_id

683a15ffc782e11e38d1b10e

id

2021

title

AUDIT-C for Alcohol Use

full_title

AUDIT-C for Alcohol Use

short_title

AUDIT-C

med_description

Identifies at-risk drinkers (i.e., binge drinking) who may not be alcohol-dependent.

short_description

Screens for at-risk drinkers, not necessarily dependence.

slug

audit-c-alcohol-use

description

The AUDIT-C for Alcohol Use identifies at-risk drinkers (i.e., binge drinking) who may not be alcohol-dependent.

keywords

Audit-C, audit alcohol, audit consumption, audit alcohol consumption, audit etoh consumption, audit calc, etoh calc, etoh disorder calc, alcohol use disorder calc, audit mdcalc, audit mdcalc, audit C calc, Audit-c calc, audit c score, audit c

complaint

[ "Intoxication/Overdose" ]

formula

Addition of the selected points.

evidence

Original article:

The AUDIT was developed by the World Health Organization (WHO) as a simple method of screening for excessive drinking and to assist in brief assessment. It was first published as a manual in 1989, and most recently updated in 2001. The AUDIT-C was developed in 1998 due to the recognition that the 10-question length of the AUDIT made it unlikely that primary providers would incorporate it into routine patient interviews or general health history questionnaires. In studying a VA primary care setting, they found that although the full AUDIT performed better than AUDIT-C for detecting active alcohol abuse or dependence (0.811 vs 0.786;P<.001), the 2 questionnaires performed similarly for detecting heavy drinking and/or active abuse or dependence (0.880 vs 0.881). This validated the AUDIT-C for use in detecting heavy drinking and active abuse/dependence.

Validation article (Bradley 2007):

This was a cross-sectional validation study that compared several types of alcohol screening questionnaires with standardized interviews in a primary care setting. The AUDIT-C, full AUDIT, self-reported risky drinking, AUDIT question #3, and an augmented CAGE questionnaire were compared with an interview primary reference standard of alcohol misuse, defined as a DSM, 4th ed. alcohol use disorder and/or drinking above recommended limits in the past year. The results indicated that AUDIT-C was an effective screening test for alcohol misuse in this primary care sample, with optimal screening thresholds for alcohol misuse among men (≥4) and women (≥3).

Validation article (Frank 2008):

The first validation article utilized primarily a CaucasianWhite population. This article evaluated the validity of the AUDIT-C among primary care patients from an expanded group of racial subgroups including CaucasiansWhites, African Americans, and Hispanics. Areas under the receiver operating curve (AuROCs) evaluated overall AUDIT-C performance in the 3 racial/ethnic groups compared to diagnostic interviews for alcohol misuse. The overall performance of the AUDIT-C was excellent in all 3 racial/ethnic groups as reflected by high AuROCs.

measurements

[]

information

The AUDIT-C (Alcohol Use Disorder Identification Test) quantifies alcohol misuse, based on 3 questions posed to patients about their consumption habits. It was adapted from the longer AUDIT, which is mainly used in primary care settings.

Score interpretation:

• Males: Scores ≥4 suggest alcohol misuse.
• Females: Score ≥3 suggest alcohol misuse.
• Higher score correlates with greater severity of alcohol misuse.

refrences

{ "Clinical Practice Guidelines": [ { "href": "", "text": "" } ], "Manufacturer Website": [ { "href": "", "text": "" } ], "Original/Primary Reference": [ { "href": "https://apps.who.int/iris/bitstream/handle/10665/67205/WHO_MSD_MSB_01.6a.pdf;jsessionid=1FAFA3CC325018FC69178F3AF9944665?sequence=1", "text": "Babor TF, Higgins-Biddle JC, Saunders JB and Monteiro M. AUDIT. The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Care. Geneva: World Health Organization, 2001 (Second Edition)." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/9738608", "text": "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. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Arch Intern Med. 1998 Sep 14;158(16):1789-95." } ], "Other References": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/7966928", "text": "Kitchens JM. Does this patient have an alcohol problem? JAMA. 1994 Dec 14;272(22):1782-7. PubMed PMID: 7966928." }, { "href": "https://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm", "text": "Centers for Disease Control and Prevention. Alcohol use and health. 2014." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/1530196", "text": "Klatsky AL, Armstrong MA, Friedman GD. Alcohol and mortality. Ann Intern Med. 1992;117:646-654. PubMed PMID:1530196." }, { "href": "https://pubs.niaaa.nih.gov/publications/aa65/AA65.htm", "text": "The Physicians' Guide to Helping Patients With Alcohol Problems. Washington, DC US Dept of Health and Human Services, Public Health Service, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, 1995." } ], "Outcomes": [ { "href": "", "text": "" } ], "Validation": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/17451397", "text": "Bradley KA, et. al. AUDIT-C as a brief screen for alcohol misuse in primary care. Alcohol Clin Exp Res. 2007 Jul;31(7):1208-17. Epub 2007 Apr 19." }, { "href": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2517893/", "text": "Frank D, DeBenedetti AF, Volk RJ, Williams EC, Kivlahan DR, Bradley KA. Effectiveness of the AUDIT-C as a Screening Test for Alcohol Misuse in Three Race/Ethnic Groups. Journal of General Internal Medicine. 2008;23(6):781-787. doi:10.1007/s11606-008-0594-0." } ], "Validations": [] }

pearls

• AUDIT-C is a 3-item alcohol screen that can help identify persons who are hazardous drinkers or have active alcohol use disorders.
• The AUDIT-C is a modified, shortened version of the 10-question AUDIT instrument. Its briefer design makes it more practical for incorporation into routine patient interviews or health history questionnaires in a primary care setting.
• AUDIT-C is a screening tool. An abnormal or positive screening result may thus “raise suspicion” about the presence of an alcohol use problem, while a normal or negative result should suggest a low probability of an alcohol use problem. Assessment for purposes of diagnosis occurs in subsequent stages of evaluation.

usecase

• The 4-item CAGE questionnaire is the briefest effective screening test for lifetime alcohol abuse/dependence, but it is not sensitive for detecting heavy drinking and does not distinguish between active and past problem drinking. The AUDIT-C is more effective in identifying this population.
• AUDIT-C can be included among standard history questions or general health intake questionnaires in primary care, emergency department, psychiatric and inpatient hospital settings.
• Other at-risk populations where AUDIT-C or another alcohol screening assessment is indicated include:
  • Pregnant women
  • College students
  • Arrested and incarcerated persons, especially DWI and domestic violence offenders

reasons

Physicians often overlook alcohol problems in patients. (Kitchens JM 1994) Simply asking patients how much they drink often leads to an estimate lower than the actual number of alcoholic drinks per day. Alcohol disorders are treatable despite physician bias otherwise. (Kitchens JM 1994) Without identification and treatment alcohol problems lead to significant morbidity and mortality:Alcohol is a major factor in suicides, homicides, violent crimes, and fatal motor vehicle accidents. Nearly 88,000 people die from alcohol-related causes annually, making it the third leading preventable cause of death in the United States. (Centers for Disease Control and Prevention 2014)Alcohol is primarily or secondarily implicated in a large number of medical problems.The mortality rate in those who drink six or more drinks per day is 50% higher than the rate in matched controls. (Klatsky AL 1992) Alcohol is a major factor in suicides, homicides, violent crimes, and fatal motor vehicle accidents. Nearly 88,000 people die from alcohol-related causes annually, making it the third leading preventable cause of death in the United States. (Centers for Disease Control and Prevention 2014) Alcohol is primarily or secondarily implicated in a large number of medical problems. The mortality rate in those who drink six or more drinks per day is 50% higher than the rate in matched controls. (Klatsky AL 1992)

next_advice

If a clinician suspects that the patient is minimizing his or her alcohol use, or if a patient’s score is near the cutoff, one may consider utilizing a more lengthy screening test to better determine the nature and extent of the problem. (The Physicians' Guide to Helping Patients With Alcohol Problems 1995)

Other validated tests for further assessment include:

• Michigan Alcoholism Screening Test (MAST)
• Alcohol Use Disorders Identification Test (AUDIT)

next_actions

In any hospital setting where access to alcohol may be limited, always monitor for signs/symptoms of alcohol withdrawal, even in patients who have not screened positive for an alcohol problem.

next_management

• When screening results are positive, the patient should be referred for further evaluation and treatment of an alcohol use problem.
• This will vary based on available resources but is ideally to an addiction psychiatrist, psychologist, or addiction treatment program.

diseases

[ "Alcoholism", "Drug/Alcohol Use" ]

input_schema

[ { "conditionality": "", "default": 0, "label_en": "How often did you have a drink containing alcohol in the past year?", "mdcalc_info_concept": null, "name": "often", "option_fhir_rules": null, "optional": false, "options": [ { "label": "Never", "value": 0 }, { "label": "Monthly or less", "value": 1 }, { "label": "Two to four times a month", "value": 2 }, { "label": "Two to three times per week", "value": 3 }, { "label": "Four or more times a week", "value": 4 } ], "show_points": true, "tips_en": "", "type": "radio" }, { "conditionality": "", "default": 0, "label_en": "How many drinks containing alcohol did you have on a typical day when you were drinking in the past year?", "mdcalc_info_concept": null, "name": "count", "option_fhir_rules": null, "optional": false, "options": [ { "label": "1 or 2 drinks", "value": 0 }, { "label": "3 or 4", "value": 1 }, { "label": "5 or 6", "value": 2 }, { "label": "7 to 9", "value": 3 }, { "label": "10 or more", "value": 4 } ], "show_points": true, "tips_en": "", "type": "radio" }, { "conditionality": "", "default": 0, "label_en": "How often did you have six or more drinks on one occasion in the past year?", "mdcalc_info_concept": null, "name": "more", "option_fhir_rules": null, "optional": false, "options": [ { "label": "Never", "value": 0 }, { "label": "Less than monthly", "value": 1 }, { "label": "Monthly", "value": 2 }, { "label": "Weekly", "value": 3 }, { "label": "Daily or almost daily", "value": 4 } ], "show_points": true, "tips_en": "", "type": "radio" } ]

instructions

published

2022-04-21T20:29:05.236Z

purpose

[ "Diagnosis" ]

search_terms

[ "Alcoholism", "Diagnosis", "Psych", "rule out", "Etoh", "abuse", "intoxication", "auditc", "audit c" ]

seo

{ "keywords_en": "Audit-C, audit alcohol, audit consumption, audit alcohol consumption, audit etoh consumption, audit calc, etoh calc, etoh disorder calc, alcohol use disorder calc, audit mdcalc, audit mdcalc, audit C calc, Audit-c calc, audit c score, audit c", "meta_description_en": "The AUDIT-C for Alcohol Use identifies at-risk drinkers (i.e., binge drinking) who may not be alcohol-dependent." }

specialty

[ "Family Practice", "Geriatrics", "Hospitalist Medicine", "Internal Medicine", "Primary Care", "Psychiatry" ]

departments

[ "Psychiatric" ]

tags

[]

version_number

1

versions

[]

related

[ { "calcId": 1729, "short_title_en": "CAGE Questions", "slug": "cage-questions-alcohol-use" }, { "calcId": 1843, "short_title_en": "Hamilton Anxiety Scale", "slug": "hamilton-anxiety-scale" }, { "calcId": 4013, "short_title_en": "SMAST", "slug": "short-michigan-alcoholism-screening-test" } ]

ismed

true

section

[ "whenToUseViewed", "pearlsPitfallsViewed", "whyUseViewed", "nextStepsViewed", "evidenceViewed" ]

cleaned_departments

[ "psychiatry" ]

cleaned_use

[ "The 4-itemCAGE questionnaireis the briefest effective screening test for lifetime alcohol abuse/dependence, but it is not sensitive for detecting heavy drinking and does not distinguish between active and past problem drinking. The AUDIT-C is more effective in identifying this population.", "AUDIT-C can be included among standard history questions or general health intake questionnaires in primary care, emergency department, psychiatric and inpatient hospital settings.", "Other at-risk populations where AUDIT-C or another alcohol screening assessment is indicated include:Pregnant womenCollege studentsArrested and incarcerated persons, especially DWI and domestic violence offenders", "Pregnant women", "College students", "Arrested and incarcerated persons, especially DWI and domestic violence offenders" ]

pub

true