The WHO AUDIT in one page: ten questions to detect hazardous and harmful drinking. Scoring, the four risk zones, cut-offs by sex and how to cite it.
Ten questions from the World Health Organization to detect hazardous and harmful drinking, and possible dependence, in primary care. Validated in six countries, free for non-commercial use, with a validated Spanish version.
By Víctor Ciudad-Fernández, PhD · Updated: October 6, 2026 · Leer esta ficha en español · Instruments
The World Health Organization asked an international group of investigators to develop the AUDIT to detect alcohol problems at an early stage, with a procedure suitable for health systems in both developing and developed countries. Unlike earlier screening tests focused on alcoholism, it targets hazardous drinking (a pattern that raises the risk of harm) and harmful use (drinking that already has health consequences), as well as possible dependence.
Its ten questions cover three domains: hazardous use (frequency, typical quantity and frequency of heavy drinking), dependence symptoms (impaired control, increased salience of drinking, morning drinking) and harmful use (guilt, blackouts, injuries and others being concerned). They were selected from a 150-item schedule given to 1,888 primary care patients in six countries: Norway, Australia, Kenya, Bulgaria, Mexico and the United States.
It is used for screening in primary care, emergency departments and other services, and as a research measure. It is not a diagnosis: a high score calls for an assessment and, depending on the level, a brief intervention or a referral.
Each question is scored from 0 to 4 and the total is the sum, from 0 to 40. It can be given as an interview or as a self-report questionnaire; the manual includes a self-report version. The first three questions, on consumption, form the basis of the short AUDIT-C, which is studied separately.
The manual also asks you to look at individual answers: anyone scoring 2 or more on the dependence questions (4, 5 and 6), or 4 on the problem questions (9 or 10), should be offered the next level of intervention even if their total does not call for it.
The AUDIT yields a total score, which the WHO manual uses as a general measure of severity to step up the intervention. According to the manual, published studies find high internal consistency, consistent with a single construct, while the three domains let you look at consumption, dependence and problems separately.
The manual itself leaves open, as a research question, whether hazardous use, harmful use and dependence can be scored separately, and notes that there is still no well-established cut-off to distinguish hazardous drinking from dependence.
The WHO manual proposes 8 or more as an indicator of hazardous and harmful drinking and possible dependence. A cut-off of 10 gives more specificity at the expense of sensitivity, and lowering it to 7 for women and for men over 65 increases sensitivity in those groups. It also sorts scores into four risk zones, each with its intervention.
| Score | Risk zone and intervention | Source |
|---|---|---|
| 0-7 | Zone I: low-risk drinking or abstinence. Alcohol education | Babor et al. (2001) |
| 8-15 | Zone II: drinking above low-risk guidelines. Simple advice | Babor et al. (2001) |
| 16-19 | Zone III: hazardous and harmful drinking. Simple advice plus brief counseling and continued monitoring | Babor et al. (2001) |
| 20-40 | Zone IV: possible dependence. Referral to a specialist for diagnostic evaluation and treatment | Babor et al. (2001) |
| ≥9 (men) | Hazardous drinking in Spanish primary care | Contel Guillamón et al. (1999) |
| ≥6 (women) | Most effective cut-off for hazardous drinking and dependence in Spanish women | Pérula de Torres et al. (2005) |
The manual stresses that the cut-off may vary with the country’s drinking patterns, the alcohol content of a standard drink and the nature of the screening program. In Spain, validation studies found different cut-offs for men and women.
A screening questionnaire is not a diagnosis: a high score means a clinical assessment is warranted, not that a disorder is present.
Contel Guillamón, Gual Solé and Colom Farran (1999) translated and validated the AUDIT into Catalan and Spanish in primary care, with 409 patients assessed with the test, DSM-III-R criteria and laboratory tests. Both versions performed alike, but men and women did not: in men the best cut-off for hazardous drinking was 9, while in women they found no adequate cut-off and called for further research.
Pérula de Torres et al. (2005) then studied women specifically: 414 women from two primary care centres and a drug-dependency centre, with the SCAN interview as the criterion. The AUDIT showed high reliability and the most effective cut-off was 6. If your sample is mixed, justify sex-specific cut-offs with these references.
License: Free non-commercial use. The WHO manual states that the document may be freely reviewed, abstracted, reproduced and translated, in part or in whole, but not for sale or for use in conjunction with commercial purposes.
The questionnaire, scoring guide and intervention guidelines are in the WHO manual, free to download from the WHO institutional repository. The Spanish validation is open access in the journal Adicciones.
Cite the development paper or the WHO manual, and the language version you use:
@article{saunders1993audit,
author = {Saunders, John B. and Aasland, Olaf G. and Babor, Thomas F. and de la Fuente, Juan R. and Grant, Marcus},
title = {Development of the {Alcohol Use Disorders Identification Test} ({AUDIT}): {WHO} collaborative project on early detection of persons with harmful alcohol consumption-{II}},
journal = {Addiction},
year = {1993},
volume = {88},
number = {6},
pages = {791--804},
doi = {10.1111/j.1360-0443.1993.tb02093.x}
}The Spanish validations found different cut-offs by sex. If you have a diagnostic interview as the criterion, derive your own cut-off for men and for women with the ROC curve calculator, which draws the curve from your scores and gives you the area under the curve and the optimal Youden cut-off.
The WHO’s 8 is the international reference, but cut-offs vary with drinking patterns and sex. In Spain, validation studies found 9 for hazardous drinking in men in primary care (Contel Guillamón et al., 1999) and 6 in women (Pérula de Torres et al., 2005). The most defensible approach is to report the cut-off you use with its reference and, if you can, results with more than one.
The AUDIT-C is the first three questions, on consumption. It is quicker, but leaves out dependence and problems. If you need to distinguish risk levels and guide the intervention, the full AUDIT gives more information.
This fact sheet is an academic reference for information purposes: it does not reproduce any questionnaire item. Using the instrument in your research or practice may require citing its authors or asking for permission: see “How to get the instrument”.