TL;DR: Summary

✅ Available on Bravely Connect

The AUDIT-C is a self-report measure used to screen for problematic drinking by assessing the frequency of a client’s alcohol consumption, the amount of alcohol a client typically consumes, and how often a client engages in heavy drinking episodes. It consists of three items taken from the ten-item AUDIT; these three items target alcohol consumption. Limitations for the AUDIT-C include an inability to provide a diagnosis, differences in cut-points among genders, different levels of sensitivity among racial and ethnic groups, and limited research on effectiveness in different countries and cultures when compared to the body of research on its predecessor. However, the AUDIT-C has been validated in several different cultures and has overall demonstrated validity in different ethnic groups. The AUDIT-C also correlates with increased alcohol consumption, increased severity in alcohol use disorders, and increased likelihood of alcohol dependence, making it a reliable indicator of problematic alcohol consumption in “real life.” It is also sensitive to change, making it a potentially helpful tool in tracking client progress in alcohol consumption-related goals. 

Highlights

📏 Length: 3 questions, derived from the full-length 10-item AUDIT scale

📋 Administration: Self-administered

🎯 Uses: To quickly assess an individual's alcohol consumption and identify potential alcohol-related problems

⚠️ Important Caveats: Cutoff for problem drinking varies by gender

✅ Available in Bravely Connect? Yes

🌏 Culturally Applicable? Small collection of international studies indicates yes, but be cautious with regards to scale sensitivity; follow up positives with further interviewing and screening

The AUDIT-C Question type and length

The client is presented with three questions asking clients to indicate the frequency and intensity of their alcohol consumption. Each item contains answers that are associated with a certain amount of points. A higher number of points indicates increased alcohol use. Here is an example of an item from the AUDIT-C and the range of answers:

How many drinks did you have on a typical day when you were drinking in the past year?

• None, I do not drink (0 points)

• 1 or 2 (0 points)

• 3 or 4 (1 point)

• 5 or 6 (2 points)

• 7 to 9 (3 points)

• 10 or more (4 points)

For the full list of questions check out the measures on Bravely Connect, or follow the following link to the original unautomated version: 

AUDIT-C

What does the AUDIT-C measure?

The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) is a brief self-report measure designed to assess the frequency of a client’s alcohol consumption, the amount of alcohol a client typically consumes, and how often a client engages in heavy drinking episodes. The measure consists of three items: one assessing frequency of drinking, one assessing the intensity of drinking, and a third assessing the frequency of binge-like drinking. Higher AUDIT-C scores indicate higher levels of problem drinking and more potential for alcohol-related problems in a client’s life.

AUDIT-C factor structure

The AUDIT-C is derived from the ten-item AUDIT which assesses two factors: alcohol consumption and adverse consequences of drinking (Reinert & Allen, 2007). The AUDIT-C contains the AUDIT items found to assess alcohol consumption. As a unidimensional measure, the AUDIT-C consists of just three questions that focus on an individual's alcohol consumption. 

The history and theory behind the AUDIT-C 

The original 10-item Alcohol Use Disorders Identification Test (AUDIT) was developed by a team of researchers associated with the World Health Organization (WHO) in the 1980s (Babor et al., 1992). The AUDIT was designed to provide a standardised and reliable tool for screening and assessing problematic alcohol use in various healthcare and clinical settings. Whereas prior measures of alcohol consumption aimed to identify cases of alcoholism, the AUDIT was created to identify early signs of problematic drinking behaviours (Babor et al., 1992). 

The AUDIT-C, developed in 1998, utilises the first three items of the AUDIT that focus on the frequency and intensity of one’s alcohol consumption. The authors of the AUDIT-C proposed that the AUDIT’s 10-item length would make the AUDIT less likely to be used by primary care providers during routine patient interviews or general health history questionnaires (Bush et al., 1998). Since problematic drinking behaviours have wide-ranging negative effects on the body (Babor et al., 1992), the AUDIT-C authors intended to create an efficient and effective measure which could be used by primary care providers and their patients to screen for and initiate conversations about dangerous drinking behaviours. Since 2003, the AUDIT-C has been implemented as part of routine screenings in the U.S. Veterans Health Administration (Bradley et al., 2006).

AUDIT-C Scoring Interpretation

The AUDIT-C (Alcohol Use Disorders Identification Test-Consumption) is scored based on the responses to its three questions, each of which is scored on a scale of 0 to 4. The potential total scores range from 0 to 12. The total score is used to assess an individual's alcohol consumption and potential risk of alcohol-related problems. Higher AUDIT-C scores have been found to be associated with increased alcohol consumption, increased severity in alcohol use disorders, and increased likelihood of alcohol dependence (Rubinsky et al., 2013). Although the AUDIT-C is not a diagnostic instrument, positive results on the AUDIT-C should stimulate further discussion between providers and clients about problematic alcohol use. The AUDIT-C has also demonstrated sensitivity to change, making it suitable for evaluating the effectiveness of alcohol consumption-related interventions (Bradley et al., 2013).

Studies suggest that the AUDIT-C performs differently in cisgender men, cisgender women, and gender minority individuals (Flentje et al., 2020; Reinert & Allen, 2007). Due to differences in performance among genders, cut-off scores indicating potential problematic alcohol use vary. For cisgender women, a cut-point of 3 is effective in identifying hazardous drinking habits while a cut-point of 4 can be used for identifying hazardous drinking in cisgender men (Reinert & Allen, 2007). A 2020 study finds that a cut-point of 3 may be effective in identifying problem drinking in transgender and gender minority people (Flentje et al.).

Who developed the measures, licensing and how to obtain the AUDIT-C

The original 10-item AUDIT was developed by researchers Thomas F. Babor, Juan Ramon de la Fuente, John Saunders, and Marcus Grant in collaboration with the World Health Organization. The measure was then abbreviated into the three-item AUDIT-C scale by researchers Kristen Bush, Daniel R. Kivlahan, Mary B. McDonell, Stephan D. Fihn, and Katharine A. Bradley.

Both the AUDIT and the AUDIT-C are available without royalty fees (Reinert & Allen, 2007).

The AUDIT-C is available on Bravely Connect as part of our automated measures. 

• See the AUDIT-C on Bravely Connect →

Limitations, biases and when you should/shouldn’t use the AUDIT-C

The AUDIT-C is a self-report measure that assesses the frequency of a client’s alcohol consumption, the amount of alcohol a client typically consumes, and how often a client engages in heavy drinking episodes. Although scores on the AUDIT-C and its preceding AUDIT measure may be associated with alcohol-related problems in a client’s life and serve as a signal for further conversation, neither the AUDIT or AUDIT-C provide diagnoses for alcohol use disorders (Babor et al., 1992). The AUDIT-C is primarily designed for the screening of alcohol consumption patterns and may not fully capture the complexity of alcohol use disorders, which encompass a range of symptoms, including cravings, tolerance, and withdrawal (Schuckit, 2009).

While the full-length AUDIT was designed for international uses and validated using primary health care patients in six countries—Norway, Australia, Kenya, Bulgaria, Mexico, and the U.S. (Babor et al., 1992)—there are still special considerations when using the three AUDIT items comprising AUDIT-C in different demographics. The AUDIT-C was first validated using a sample of all men, predominantly older and white with multiple medical issues; women were excluded for statistical reasons as there were not enough available in the potential sample pool to provide adequate data (Bush et al., 1998).

The AUDIT-C was later validated in a sample of women, although a different cut-off score was a more accurate signifier of problem drinking (Bradley et al., 2003). The bulk of studies examining different cut-off points among genders have focused on cisgender individuals. For cisgender women, a cut-point of 3 or higher is effective in identifying hazardous drinking habits while a cut-point of 4 or higher can be used for identifying hazardous drinking in cisgender men (Reinert & Allen, 2007). Some preliminary research on transgender and other gender minority people suggests that a cut-point of 3 or higher may be effective in identifying hazardous drinking in these populations (Flentje et al., 2020).

Other demographics with whom the AUDIT-C has been validated include adolescents in both clinical and community settings (Liskola et al., 2018) and older adults in community settings (Van Gils et al., 2021). Much international research has focused on the ten-item AUDIT; however, the AUDIT-C has been validated in South Korea (Lee et al., 2018), Japan (Osaki et al., 2014), Zambia (Inoue et al., 2021), Finland (Kaarne et al., 2010), and Sweden (Lundin et al., 2015).

A study of the AUDIT-C’s efficacy in an African-American, Hispanic, and white U.S. sample found that the AUDIT-C “was an effective screening test for the full spectrum of alcohol misuse” (Frank et al., 2008, p. 785) among the three racial/ethnic groups; however, there were differences in sensitivity between groups, with the AUDIT-C being most sensitive in Hispanic women and white men, and the least sensitive in African-American men and women. Even so, the authors advise using the standard cut-points for problematic drinking to be 3 or higher for women across ethnic groups and 4 or higher for men (Frank et al., 2008)

As with many measures developed and validated in Western cultures, we recommend that the AUDIT-C be used in conjunction with comprehensive clinical assessments taking a client’s unique sociocultural background into consideration. 

Full reference list available on request.