A brief review of the AUDIT (Alcohol Use Disorders Identification Test). Includes administration procedures, scoring, target population usage, validity and reliability

1. J O H N G . K U N A , P S Y D A N D A S S O C I A T E S
W W W . J O H N G K U N A P S Y D A N D A S S O C I A T E S . C O M
Review of the Alcohol Use Disorders
Identification Test
(AUDIT)

2.  Authors:
 Babor, T. F..; de la Fuente, J. R.; Saunders, J.; Grant, M.
 Publisher:
 World Health Organization (WHO)
 Pub Date:
 1992
 Administration time:
 10 minutes
 Cost:
 Test and manual are free; $75 per training module
 Type of Test:
 Screening measure that purports “to identify persons whose alcohol
consumption has become hazardous or harmful to their health.”

3.  Target Population:
 Adults; Individual or group
 Style of test content:
 10 questions. Most on a 4 point Likert scale
 E.g., how many drinks containing alcohol do you have on a
typical day when you are drinking?
 (0) 1 or 2
 (1) 3 or 4
 (2) 5 or 6
 (3) 7, 8, or 9
 (4) 10 or more

4.  Description of test items and scores (including sub
scales)
 Three Domains:
 1) Hazardous Alcohol Use:
 Frequency of drinking,
 Typical quantity,
 Frequency of heavy drinking

5. Three Domains, cont.
 2) Dependence Symptoms:
 Impaired control over drinking
 Increased salience of drinking, and
 Morning Drinking
 3) Harmful Alcohol Use:
 Guilt after drinking,
 Alcohol Blackout
 Alcohol-related injuries,
 Others concerned about drinking

6.  Features of the test
 WHO collaborative project
 Developed in a six-country (Australia, Bulgaria, Kenya,
Mexico, Norway, USA)
 First instrument of its kind to be derived on the basis of a
cross-national study
 (Babor, de la Fuente, Saunders, & Grant, 1992).

7.  Directions for administration:
 Can be administered as self-report or Interview.
 Strengths and weakness of each approach is outlined below
(Babor, et al., 1992)

Questionnaire Interview
Takes less time Allows clarification of ambiguous answers
Easy to administer Can be administered to patients with poor
reading skills
Suitable for computer
administration and scoring
May produce more accurate answers Allows seamless feedback to patient and
initiation of brief advice

8.  Scoring procedures: Simple to score; each response
has a score ranging from 0 to 4. Scores are totaled
and compared to cut-off scores provided in the
manual.
 For example:
Risk Level Intervention AUDIT score
Zone I Alcohol Education 0-7
Zone II Simple Advice 8-15
Zone III Simple Advice plus Brief
Counseling and Continued
Monitoring
16-19
Zone IV Referral to Specialist for
Diagnostic Evaluation and
Treatment
20-40

9.  Standardization procedures:
 Cross-national standardization: validated on primary health care
patients in six countries (Norway, Australia, Kenya, Bulgaria,
Mexico, and the United States of America).
 Method of Standardization: ~2,000 patients were recruited from
a variety of health care facilities, including specialized alcohol
treatment centers. 64% percent were current drinkers, 25% of
whom were diagnosed as alcohol dependent.
 Participants were given a physical examination (including a blood
test for standard blood markers of alcoholism), as well as an
extensive interview assessing demographic characteristics,
medical history, health complaints, use of alcohol and drugs,
psychological reactions to alcohol, problems associated with
drinking, and family history of alcohol problems.

10.  Standardization procedures, cont:
 Items were selected for the AUDIT from this pool of questions
primarily on the basis of correlations with daily alcohol intake,
frequency of consuming six or more drinks per drinking episode,
and their ability to discriminate hazardous and harmful drinkers.
 Items were also chosen on the basis of face validity,
clinical relevance, and coverage of relevant
conceptual domains (alcohol use, alcohol
dependence, and adverse consequences of drinking).
Finally, special attention in item selection was given
to gender appropriateness and cross-national
generalizability

11.  Reliability:
 Both test-retest and internal consistency measures have shown
satisfactory reliability. (Fleming, Barry, & MacDonald, 1991).
 High intra-scale reliabilities, with alpha coefficient mean
values of .93 and .81 respectively, were found among patients'
drinking behavior and adverse psychological reactions
domains (Saunders et al., 1993, pp. 794-795).

12.  Validity:
 High Face Validity
 Significant concurrent validities were found against other alcoholism
measures such as the MAST (Michigan Alcohol Screening Test) and
the MacAndrews scales (r = .31 to r = .887). (Bohn, Babor, and
Kranzler, 1995, p. 425ff).
 Construct validities for five risk factors, four drinking consequences,
and three drinking attitudes showed significant correlations (r = .27
to r = .88) for 11 of the 12 measures for male subjects (n = 107), but
fewer significant correlations for female subjects (n = 91).
 Analysis of discriminant validity found a significant difference
between non-drinkers and harmful drinkers, but no significant
gender or gender x drinker group difference. (Babor et al., 1992, p.
21).

13.  Reviewer’s comments
 “The AUDIT is more successful than the Michigan Alcohol
Screening Test (MAST) in discriminating hazardous drinkers
from nonhazardous drinkers. A well-written manual and
substantial published supporting research commend the
instrument for serious consideration in the assessment of
people with difficult alcohol problems. Its multinational
origins and translations also commend it as a device for
conducting cross-cultural alcoholism studies.”
 (Babor et al., 1992)

14.  Personal comments:
 A solid little measure with high face validity.
 Hailed as first cross cultural alcohol screening measure, but
seemingly seriously deficient in that area. For example, the
measurement assumes that a drink containing 10g of alcohol is
the cross cultural standard, and only provides a brief account
(Appendix C of the manual) discussing cultural differences in
alcohol content in beverages.
 Glaringly absent is a discussion of how alcohol consumption is
viewed across different cultures, how this may affect results, or
how to control for such effects. Without such normative data,
an administrator of the AUDIT may be confused, lacking a
cultural context with which to interpret results.

15.  References
 Allen, J. P., Litten, R. Z., Fertig, J. B. and Babor, T. (1997), A
Review of Research on the Alcohol Use Disorders
Identification Test (AUDIT). Alcoholism: Clinical and
Experimental Research, 21: 613–619. doi: 10.1111/j.1530-
0277.1997.tb03811.x
 Babor, T. F., de la Fuente, J. R., Saunders, J., & Grant, M.
(1992). Programme on Substance Abuse: AUDIT--The Alcohol
Use Disorders Test: Guidelines for Use in Primary Health Care
(an update of WHO Document No. WHO/MNH/DAT/89.4
under the same title) [Switzerland]: World Health
Organization.

16.  References, cont.
 Bohn, M. J., Babor, T. F., & Kranzler, H. R. (1995). The Alcohol Use Disorders
Identification Test (AUDIT): Validation of a screening instrument for use in medical
settings. Journal of Studies on Alcohol, 56(4), 423-432.
 Fleming, M. F., Barry, K. L., & MacDonald, R. (1991). The Alcohol
Use Disorders Identification Test (AUDIT) in a college sample.
International Journal of the Addictions, 26, 1173-1185.
 MacKenzie, D. M., Langa, A., & Brown, T. M. (1996). Identifying
hazardous or harmful alcohol use in medical admissions: A
comparison of AUDIT, CAGE, and Brief MAST. Alcohol and
Alcoholism, 31(6), 591-599.
 Saunders, J. B., Aasland, O. G., Babor, T. F., de la Fuente, J. R., &
Grant, M. (1993). Development of the Alcohol Use Disorders
Identification Test (AUDIT): WHO collaborative project on early
detection of persons with harmful alcohol consumption--II.
Addiction, 88, 791-804.

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