AUDIT-C alcohol screening: questions, scores and next steps
An alcohol screening is a few questions about how much and how often you drink, most often the 3-question AUDIT-C or a single question about heavy-drinking days. The USPSTF says 1- to 3-question tools have the best accuracy for adults. A positive screen is not a diagnosis: it leads to a short follow-up conversation with your clinician. (USPSTF, 2018) (NIAAA)
If you want help now: SAMHSA's National Helpline, 1-800-662-HELP (4357), is free, confidential and open 24 hours a day, every day of the year, in English and Spanish, with referrals to local treatment and support. If you are in crisis, call or text 988. (SAMHSA)
Who is screened
The USPSTF recommends screening adults 18 and older for unhealthy alcohol use in primary care, including during pregnancy, and offering brief counseling to people who drink at risky or hazardous levels (grade B, 2018). For teens 12 to 17 it found the evidence insufficient (grade I). It found no adequate evidence for a best screening interval. (USPSTF, 2018) A draft update posted on August 5, 2025 keeps the same grades and adds that screening questions should pick up binge drinking; until it is final, the 2018 statement applies. (USPSTF draft, 2025) For screening by age, see alcohol use screening.
NIAAA suggests clinicians make the questions a routine part of care and tell patients "we ask everyone". (NIAAA)
What the questions ask
The questionnaires are described here in our own words. Your clinician uses the exact form.
- AUDIT-C (3 questions): how often you had a drink containing alcohol in the past year, how many drinks you usually had on a drinking day, and how often you had a heavy-drinking occasion. It takes 1 to 2 minutes. (USPSTF, 2018) (NIAAA) Each answer scores 0 to 4, for a total of 0 to 12. (Calabria et al., 2014)
- Single alcohol screening question (SASQ): how many times in the past year you had 5 or more drinks in a day (4 or more for women; the USPSTF wording also uses 4 for all adults older than 65). It takes under a minute. (USPSTF, 2018) NIAAA says an answer of 1 or more calls for follow-up. (NIAAA)
- Full AUDIT (10 questions): the AUDIT-C questions are the first 3 of the full AUDIT. (NIAAA) (Calabria et al., 2014) It adds 3 questions on signs of dependence and 4 on harm from drinking, such as whether someone close to you or a health worker has been concerned about your drinking. The total runs from 0 to 40. (Cunningham et al., 2017)
The USPSTF notes that the well-known CAGE questions pick up alcohol dependence only, not the full range of unhealthy alcohol use. (USPSTF, 2018)
How the scores are read
In a 2007 study of 1,319 adults at a family practice clinic, the AUDIT-C cut-offs that best balanced finding alcohol misuse against flagging people without it were 4 or more for men and 3 or more for women. The AUDIT-C did as well as the full AUDIT. (Bradley et al., 2007)
| Group | Below the cut-off | Positive screen |
|---|---|---|
| Men | 0 to 3 | 4 to 12 (Bradley et al., 2007) |
| Women | 0 to 2 | 3 to 12 (Bradley et al., 2007) |
- AUDIT-C of 4 or more in men picked out 86% of men with alcohol misuse and correctly cleared 89% of men without it. (Bradley et al., 2007)
- AUDIT-C of 3 or more in women picked out 73% of women with alcohol misuse and correctly cleared 91% of women without it. (Bradley et al., 2007)
- Full AUDIT of 8 or more is the usual sign of hazardous or harmful drinking. (Cunningham et al., 2017) The WHO advises a brief intervention at 8 or more out of 40. (Yip et al., 2015)
- The higher the AUDIT-C score, the more likely alcohol is affecting health and safety. (NIAAA)
Where they differ: the original AUDIT-C asks about 6 or more drinks on one occasion for everyone. US versions such as the USAUDIT-C, and the single question, use 5 for men and 4 for women, to match US drink sizes. (NIAAA) Cut-offs also vary by group: a study of men in Hong Kong primary care found 5 or more the best AUDIT-C cut-off, and later studies of the full AUDIT have reported cut-offs other than 8. (Yip et al., 2015) The first AUDIT-C study was in men at Veterans Affairs clinics. (Bush et al., 1998)
Whatever the score, a short questionnaire does not diagnose alcohol use disorder. Your doctor decides what your result means for you.
What counts as a drink
In the US, one standard drink has about 14 grams (0.6 fluid ounces) of pure alcohol. That is about 12 ounces of regular beer at 5% alcohol, 5 ounces of wine at 12% or 1.5 ounces of spirits at 40%. A 12-ounce bottle of craft beer at 10% holds 2 standard drinks. (NIAAA, standard drink)
- Risky drinking (NIAAA limits, as cited by the USPSTF): more than 4 drinks a day or 14 a week for healthy men 21 to 64; more than 3 drinks a day or 7 a week for women of any age and men 65 and older. (USPSTF, 2018)
- Binge drinking: drinking that brings blood alcohol to 0.08% or higher, for a typical adult about 5 or more drinks for men or 4 or more for women in about 2 hours. (NIAAA, drinking levels)
- Heavy drinking: 5 or more drinks on any day or 15 or more a week for men; 4 or more on any day or 8 or more a week for women. (NIAAA, drinking levels)
NIAAA notes that harms may come with any amount of drinking, and rise as the amount rises. (NIAAA, drinking levels)
Where they differ (US and UK): a UK unit is 10 ml or 8 grams of pure alcohol, smaller than a US standard drink. The NHS advises men and women alike not to drink more than 14 units a week on a regular basis, spread over 3 or more days. (NHS) The US limits above are counted in 14-gram drinks and differ by sex and age. (USPSTF, 2018) So the same glass can be 1 US drink and close to 2 UK units.
What happens after a positive screen
NIAAA describes the next step as a few more questions: how many days a week you usually drink and how many drinks on a typical day, to get your usual weekly amount, and then a short check for symptoms of alcohol use disorder. (NIAAA) That check uses 11 diagnostic criteria: 2 to 3 symptoms mean mild, 4 to 5 moderate and 6 or more severe alcohol use disorder. (NIAAA) The USPSTF recommends brief behavioral counseling for adults who drink at risky or hazardous levels. (USPSTF, 2018) Your doctor decides the next step with you. This page does not give treatment advice. See also after an abnormal screening result.
Drinking can also matter for other screenings, such as checks for liver scarring: see fatty liver screening and FIB-4.
Questions people ask
What questions are on the AUDIT-C?
Three questions about the past year: how often you had a drink containing alcohol, how many drinks you usually had on a day when you drank, and how often you had a heavy-drinking occasion. Each answer scores 0 to 4, so the total runs from 0 to 12. (NIAAA) (USPSTF, 2018) (Calabria et al., 2014)
What is a positive AUDIT-C score?
In a 2007 primary care study, the cut-offs that best balanced finding alcohol misuse against flagging people without it were 4 or more for men and 3 or more for women. Some studies in other groups found other cut-offs. A positive screen is not a diagnosis. (Bradley et al., 2007) (Yip et al., 2015)
What is the single alcohol screening question?
It asks how many times in the past year you had 5 or more drinks in a day (4 or more for women; the USPSTF wording also uses 4 for all adults older than 65). NIAAA says an answer of 1 or more calls for follow-up. It takes under a minute. (USPSTF, 2018) (NIAAA)
How much alcohol is one drink?
In the US, one standard drink has about 14 grams of pure alcohol: 12 ounces of regular beer at 5%, 5 ounces of wine at 12% or 1.5 ounces of spirits at 40%. A UK unit is smaller, 8 grams. (NIAAA, standard drink) (NHS)
Does Medicare cover alcohol screening?
Medicare Part B covers one alcohol misuse screening a year for adults who use alcohol but do not meet the conditions for alcohol dependency. If your provider finds misuse, you can get up to 4 brief face-to-face counseling sessions a year in a primary care setting. You pay nothing if your provider accepts assignment. (Medicare.gov)