USAUDIT

It is important to consider an individual’s alcohol consumption when planning their diet, as alcohol is a source of energy that can affect overall health. To assess alcohol consumption and potential harm, the U.S Alcohol Use Disorders Identification Test (USAUDIT-C) is recommended as a first step. This test has been adjusted to reflect the higher ethanol content in a U.S. standard drink and U.S. low-risk drinking guidelines, which differ from other countries. Keeping track of alcohol consumption is easier with the USAUDIT-C.

The USAUDIT-C is a tool used to determine an individual’s alcohol consumption and potential for harm. It consists of three questions that assess the frequency and amount of alcohol consumption, as well as binge drinking. A positive score (7 or more for men and 5 or more for women and men over 65) indicates a risk for alcohol-related harm. If the score is positive, further evaluation using the full AUDIT questionnaire is recommended to understand the level of dependence and harm. Based on the results, the individual may need education, counseling, or intervention to reduce the risk of future harm.

USAUDIT-C

U.S Alcohol Use Disorders Identification Test
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USAUDIT Questionnaire

Questions0123456
How often do you have a drink containing alcohol?NeverLess than monthlyMonthlyWeekly2-3 times a week4-6 times a weekDaily
How many drinks containing alcohol do you have on a typical day you are drinking?1 drink2 drinks3 drinks4 drinks5-6 drinks7-8 drinks10 or more drinks
How often do you have X (5 for men; 4 for women & men over age 65) or more drinks on one occasion?NeverLess than monthlyMonthlyWeekly2-3 times a week4-6 times a weekDaily
How often during the last year have you found that you were not able to stop drinking once you had started?NeverLess than monthlyMonthlyWeeklyDaily or almost daily  
How often during the past year have you failed to do what was expected of you because of drinking?NeverLess than monthlyMonthlyWeeklyDaily or almost daily  
How often during the past year have you needed a drink first thing in the morning to get yourself going after a heavy drinking session?NeverLess than monthlyMonthlyWeeklyDaily or almost daily  
How often during the past year have you had a feeling of guilt or remorse after drinking?NeverLess than monthlyMonthlyWeeklyDaily or almost daily  
How often during the past year have you been unable to remember what happened the night before because you had been drinking?NeverLess than monthlyMonthlyWeeklyDaily or almost daily  
Have you or someone else been injured because of your drinking?No Yes, but not in the past year Yes, during the past year  
Has a relative, friend, doctor, or other health care worker been concerned about your drinking and suggested you cut down?No Yes, but not in the past year Yes, during the past year  
  Instructions: Alcohol can affect your health, medications, and treatments, so we ask patients the following questions. Your answers will remain confidential. Place an X in one box to answer. Think about your drinking in the past year. A drink means one beer, one small glass of wine (5 oz.), or one mixed drink containing one shot (1.5 oz.) of spirits.

Scoring the USAUDIT

Risk LevelInterventionUSAUDIT ScorePossible AUD (DSM-5, ICD-10)
Zone IFeedback0-6/7 (Women/Men)None
Zone IIFeedback7/8-15 (Women/Men)Mild AUD, hazardous use
Zone III
Feedback/monitoring brief outpatient treatment
16-19Moderate AUD, harmful use
Zone IVReferral to evaluation and treatment20-40Moderate/severe AUD, alcohol dependence

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Zones

Zone I

Zone I refers to either low-risk drinking or not drinking alcohol. The majority of patients are in this category and no additional steps are required other than to inform them of the recommended low-risk alcohol consumption levels and acknowledge their adherence to those guidelines or abstinence. Approximately 80% of primary care patients fall into this category (Madras et al., 2009; Rubinsky, Kivlahan, Volk, Maynard, & Bradley, 2010).

Zone II

Zone II is assigned to individuals who drink above low-risk guidelines, as indicated by a USAUDIT score of 7-15 for women or 7-8 for men. For these patients, the best approach is a brief intervention involving feedback, reflective conversations, and education materials. Approximately 16% of primary care patients fall into this category, according to studies (Madras et al., 2009; Rubinsky et al., 2010).

Zone III

Patients who score between 16 to 19 on the USAUDIT are considered to have harmful drinking habits. The best approach to managing their alcohol consumption is through a combination of feedback, repeated brief interventions, and monitoring, with further diagnostic evaluation if the patient does not show improvement or is suspected of having alcohol dependence. If a behavioral health service provider is available in the primary care clinic, these patients may be eligible for brief outpatient treatment.

Zone IV

Zone IV is indicated by a score of 20 or higher on the USAUDIT test and indicates probable alcohol dependence. These patients should receive a referral to a specialist for diagnostic evaluation and treatment. If specialist services are not available, the patient may receive care in primary care, especially if the provider has access to medications, behavioral health services, and support from mutual-help organizations. The healthcare provider may also screen the patient for additional medical needs that may require immediate attention.