AUDIT-C
Three-item alcohol consumption screen with sex-specific cut-offs
- AWMF S3 Alkohol (076-001)
Sources last checked: 2026-10-13
AUDIT-C
Three-item alcohol consumption screen with sex-specific cut-offs
Thresholds come from US primary-care samples (Bradley 2007). German validation studies often use ≥ 4 (women) and ≥ 5 (men); local pathways may differ. Items are paraphrased from the WHO AUDIT.
Interpretation
| 0–2 — negative | Below the screening threshold for both women and men. |
|---|---|
| 3 — positive in women | Women: ≥ 3 is positive (sensitivity 0.73, specificity 0.91). Men: still below the ≥ 4 threshold. |
| ≥ 4 — positive | Positive for alcohol misuse in women and men (men ≥ 4: sensitivity 0.86, specificity 0.89). A positive AUDIT-C is a screen; the full AUDIT grades the risk zone. |
What is the AUDIT-C?
The AUDIT-C uses the three consumption questions of the AUDIT: drinking frequency, typical quantity and frequency of heavy episodes, for a score of 0–12. Bush and colleagues validated it in 1998 in US Veterans Affairs patients; Bradley and colleagues confirmed in 2007 that ≥ 4 in men and ≥ 3 in women best balanced sensitivity and specificity in a mixed primary-care population.
When to use it
- Rapid screening for alcohol misuse in any clinical setting
- When the full AUDIT is impractical (German S3 guideline recommendation)
- Tracking consumption over time
When not to use it
- To assess dependence or alcohol-related harm — use the full AUDIT
- As a diagnosis of an alcohol use disorder
How it is calculated
| Criterion | Points |
|---|---|
| 1. How often do you drink alcohol? | |
| Never | 0 |
| Monthly or less | 1 |
| 2–4 times a month | 2 |
| 2–3 times a week | 3 |
| 4 or more times a week | 4 |
| 2. Standard drinks on a typical drinking day | |
| 1–2 | 0 |
| 3–4 | 1 |
| 5–6 | 2 |
| 7–9 | 3 |
| 10 or more | 4 |
| 3. How often six or more drinks on one occasion? | |
| Never | 0 |
| Less than monthly | 1 |
| Monthly | 2 |
| Weekly | 3 |
| Daily or almost daily | 4 |
Clinical pearls and limitations
- Thresholds come from US primary-care samples (Bradley 2007). German validation studies often use ≥ 4 (women) and ≥ 5 (men); local pathways may differ. Items are paraphrased from the WHO AUDIT.
- Sex-specific thresholds: women ≥ 3, men ≥ 4 (Bradley 2007). German validation work often uses ≥ 4 for women and ≥ 5 for men.
- Higher scores track higher risk; very high scores raise the possibility of dependence.
- If points come only from item 1 (frequent but small amounts), interpret the result with that in mind.
Frequently asked questions
What is a positive AUDIT-C for women and men?
In the US validation studies: 3 or more in women and 4 or more in men. Local pathways may use higher thresholds.
Why are the cut-offs different by sex?
Women reach higher blood alcohol levels and harm at lower intake, so a lower threshold keeps sensitivity comparable.
What follows a positive AUDIT-C?
Usually the full AUDIT; the WHO manual links each AUDIT risk zone to a level of intervention.
Evidence and guidelines
- Primary source: 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 et al. AUDIT-C as a brief screen for alcohol misuse in primary care. Alcohol Clin Exp Res 2007;31(7):1208-1217 — thresholds ≥ 4 men, ≥ 3 women.
- S3-Leitlinie alkoholbezogene Störungen (AWMF 076-001), Kurzfassung 2020: AUDIT-C soll eingesetzt werden, wenn der AUDIT zu aufwendig ist.
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<p><a href="https://medelix.ai/en/calculators/audit-c">AUDIT-C calculator by Medelix</a></p>For healthcare professionals and medical students. These tools support, and do not replace, clinical judgement. Always check results against the original source and your local protocols.