AUDIT-C — alcohol use 3-question screen
The 3-question version of the WHO AUDIT (Bush, Kivlahan, McDonell, Fihn, Bradley, 1998). Embedded in every VA primary-care visit and the SAMHSA SBIRT primary-care framework. A positive AUDIT-C is the standard trigger for the full 10-question AUDIT — it isn't a diagnosis, it's a checkpoint.
AUDIT-C takes about 60 seconds, scores 0–12, and uses sex-specific cutoffs: ≥4 for men, ≥3 for women and adults 65+ (Bradley et al. 2007 validation). A positive screen does not diagnose alcohol use disorder. It means you should complete the full AUDIT-10 next. Both instruments are public-domain.
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Below the sex-specific cutoff. Hazardous drinking unlikely on this screener. If you still feel something is off about your drinking, you can take the full AUDIT-10 for a more detailed view.
A positive AUDIT-C means hazardous drinking is plausible and a fuller evaluation is warranted. This is information, not a diagnosis. The standard next step is the full 10-question AUDIT, which surfaces dependence symptoms and alcohol-related harm items.
If you're already drinking heavily and want to cut back: do NOT stop suddenly without medical advice. Withdrawal from heavy chronic drinking can be medically dangerous (seizures, delirium tremens). Talk to a doctor or call a helpline first.
Where AUDIT-C came from and why it works
AUDIT-C is the first three items of the WHO Alcohol Use Disorders Identification Test (AUDIT, originally developed in 1989). It was extracted and validated as a stand-alone primary-care instrument by Kristen Bush and colleagues at the VA Puget Sound Health Care System in 1998. The three items cover the consumption fundamentals: frequency of drinking, typical quantity per occasion, and frequency of heavy episodic (5+ drinks) drinking.
The original 1998 study (Bush et al., Archives of Internal Medicine) tested AUDIT-C in 243 male veterans against a structured clinical interview. Sensitivity at cutoff ≥4 was 86% with specificity of 72% — comparable to the full 10-item AUDIT. The 2007 follow-up (Bradley et al., Alcoholism: Clinical and Experimental Research) extended validation to women, finding the lower cutoff of ≥3 was needed for similar sensitivity (73%) at acceptable specificity.
How clinicians actually use it
VA primary care administers AUDIT-C at every routine visit; it's a structured EHR question. SAMHSA's SBIRT framework also recommends AUDIT-C as the first screen. The standard workflow is: (1) AUDIT-C every visit → (2) if positive, brief intervention or full AUDIT-10 same visit → (3) AUDIT-10 result + clinical interview guides referral. This approach catches hazardous drinking at the population level while not over-flagging moderate drinkers.
When NOT to use AUDIT-C
- If you already know you have AUD and want to grade severity → use the full AUDIT-10 (the dependence-symptom items are absent in AUDIT-C).
- If you're worried specifically about a loved one's drinking and want a relationship-impact screener → consider CAGE, which asks about social/emotional consequences.
- If you're in active withdrawal — call 911. Self-tests are not a triage tool for medical emergencies.
- For drug use other than alcohol, use DAST-10.
AUDIT-C alongside depression/anxiety screens
Co-occurring alcohol use and mood/anxiety disorders are extremely common — population studies put the comorbidity rate at 30–40%. That's why SAMHSA's SBIRT primary-care framework pairs AUDIT-C with PHQ-2 (or its full version PHQ-9) and GAD-7. If you took AUDIT-C because of mood concerns, the right pair is AUDIT-C + PHQ-2 together — full standard primary-care behavioral-health bundle.
Quick definitions
FAQ
What does a positive AUDIT-C mean?
In men, ≥4 of 12 = positive. In women and adults 65+, ≥3 = positive. Sensitivity at these cutoffs is 86% (men) / 73% (women) for active alcohol use disorder. Positive does not diagnose AUD — it indicates the full 10-question AUDIT should be administered next.
Difference between AUDIT-C and AUDIT-10?
AUDIT-C = first 3 items of AUDIT-10 (consumption pattern). AUDIT-10 adds 7 items on dependence symptoms and alcohol-related harm. AUDIT-C: ~1 minute. AUDIT-10: ~5 minutes.
Why are men's and women's cutoffs different?
At equivalent intake, women reach higher blood-alcohol concentrations and develop alcohol-related health problems at lower drinking levels. The lower cutoff for women (and adults 65+, who metabolize alcohol differently) reflects this physiology.
Is AUDIT-C public-domain?
Yes. AUDIT-C is derived from the WHO AUDIT, which is in the public domain. AUDIT-C was developed by VA researchers and is freely usable for personal, clinical, and research purposes without license fee.
What if my score is high?
Take the full AUDIT-10 next, then talk to your doctor or call a helpline. If you're in active withdrawal — shaking, sweating, racing heart, hallucinations after stopping — call 911. Withdrawal from heavy chronic drinking can be medically dangerous.
Sources
- Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Arch Intern Med. 1998;158(16):1789-1795.
- Bradley KA, DeBenedetti AF, Volk RJ, Williams EC, Frank D, Kivlahan DR. AUDIT-C as a brief screen for alcohol misuse in primary care. Alcohol Clin Exp Res. 2007;31(7):1208-1217.
- WHO AUDIT manual (Saunders et al. 1993; Babor et al. 2001).
- SAMHSA — Screening, Brief Intervention, and Referral to Treatment (SBIRT).
- USPSTF Unhealthy Alcohol Use in Adolescents and Adults: Screening (2018, B-grade).
Other validated screeners
AUDIT-10 (Alcohol Use Disorders Identification Test)
10-question WHO-validated alcohol screener. Pair with PHQ-9 for a full alcohol-plus-depression picture — the combination is the standard primary-care SBIRT workflow.
DAST-10 (Drug Abuse Screening Test)
10-question Skinner-1982 drug-use screener (excluding alcohol and tobacco). Pair with PHQ-9 if substance use other than alcohol is a concern.
PHQ-9 (Patient Health Questionnaire-9)
9-question Kroenke-2001 depression severity screener. Depression co-occurs with substance use disorder in 30–40% of cases — integrated treatment is best evidence.
GAD-7 (Generalized Anxiety Disorder)
7-question anxiety severity screener (Spitzer 2006 — same author family as PHQ-9). Anxiety co-occurs with depression in roughly 50% of cases. At cutoff ≥10: 89% sensitivity, 82% specificity for GAD.
CAGE-4
4-question alcohol screener (Ewing JAMA 1984). Faster than AUDIT-10 but less sensitive. Public-domain. Cutoff ≥2 has 71% sensitivity / 90% specificity for AUD.
PHQ-2
2-item subset of PHQ-9 (anhedonia + depressed mood). Faster pre-screen used in primary care before triggering full PHQ-9.
ACE (Adverse Childhood Experiences)
10-question retrospective measure of childhood adversity (Felitti / CDC 1998). Public-domain. ACE ≥4 increases adult substance use disorder risk by 7×. Trauma-informed counterpart to current-symptom screeners.
PCL-5 (PTSD Checklist for DSM-5)
20-question current-symptom screener developed by VA National Center for PTSD (Weathers 2013). Public-domain. DSM-5-aligned with 4 cluster sub-scores. Pairs with ACE (past exposure + current symptoms = standard trauma workup). Cutoff ≥31 for probable PTSD.
WHO ASSIST
Longer 8-item WHO instrument covering alcohol, tobacco, cannabis, cocaine, stimulants, inhalants, sedatives, hallucinogens, opioids. For one-shot multi-substance screening. WHO ASSIST manual.
