behavior, adverse reactions and alcohol-related
problems.^158
AUDIT was developed through a six-country*
WHO project to find a screening instrument
suited for primary care settings.^159
The questionnaire can be self-administered or
administered through an interview with a trained
practitioner.^160 Respondents’ answers to each
question are scored from zero to four, with a
maximum score of 40.^161 Researchers have
suggested the use of a cut-off score of eight as
an indicator of risk.^162
The AUDIT is copyrighted but available through
the WHO.† 163 It can be self-administered via
computer.^164
Populations and Settings Served. The AUDIT
was developed for use in primary care settings,
but also has been deemed appropriate by the
National Institute on Alcohol Abuse and
Alcoholism (NIAAA) for use with hospital,
emergency department and psychiatric patients
as well as in criminal justice, armed forces,
workplace and college settings.^165
Clinical Utility. The AUDIT has demonstrated
good validity and reliability across multiple
populations with vastly differing cultural norms
and behaviors.^166 Using a cut-off score of eight
results in high sensitivity and specificity:
according to WHO data evaluating the AUDIT,
92 percent of risky drinkers had AUDIT scores
of eight or higher and 94 percent of non-risky
drinkers had scores lower than eight.‡ 167 A cut-
off score of eight identified accurately 95
percent of drinkers who had experienced
medical, trauma, domestic or social problems
associated with their alcohol use and 97 percent
of male drinkers who consumed five or more
drinks per day or female drinkers who drank
three or more drinks per day.^168
- Australia, Bulgaria, Kenya, Mexico, Norway and
the United States.
† The training module can be purchased through the
Division of Mental Health and Prevention of
Substance Abuse at the WHO.
‡ In the American study group, these figures were 90
percent and 92 percent, respectively.
The AUDIT’s greatest strengths include its
brevity, focus on current practices, ease of
administration and cultural neutrality.^169 A
limitation of the AUDIT is that its threshold for
identifying risky alcohol use is higher than that
recommended by the U.S. Department of
Agriculture’s (USDA) Dietary Guidelines for
safe alcohol use.§ 170 Some research suggests
that a lower AUDIT cut-off score would be
more effective in identifying risky alcohol use,
particularly in female populations.^171The T-ACE Questionnaire
T-ACE is a four-question screening instrument
for identifying risky alcohol use, including
lifetime use and prenatal use in pregnant
women.^172 It was created in 1989 and is based
on the CAGE:- How many drinks does it take to make you
feel high (Tolerance)? - Have people Annoyed you by criticizing
your drinking? - Have you ever felt you ought to Cut down
on your drinking? - Have you ever had a drink first thing in the
morning to steady your nerves or get rid of a
hangover (Eye-opener)?^173
Affirmative answers to questions two through
four are scored as one point each, and a
tolerance greater than two drinks is worth two
points. Patients whose total score is at least two
screen positive for risky alcohol use.^174 The
screening and scoring process takes only a few
minutes.^175Although the T-ACE is copyrighted, it is widely
available for use. It does not require training to
administer.^176§ Among the USDA Dietary Guidelines for safe
alcohol use are the guidelines of no more than one
drink a day for women and no more than two drinks a
day for men--which are lower thresholds of risk than
those included in the AUDIT.