous drinking for men is the consumption of 6 or more glasses of alcohol, while for women, it is four or more at least once a week (Verhoog et al., 2020).

The ways the AUDIT is used varies to assess a patient’s alcohol use; thus, guidelines of administration consider the patient’s capabilities and circumstances. Also, care is taken to explain to the patients the content of the questions, why the questions are about their alcohol use, and the need to provide appropriate responses. The administration of the AUDIT can be done orally or as a written, self-report questionnaire. For greater efficiency of the test, skip-outs need to be used to shorten the screening.

Consequently, the scoring of the questions is 0,1,2,3, or 4 in eight questions, apart from questions 9 and 10 as the likely responses are 0, 2, and 4. The score range for the questions is from 0 to 40, where 0 designates an abstainer with no problems from alcohol. Low-risk consumption is a score of 1 to 7, while harmful or hazardous consumption is from 8 to 14, and the likelihood of alcohol dependence is a score of 15 or more (Saunders, n.d.). For questions 2 and 3, the term “drink” encompasses alcohol amounts ranging from 8 grams to 13 grams. An amount outside the range is considered a standard drink. Thus, response categories are recommended to modify accordingly.

The scores are then used to classify the patient as having no AUD, with DSM-5 or DSM-4 AUD (either abuse or having a more severe form of dependence), and the presence or absence of binge drinking (Hagman, 2016). Having such information makes it easy for clinicians to diagnose the patient and provide them with individualized treatment plans. In the end, the AUDIT is considered a valid and reliable screening device for AUD, which leads to enhancing health services outreach for such individuals. Furthermore, the U.S. Preventive Services Task Force recommends that clinicians administer screening tests like the AUDIT and later provide them with brief counseling involvements, especially for at-risk patients (Babor & Robaina, 2016).

In summary, the AUDIT has three critical spheres of alcohol consumption, potential addiction on alcohol, and experience of those with alcohol-related harm. It is a simple, flexible, and rapid instrument that allows HCPs to diagnose and treat their patients for emerging AUD or alcohol dependence. It is also an instrument widely accepted in international countries, and its translation to different languages makes it easy for others to employ in their populations. The AUDIT is widely used in PHC.


Babor, T. F., & Robaina, K. (2016). The Alcohol Use Disorders Identification Test (AUDIT): A review of graded severity algorithms and national adaptations. The International Journal of Alcohol and Drug Research, 5(2), 17-24. DOI:

Hagman, B. T. (2016). Performance of the AUDIT in detecting DSM-5 alcohol use disorders in college students. Substance Use & Misuse, 51(11), 1521-1528. DOI: 10.1080/10826084.2016.1188949

Neufeld, M., Bunova, A., Ferreira-Borges, C., Bryun, E., Fadeeva, E., Gil, A., … & Rehm, J. (2021). The Alcohol Use Disorders Identification Test (AUDIT) in the Russian language-a systematic review of validation efforts and application challenges. Substance Abuse Treatment, Prevention, and Policy, 16(1), 1-14. DOI:

Saunders, J. B. (n.d.). Scoring the AUDIT.

Substance Abuse and Mental Health Services Administration (SAMHSA). (2020). Substance abuse treatment: Addressing the specific needs of women [Internet]. Treatment Improvement Protocol (TIP) Series, No. 51. 4 Screening and Assessment. Rockville (M.D.).

Verhoog, S., Dopmeijer, J. M., de Jonge, J. M., van der Heijde, C. M., Vonk, P., Bovens, R. H., … & Kuipers, M. A. (2020). The use of the alcohol use disorders identification test–Consumption as an indicator of hazardous alcohol use among university students. European addiction research, 26(1), 1-9.


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