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Page 1
One drink equals:

12 oz.
 beer

5 oz.
wine

1.5 oz.
liquor
(one shot)
1. How often do you have a drink containing
alcohol?
Never
Monthly
or less
2 - 4
times a
month
2 - 3
 times a
week
4 or more
times a
week
2. How many drinks containing alcohol do you have
on a typical day when you are drinking?
0 - 2
3 or 4
5 or 6
7 - 9
10 or
more
3. How often do you have five or more drinks on
one occasion?
Never
Less than
monthly
Monthly
Weekly
Daily or
almost
daily
4. How often during the last year have you found
that you were not able to stop drinking once you
had started?
Never
Less than
monthly
Monthly
Weekly
Daily or
almost
daily
5. How often during the last year have you failed to
do what was normally expected of you because of
drinking?
Never
Less than
monthly
Monthly
Weekly
Daily or
almost
daily
6. How often during the last year have you needed a
first drink in the morning to get yourself going
after a heavy drinking session?
Never
Less than
monthly
Monthly
Weekly
Daily or
almost
daily
7. How often during the last year have you had a
feeling of guilt or remorse after drinking?
Never
Less than
monthly
Monthly
Weekly
Daily or
almost
daily
8. How often during the last year have you been
unable to remember what happened the night
before because of your drinking?
Never
Less than
monthly
Monthly
Weekly
Daily or
almost
daily
9. Have you or someone else been injured because
of your drinking?
No

Yes, but
not in the
last year

Yes, in the
last year
10. Has a relative, friend, doctor, or other health
care worker been concerned about your drinking
or suggested you cut down?
No

Yes, but
not in the
last year

Yes, in the
last year

0
1
2
3
4
Have you ever been in treatment for an alcohol problem?       Never        Currently      In the past
Alcohol screening questionnaire (AUDIT)
Drinking alcohol can affect your health and some medications you may take. Please help us provide you with the
best medical care by answering the questions below.

Patient name: ___________________

Date of birth: ____________________
   I        II       III     IV
  0-3     4-9    10-13    14+

Page 2
(For the Provider)

Scoring and interpreting the AUDIT:

1. Each response has a score ranging from 0 to 4. All response scores are added for a total score.

2. The total score correlates with a risk zone, which can be circled on the bottom left corner.


Score
Zone
Explanation
Action
0-3
I - Low Risk
"Someone using alcohol at this level
is at low risk for health or social
complications."
Positive Health Message - describe
low risk drinking guidelines
4-9
II - Risky
"Someone using alcohol at this level
may develop health problems or
existing problems may worsen."

Brief intervention to reduce use
10-13 III - Harmful
"Someone using alcohol at this level
has experienced negative effects
from alcohol use."

Brief Intervention to reduce or
abstain and specific follow-up
appointment (Brief Treatment if
available)
14+
IV - Severe
"Someone using alcohol at this level
could benefit from more assessment
and assistance."

Brief Intervention to accept referral to
specialty treatment for a full
assessment


Positive Health Message: An opportunity to educate patients about the NIAAA low-risk drinking levels and
the risks of excessive alcohol use.

Brief Intervention to Reduce Use: Patient-centered discussion that uses Motivational Interviewing
concepts to raise an individual's awareness of his/her substance use and enhance his/her motivation to
change behavior. Brief interventions are typically 5-15 minutes, and should occur in the same session as
the initial screening. Repeated sessions are more effective than a one-time intervention. The
recommended behavior change is to cut back to low-risk drinking levels unless there are other medical
reasons to abstain (liver damage, pregnancy, medication contraindications, etc.).

Brief Intervention to Reduce or Abstain (Brief Treatment if available) & Follow-up: Patients with
numerous or serious negative consequences from their alcohol use, or patients who likely have an alcohol
use disorder who cannot or are not interested in obtaining specialized treatment, should receive more
numerous and intensive BIs with follow up. The recommended behavior change is to cut back to low-risk
drinking levels or abstain from use.  Brief treatment is 1 to 5 sessions, each 15-60 minutes. Refer for brief
treatment if available. If brief treatment is not available, secure follow-up in 2-4 weeks.

Brief Intervention to Accept Referral: The focus of the brief intervention is to enhance motivation for the
patient to accept a referral to specialty treatment. If accepted, the provider should use a proactive process
to facilitate access to specialty substance use disorder treatment for diagnostic assessment and, if
warranted, treatment. The recommended behavior change is to abstain from use and accept the referral.

More resources: www.sbirtoregon.org

* Johnson J, Lee A, Vinson D, Seale P. "Use of AUDIT-Based Measures to Identify Unhealthy Alcohol Use and Alcohol
Dependence in Primary Care: A Validation Study." Alcohol Clin Exp Res, Vol 37, No S1, 2013: pp E253-E259