AUDIT Score

Formula

Q1–Q8

Frequency items scored 0, 1, 2, 3 or 4. The wording of the frequency options differs between Q1, Q2 and Q3–Q8, so the options are not interchangeable even though the point values are.

Q9–Q10

Scored 0 (no), 2 (yes, but not in the last year) or 4 (yes, during the last year). Values of 1 and 3 are not available on these two items.

• No weighting and no transformation — a plain sum. Every item contributes equally, which means a high total can be reached by consumption alone with no reported harm at all.
• Maximum 40. Items 9 and 10 can contribute a maximum of 8 between them despite covering the two most serious domains.
• The reference period is the last year for items 4–8 and lifetime-with-recency for items 9–10. Applying a single time frame to all ten items is a common error.
• AUDIT-C uses the same first three items with the same point values; it is a subscore, not a separate questionnaire with its own scoring.

Interpreting the result

Read the zone first, then read where the points came from. A total of 8 or more is screen-positive and warrants a conversation; below 8, alcohol education is all the instrument asks for, though a low total with a high Q3 still deserves attention because episodic heavy drinking is a genuine risk for pancreatitis and injury regardless of weekly intake. Zone II is where brief intervention has its best evidence and where most patients with early alcohol-related liver disease sit. Zones III and IV move progressively toward formal assessment, and a Zone IV score with positive answers on Q4 and Q6 should prompt planning for withdrawal management before any advice to stop is given, because abrupt cessation in a dependent patient is not a safe instruction. One important qualification carried by the literature: the threshold of 8 was derived largely in men, and the recommendation from a later review of the evidence is that cut-points be lowered for women.

What the AUDIT Score needs (10 inputs)

Q1 — How often do you have a drink containing alcohol?

Frequency of any drinking, from never (0) to four or more times a week (4). The first of the three consumption questions that make up AUDIT-C.

Q2 — How many drinks on a typical drinking day?

Scored 0 for 1–2 drinks rising to 4 for 10 or more. 'Drink' means a standard drink, which is where most of the error in this questionnaire enters — see the unit note.

Q3 — How often do you have six or more drinks on one occasion?

The binge-drinking item, and the third AUDIT-C question. A patient who drinks little overall but answers weekly or daily here is already flagged, which is deliberate.

Q4 — Unable to stop drinking once started

First of the three dependence items. Impaired control, scored by frequency over the last year.

Q5 — Failed to do what was expected of you because of drinking

Dependence item covering neglect of obligations at work, at home or in study.

Q6 — Needed a first drink in the morning after a heavy session

Morning relief drinking. Clinically the most specific of the three dependence items — a positive answer here rarely occurs in the absence of physiological dependence.

Q7 — Guilt or remorse after drinking

First of the four items covering harm already experienced.

Q8 — Unable to remember what happened the night before

Alcohol-related amnesia. Scored by frequency, like the other harm items in this group.

Q9 — You or someone else injured because of your drinking

Scored differently from the frequency items: 0 for no, 2 for yes but not in the last year, 4 for yes in the last year. There is no intermediate value, so the item jumps.

Q10 — A relative, friend or health worker concerned, or suggested you cut down

Also scored 0, 2 or 4. Third-party concern carries real weight in this instrument, and it is the item patients most often under-report.

Units. The whole instrument rests on the 'standard drink', which is not standard between countries: roughly 14 g of alcohol in the United States, 10 g in Australia, and 8 g in a UK unit. A patient answering Q2 against a UK unit rather than a US standard drink will under-score. Define the unit explicitly, with a physical example, before administering the questionnaire — and in a mixed-nationality clinic, record which definition you used.

What it returns

AUDIT total (0–40)

The sum of all ten items. Eight or more is the conventional screen-positive threshold.

Risk zone (I–IV)

Zone I 0–7, Zone II 8–15, Zone III 16–19, Zone IV 20–40. Each zone maps to a specific level of intervention in the WHO manual rather than merely describing severity.

AUDIT-C subscore (0–12)

Questions 1–3 only. Reported alongside the total because it isolates consumption from consequences, and because it is what many services use for routine screening.

How it is calculated

The ten items were selected from a 150-item assessment schedule administered to 1,888 people attending primary health care in six countries, chosen to represent three conceptual domains — consumption, drinking behaviour and alcohol-related problems — and for their usefulness in guiding intervention rather than purely for statistical discrimination. That design choice explains the structure: the questionnaire is organised by domain, three or four items each, so the profile of a score is interpretable and not just its magnitude. Scoring is deliberately simple arithmetic so that it can be administered on paper by non-specialist staff, and the zones exist because the WHO's aim was to link a screening result directly to a graded intervention rather than to produce a severity index.

Facts & figures

Evidence

How it compares

Pearls & pitfalls

• Items 9 and 10 score 0, 2 or 4 — never 1 or 3. Scoring them on the five-point frequency scale used by the other items inflates or deflates the total.
• A standard drink is not a glass. Q2 asks about standard drinks, and a large glass of wine or a home-poured spirit can be two or three, so a patient answering honestly still under-reports unless the unit is defined for them.
• Read the subtotals, not just the zone. Twelve points of pure consumption and twelve points of dependence and harm need different responses.
• A low total with a high Q3 is not reassuring. Episodic heavy drinking carries its own risk for pancreatitis, injury and arrhythmia independent of average weekly intake.
• Do not tell a Zone IV patient with positive Q4 and Q6 answers to stop drinking without planning withdrawal management. Unsupervised abrupt cessation in dependence risks seizures and delirium.
• The threshold of 8 came from a largely male derivation population, and the published recommendation is to lower it in women.
• Q10 is under-reported. Patients frequently answer no despite a family member having raised it, and a discrepancy with a collateral history is informative rather than a scoring failure.
• The questionnaire measures the last year. It does not describe a patient who stopped drinking six months ago, and using it to argue current abstinence in a transplant assessment misreads the instrument.

Critical actions

• Define a standard drink before asking Q2 — in grams of alcohol or in local units, with an example the patient recognises.
• Record the total, the zone and the three subtotals. Only the subtotals let you tell at the next visit what actually changed.
• In any patient with a score of 8 or more and abnormal liver tests, work up alcohol-related liver disease rather than treating the score as an isolated behavioural finding.
• Assess withdrawal risk before advising cessation in Zone IV, and arrange medically supervised withdrawal where the history suggests dependence.
• Deliver brief intervention at the visit rather than deferring it — Zone II is where the evidence for it is strongest and a referral often does not happen.
• Repeat the questionnaire at follow-up. A falling AUDIT is one of the few objective markers of a behavioural change you can document.
• Lower your threshold for concern in women, and be explicit in the notes that you have done so.

Why this score exists

The instrument was commissioned to solve a specific problem: existing questionnaires such as CAGE were built to detect established alcoholism, and were therefore least sensitive in the group where intervention has the most to offer — people drinking hazardously who are not yet dependent. The WHO project set out to detect that earlier stage, across cultures, which is why items were chosen partly for their 'perceived usefulness for intervention' rather than purely for diagnostic accuracy, and why the questionnaire covers consumption at all. CAGE contains no question about how much anyone drinks. The four zones follow from the same intent — the authors wanted a screening result that told a clinician what to do next, not merely how bad things were.

About the creator

• John B. Saunders

  First author, WHO Collaborative Project on Early Detection

  Led the development and first publication of the AUDIT in 1993.

• Thomas F. Babor

  Co-author; lead author of the WHO AUDIT manual

  Co-authored the derivation paper and wrote the WHO guidelines that define the four risk zones and their linked interventions.

• Katharine Bush

  First author of the AUDIT-C short form

  Derived and validated the three-item consumption subscore now used for routine screening in many services.

Limitations

• Entirely self-reported, and under-reporting is the norm rather than the exception, particularly where drinking has consequences the patient anticipates — transplant assessment, employment, custody.
• The 'standard drink' is not standard internationally, and the questionnaire's accuracy depends on a definition that varies between countries and is often not given to the patient at all.
• The threshold of 8 was derived predominantly in men; a later evidence review concluded cut-points should be lower in women, and no single revised value is universally agreed.
• Equal weighting means a total can be reached by very different routes, so the number alone is a poor summary of the clinical problem.
• Screens rather than diagnoses. Zone IV indicates that formal assessment is warranted, not that alcohol dependence is present.
• Covers the last year, so it neither describes established abstinence nor detects a recent relapse in someone previously abstinent.
• Validated mainly in primary care and general medical settings; performance in specialist hepatology clinics, where the population is heavily selected and the stakes of the answer are higher, is less well characterised.

If you are the patient

The AUDIT is a ten-question form about drinking. Each answer scores between 0 and 4, and the answers are added up to a total out of 40. A total under 8 suggests your drinking is unlikely to be harming you; 8 to 15 suggests it is above safe limits; 16 to 19 suggests it is probably already causing harm; and 20 or more means it is worth a proper assessment with someone who specialises in this. It is a screening questionnaire, not a diagnosis or a judgement — the point is to work out what kind of help, if any, would be useful. Two things are worth knowing. First, a 'drink' means a standard measure, and a large glass of wine or a generous pour of spirits often counts as two or more, so ask your doctor to show you what one drink means before you answer. Second, if you drink heavily every day, do not simply stop on your own — stopping suddenly can be dangerous, and your doctor can arrange for it to be done safely. Answering honestly genuinely helps; the score guides the offer of support rather than deciding anything about you.

Frequently asked questions

Related calculators

• CAGE — Alcohol use disorder screening (4 questions)
• Alcohol Content — Standard drinks & alcohol grams calculator
• Maddrey's DF — Alcoholic hepatitis severity
• GAHS — Glasgow alcoholic hepatitis score
• FIB-4 Index — Liver fibrosis scoring index

References