JOHN G. KUNA, PSYD AND ASSOCIATES

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Review of the Alcohol Use Disorders Identification Test

(AUDIT)

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.”

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

Description of test items and scores (including sub scales)

Three Domains: 1) Hazardous Alcohol Use:

Frequency of drinking, Typical quantity, Frequency of heavy drinking

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

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).

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 

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 scoreZone I Alcohol Education 0-7Zone II Simple Advice 8-15Zone III Simple Advice plus

Brief Counseling and Continued Monitoring

16-19

Zone IV Referral to Specialist for Diagnostic Evaluation and Treatment

20-40

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.

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

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).

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).

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)

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.

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.

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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