Calculators / Substance use and withdrawal
AUDIT-C
Alcohol Use Disorders Identification Test, Consumption. Alcohol screening.
Members Library
The AUDIT-C calculator is in the Library.
Every rating scale calculator comes with the Library, along with the prescribing guides, medication handouts, DSM-5 criteria and sheets, and the Guide Builder.
Use it for
- Screening adult patients for unhealthy alcohol use in primary care, psychiatry and the emergency department.
- Deciding who needs brief advice or a fuller assessment.
- Checking consumption again over time.
Do not use it for
- Diagnosing alcohol use disorder. That needs the DSM-5 criteria.
- Assessing withdrawal risk or withdrawal severity. Use a withdrawal risk tool and the CIWA-Ar for that.
- Screening people under 18 or people who are pregnant for risk limits. Any drinking in pregnancy deserves advice.
Ask all three questions about the past year. A standard drink is 14 g of alcohol: 12 oz of beer, 5 oz of wine or 1.5 oz of distilled spirits.
If the answer to the first question is never, the score is 0 and the other two are skipped.
AUDIT-C
Answer the questions to see the result.
This calculator adds up the score in your browser. Nothing you enter is stored or sent.
More about the AUDIT-C
About the AUDIT-CWhat it is and what it is for
The AUDIT-C is the first three questions of the 10-item AUDIT. It asks how often the person drinks, how much they drink on a typical day, and how often they have six or more drinks on one occasion, all over the past year. Each question scores 0 to 4, so the total runs from 0 to 12.
It screens for unhealthy alcohol use, meaning drinking above recommended limits and alcohol use disorder, in adults. The cutoff differs by sex: 4 or more for men and 3 or more for women. It measures consumption only. It does not ask about consequences or dependence.
How to use itGiving it and scoring it
Choose the cutoff for the person's sex. Ask the three questions for the past year. Question 1 scores 0 to 4. If it scores 0, stop. Questions 2 and 3 each score 0 to 4. Add the three scores.
A total of 4 or more in men and 3 or more in women is a positive screen.
Interpreting the scoreScore ranges and what they suggest
| Score | What it suggests | Usual response |
|---|---|---|
| 0 to 2 | NegativeBelow the cutoff for men and for women. | Reinforce low-risk drinking limits. |
| 3 | Positive for women, negative for menAt the cutoff for women and one point under it for men. | Women: brief intervention and a fuller look. Men: review the history and the limits. |
| 4 to 7 | Positive screenUnhealthy alcohol use is likely: risky drinking, or alcohol use disorder. | Brief intervention and a fuller assessment such as the full AUDIT. |
| 8 to 12 | High rangeAlcohol use disorder is more likely, and the drinking pattern is heavy. | Fuller assessment for alcohol use disorder, withdrawal risk and medical complications. |
Cutoffs are from Bush 1998 and Bradley 2007: 4 or more in men, 3 or more in women. Risk rises steadily with the score. The 8 to 12 range is a common convention for a higher-risk group, not a validated cutoff.
Pearls and pitfallsTips and common mistakes
- A standard drink is 14 g of alcohol. A restaurant pour of wine or a craft beer is often more than one.
- Ask without judgment and in the same tone as questions about sleep or exercise.
- A positive screen needs a plan that matches the person's goals. Brief intervention works best when it follows right away.
- If the person already drinks heavily every day, abrupt cessation can be dangerous. Make the plan for withdrawal first.
- In older adults, risk begins at lower amounts. The same total means more risk after age 65.
EvidenceAccuracy and reliability
- Original work (Bush 1998) in male veterans found that the AUDIT-C identified heavy drinking and active alcohol abuse or dependence about as well as the full AUDIT.
- Primary care validation (Bradley 2007, women and men): a cutoff of 4 or more in men gave sensitivity 0.86 and specificity 0.89, and a cutoff of 3 or more in women gave sensitivity 0.73 and specificity 0.91, for heavy drinking or active alcohol use disorder.
- Risk rises across the whole range of scores. As the AUDIT-C score rises, mean daily consumption rises from 0 to 17 drinks a day, and a score of 7 corresponded to about 2.7 drinks a day, with a higher risk of medication non-adherence, postoperative complications and GI hospitalization (Bradley 2013, conference abstract).
- The USPSTF recommends screening adults for unhealthy alcohol use in primary care and giving brief counseling to those who screen positive (2018).
Source, license and referencesWhere it comes from
The AUDIT was developed by the World Health Organization. The AUDIT-C is the first three AUDIT items, scored and validated by Bush and colleagues at the Department of Veterans Affairs. Both are in widespread free clinical use. Item wording is adapted from the standard published form.
- Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Arch Intern Med. 1998;158(16):1789-1795.
- Bradley KA, DeBenedetti AF, Volk RJ, Williams EC, Frank D, Kivlahan DR. AUDIT-C as a brief screen for alcohol misuse in primary care. Alcohol Clin Exp Res. 2007;31(7):1208-1217.
- Bradley K, Rubinsky A, Williams E, Lapham G, Achtmeyer C, Kivlahan D. Using screening scores to provide feedback to patients on their alcohol-related risks: the association between AUDIT-C scores and average consumption and health outcomes. Addict Sci Clin Pract. 2013;8(Suppl 1):A13 (conference abstract).
- US Preventive Services Task Force. Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults. JAMA. 2018;320(18):1899-1909.
- Reus VI, Fochtmann LJ, Bukstein O, et al. The American Psychiatric Association practice guideline for the pharmacological treatment of patients with alcohol use disorder. Am J Psychiatry. 2018;175(1):86-90.