Clinical Decision-Making

AUDIT and AUDIT-C: What to Do With a Positive Screen

Quick Medical Calculator Editorial Team · Reading label 1 August 2026 · 2 min read

Retrospective study sequence, not publication date

An alcohol screen opens a conversation. It does not diagnose alcohol use disorder, prove dependence, or establish that a person below the cutoff has no alcohol-related risk.

Identify the Instrument First

The full AUDIT has ten items and a maximum of 40; AUDIT-C contains the three consumption items and has a maximum of 12. Use a validated, appropriately translated instrument with its original response options and timeframe. This guide does not reproduce or paraphrase the questionnaire for administration. WHO AUDIT manual.

Common US AUDIT-C screening cutoffs are at least three for women and at least four for men, based on validation in primary care. They identify people needing further assessment, not a diagnosis. The operating threshold should match the population and purpose. Primary AUDIT-C validation.

Worked Interpretation

Suppose the three item scores on a fictional, correctly administered AUDIT-C are 2, 1, and 1. The total is 4, which meets both commonly used US cutoffs. The next step is to clarify consumption, consequences, and the person's priorities, then assess whether an alcohol use disorder or other risk is present. Writing "dependence: score 4" would confuse a screening result with a diagnosis.

For the full AUDIT, the WHO manual uses bands of 8-15 for advice, 16-19 for a more intensive brief intervention and monitoring, and 20 or more for diagnostic evaluation and possible specialist care. These are prompts to tailor care; they are not labels assigning everyone a specific disorder. A low score is not permission to drink during pregnancy or with an alcohol-sensitive condition. WHO manual.

Do Not Mix Versions or Drink Sizes

A US standard drink contains 14 g of alcohol. Beverage containers may contain several standard drinks. NIAAA standard-drink reference.

USAUDIT modifies consumption questions and scoring for US use. Do not transfer the full AUDIT cutoff of eight, or AUDIT-C cutoffs, to USAUDIT without its own instructions. Changing question wording while keeping the original scoring creates a different, unvalidated instrument. AHRQ USAUDIT implementation guide.

A Useful Follow-Up Note

Document the instrument and language, total, clarified drink amounts, the person's concerns, further assessment, and an agreed follow-up. Ask about withdrawal risk before suggesting abrupt cessation in someone who may be physically dependent. Severe withdrawal symptoms require urgent care. Avoid a routine "repeat in one year" instruction when the current screen identifies an active problem. NIAAA screening and assessment guidance.