useful information on the frequency of episodic drinking above
recommended daily limits, which is strongly associated with
the risk of alcohol dependence. When health care systems
implement routine alcohol screening using standardized or
automated approaches, the AUDIT-C can provide added useful
information on patients’ self-reported typical drinking, as well
as additional information on the likely burden of alcohol-
related symptoms and alcohol-related health risks.
Corresponding Author: Katharine A. Bradley, MD, MPH; VA Puget
Sound Health Care System, 1100 Olive Way, Suite 1400, Seattle,
WA 98101, USA (e-mail: Katharine.firstname.lastname@example.org).
1. Saitz R. Clinical practice, Unhealthy alcohol use. N Engl J Med.
2. National Institute on Alcohol Abuse and Alcoholism, US Department of
Health and Human Services, National Institute of Health. Helping
Patients Who Drink Too Much: A Clinician’s Guide (updated 2005 guide).
3. American Psychiatric Association. Diagnostic and Statistical Manual of
Mental Disorders. 4th ed. Washington D.C.: American Psychiatric
4. Saha TD, Chou SP, Grant BF. Toward an alcohol use disorder
continuum using item response theory: results from the National
Epidemiologic Survey on Alcohol and Related Conditions. Psychol Med.
5. Saha TD, Stinson FS, Grant BF. The role of alcohol consumption in
future classifications of alcohol use disorders. Drug Alcohol Depend.
6. Kaner E, Beyer F, Dickinson H, Pienaar E, Campbell F, Schlesinger C,
Heather N, Saunders J, Burnand B. Effectiveness of brief alcohol
interventions in primary care populations. Cochrane Database Syst
7. Whitlock EP, Polen MR, Green CA, Orleans T, Klein J. Behavioral
counseling interventions in primary care to reduce risky/harmful
alcohol use by adults. A summary of the evidence for the U. S. Preventive
Services Task Force. Ann Intern Med. 2004;140:557–68.
8. Solberg LI, Maciosek MV, Edwards NM. Primary care intervention to
reduce alcohol misuse ranking its health impact and cost effectiveness.
Am J Prev Med. 2008;34(2):143–152.
9. Bradley KA, Williams EC, Achtmeyer CE, Volpp B, Collins BJ,
Kivlahan DR. Implementation of evidence-based alcohol screening in
the Veterans Health Administration. Am J Manag Care. 2006;12
10. Ewing JA. Detecting alcoholism: the CAGE questionnaire. JAMA.
11. Wallace P, Haines A. Use of a questionnaire in general practice to
increase the recognition of patients with excessive alcohol consumption.
12. Fleming MF, Barry KL. A three-sample test of a masked alcohol
screening questionnaire. Alcohol Alcohol. 1991;26(1):81–91.
13. Bradley KA, Bush KR, McDonell MB, Malone T, Fihn SD. Screening for
problem drinking: comparison of CAGE and AUDIT. Ambulatory Care
Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identifi-
cation Test. J Gen Intern Med. 1998;13(6):379–88.
14. Smith PC, Schmidt SM, Allensworth-Davies D, Saitz R. Primary Care
Validation of a Single-Question Alcohol Screening Test. J Gen Intern
Med. doi:10.1007/s11606-009-0928-6 JULY 2009.
15. Bradley KA, Maynard C, Kivlahan DR, McDonell MB, Fihn SD. The
relationship between alcohol screening questionnaires and mortality
among male veteran outpatients. J Stud Alcohol. 2001;62(6):826–33.
16. Saunders JB, Aasland OG, Babor TF, De la Fuente JR, Grant M.
Development of the Alcohol Use Disorders Identification Test (AUDIT):
WHO collaborative project on early detection of persons with harmful
alcohol consumption - II. Addiction. 1993;88:791–804.
17. Wechsler H, Davenport A, Dowdall G, Moeykens B, Castillo S. Health
and behavioral consequences of binge drinking in college: a national
survey of students at 140 campuses. JAMA. 1994;272(21):1672–77.
18. Dawson DA, Li TK, Grant BF. A prospective study of risk drinking: at
risk for what? Drug Alcohol Depend. 2008;95(1–2):62–72.
19. 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. Ambulatory Care Quality Improvement Project
(ACQUIP). Alcohol Use Disorders Identification Test. Arch Intern Med.
20. Bradley KA, Bush KR, Epler AJ, Dobie DJ, Davis TM, Sporleder JL,
Maynard C, Burman ML, Kivlahan DR. Two brief alcohol-screening
tests From the Alcohol Use Disorders Identification Test (AUDIT),
validation in a female Veterans Affairs patient population. Arch Intern
21. Bradley KA, DeBenedetti AF, Volk RJ, Williams EC, Frank D,
Kivlahan DR. AUDIT-C as a brief screen for alcohol misuse in primary
care. Alcohol Clin Exp Res. 2007;31(7):1208–17.
22. Williams R, Vinson DC. Validation of a single screening question for
problem drinking. J Fam Pract. 2001;50(4):307–12.
23. Canagasaby A, Vinson DC. Screening for hazardous or harmful
drinking using one or two quantity-frequency questions. Alcohol Alcohol.
24. Seale JP, Boltri JM, Shellenberger S, Velasquez MM, Cornelius M,
Guyinn M, Okosun I, Sumner H. Primary care validation of a single
screening question for drinkers. J Stud Alcohol. 2006;67(5):778–84.
25. Frank D, DeBenedetti AF, Volk RJ, Williams EC, Kivlahan DR,
Bradley KA. Effectiveness of the AUDIT-C as a screening test for alcohol
misuse in three race/ethnic groups. J Gen Intern Med. 2008;23(6):781–
26. Taj N, Devera-Sales A, Vinson DC. Screening for problem drinking: does
a single question work. J Fam Pract. 1998;46(4):328–35.
27. Hawkins EJ, Kivlahan DR, Williams EC, Wright SM, Craig T, Bradley
KA. Examining quality issues in alcohol misuse screening. Subst Abus.
28. Bradley KA, Kivlahan DR, Zhou XH, Sporleder J L, Epler AJ,
McCormick KA, Merrill JO, McDonell MB, Fihn SD. Using alcohol
screening results and treatment history to assess the severity of at-risk
drinking in Veterans Affairs primary care patients. Alcohol Clin Exp Res.
29. Bryson CL, Au DH, Sun H, Williams EC, Kivlahan DR, Bradley KA.
Alcohol Screening Scores and Medication Nonadherence: A Cohort
Study. Annals of Internal Medicine. 2008;149(11):795–803.
30. Au DH, Kivlahan DR, Bryson CL, Blough D, Bradley KA. Alcohol
Screening Scores and Risk of Hospitalizations for GI Conditions in Men.
Alcohol Clin Exp Res. 2007;31(3):443–51.
31. Harris AHS, Bryson CL, Sun H, Blough DK, Bradley KA. Alcohol
Screening Scores Predict Risk of Subsequent Fractures. Substance Use
and Misuse. In press.
32. Kinder LS, Bryson CL, Sun H, Williams EC, Bradley KA. Alcohol
screening scores and all-cause mortality in male Veterans Affairs
patients. J Stud Alcohol Drugs. 2009;70(2):253–60.
Kriston L, Holzel L, Weiser AK, Berner MM, Harter M. Meta-analysis:
are 3 questions enough to detect unhealthy alcohol use. Ann Intern Med.
34. Seale JP, Shellenberger S, Tillery WK, Boltri JM, Vogel R, Barton B,
McCauley M. Implementing alcohol screening and intervention in a
family medicine residency clinic. Subst Abus26. 2005;26(1):23–31.
Box 1. Definitions
• Unhealthy drinking refers to the entire spectrum from risky drinking
to severe alcohol dependence.
• Risky drinking
refers to drinking at levels associated with increased
risk for harm:
For men: over 14 drinks per week or 5 or more drinks on any occasion
For women: over 7 drinks per week or 4 or more drinks on any occasion.
• Alcohol use disorders are defined by DSM-IV
as alcohol abuse or
dependence, although recent evidence suggests that symptoms
designated as criteria for alcohol abuse may be indistinguishable from
those designated as criteria for alcohol dependence.
883Bradley et al.: Brief Approaches to Alcohol ScreeningJGIM