AUDIT/AUDIT-C: 4 or 6 drinks? Gender Cut-Offs? Use the right number for better accuracy!

AUDIT number of drinks sbirt

Did you Know: Use 4 Drinks on AUDIT and AUDIT-C in United States. And, Cut-Off Varies by Gender

Use 4+ as your AUDIT/AUDIT-C Question #3!

According to the Dept. of Family Medicine at Oregon Health & Science University, Question #3 on the AUDIT and AUDIT-C should read “How often do you have four or more drinks on one occasion?”

AUDIT number of drinks sbirt squareMany forms around the country still ask about “six” drinks for question #3. When the World Health Organization first validated the AUDIT, researchers used a 10-gram drink as a standard drink, which is less than the standard drink of 14 grams in the U.S. Consequently, asking about four drinks in the U.S. (56 grams) more closely resembles the amount of alcohol found in six drinks as defined in the original AUDIT (60 grams).

Page 32 of the official WHO guide1 to using the AUDIT says: “Questions 2 and 3 assume that a standard drink equivalent is 10 grams of alcohol. You may need to adjust the number of drinks in the response categories for these questions in order to fit the most common drink sizes and alcohol strength in your country.”

Applying a scoring guide for the AUDIT that accounts for gender.

The original suggested cut-off value of 8 points on the AUDIT was selected to detect at least problematic drinking for both men and women. However, this cut-off score misses risky drinkers – a prime population SBI processes are intended to identify. Selecting two, lower cut-off scores, one for men and one for women, is supported by a recent study2 as well as NIAAA guidelines that give different low-risk drinking limits for men (14 drinks per week/4 per day) and women (7 per week/ 3 per day).

Babor T, Higgins-Biddle J, Saunders J, Maristela M. “The Alcohol Use Disorders Identification Test – Guidelines for Use in Primary Care. Second Edition”. Department of Mental Health and Substance Dependence, World Health Organization. 2001.

Johnson JA, Lee A, Vinson D, Seale JP. “Use of AUDIT-based measures to identify unhealthy alcohol use and alcohol dependence in primary care: a validation study.” Alcohol Clin Exp Res. 2013 Jan.

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