AUDIT-C Alcohol Screen
Interactive AUDIT-C screen with IAEM ED thresholds for hazardous and dependent drinking. Three-question alcohol misuse tool for Irish NCHDs.
AUDIT-C alcohol screen
3-item quantity/frequency screen — IAEM ED thresholds
Sex (for thresholds)
IAEM hazardous cut-offs and binge question differ by sex.
1. How often do you have a drink containing alcohol?
2. How many units/drinks of alcohol do you drink on a typical day when you are drinking?
3. How often have you had 6+ (female) or 8+ (male) units/drinks on a single occasion in the last year?
Educational aid only. Thresholds from IAEM AWS Appendix 1. Irish unit ≈ 10 g alcohol.
AUDIT-C is adapted from the WHO AUDIT. Bush K, et al. The AUDIT alcohol consumption questions (AUDIT-C). Arch Intern Med. 1998;158(16):1789-95.
🚨 When the screen is positive
- Hazardous (IAEM): ≥4 women / ≥5 men → offer brief advice; consider oral thiamine while drinking continues; GP follow-up.
- Dependent (IAEM): ≥8 → offer advice and refer to local alcohol / addiction liaison service; assess withdrawal risk.
- If already withdrawing or high risk of AWS → use CIWA-Ar symptom-triggered treatment pathway (or fixed-dose ward regimen) per setting.
- If drowsiness, confusion, ataxia, or ophthalmoplegia → consider Wernicke’s and treat with Pabrinex — do not rely on AUDIT-C alone.
📋 What AUDIT-C is
- Three questions on alcohol quantity and frequency (max score 12). Preferred over CAGE in IAEM for detecting hazardous and at-risk drinking.
- IAEM binge question is sex-specific: 6+ units (female) or 8+ units (male) on one occasion in the last year.
- Irish standard drink ≈ 10 g alcohol (e.g. ½ pint 3.5% beer, or 25 ml spirits).
- If all points come from drinking frequency alone (typical day and binge = 0), confirm recent intake — may still be within recommended limits.
📊 IAEM thresholds
- IAEM reports AUDIT-C sensitivity/specificity ~83%/90% for alcohol dependence, and higher sensitivity than CAGE for harmful/hazardous drinking.
- CAGE (consequences-focused) remains useful: ≥2 “yes” answers raises suspicion of alcoholism — use as a complementary screen if needed.
Below cut-off
- Band
- Low risk
- Action (IAEM)
- Screen negative; opportunistic advice if needed
≥4 ♀ / ≥5 ♂
- Band
- Hazardous
- Action (IAEM)
- Offer brief advice
≥8
- Band
- Dependent
- Action (IAEM)
- Offer advice + refer to local alcohol service
| AUDIT-C | Band | Action (IAEM) |
|---|---|---|
| Below cut-off | Low risk | Screen negative; opportunistic advice if needed |
| ≥4 ♀ / ≥5 ♂ | Hazardous | Offer brief advice |
| ≥8 | Dependent | Offer advice + refer to local alcohol service |
💊 After a positive screen
- Brief intervention: feedback on units, risks, and options for change; document readiness to change.
- Hazardous (not dependent): oral thiamine while drinking continues; addiction liaison / GP as available — STT detox not usually required unless withdrawing.
- Dependent or AWS risk: medical assessment, vitamins/Pabrinex per local guideline, CIWA-Ar if in withdrawal (ED/CDU STT) or fixed-dose taper on wards.
- Refer motivated patients to local alcohol treatment services; inform GP. Avoid referrals driven only by relatives if the patient declines when sober.
Note Template
Ready-to-use clinical note structure
🕒 08 / 10 / 2026 — 16:05 ATRP re: alcohol screening (AUDIT-C) Patient: [age] [sex] Admission Dx: [reason for admission] PMHx: [alcohol / liver / psych] 🧾 Hx: • AUDIT-C: __ / 12 — band: [low / hazardous / dependent] • Typical weekly units: __ • Last drink: [time / date] • Previous withdrawal / DTs / seizures: [yes/no] • Motivation to change: [yes / ambivalent / no] 🩺 Exam: • Vitals: HR __ BP __ RR __ Temp __ SpO₂ __ • Signs of chronic liver disease / withdrawal: [yes/no] 📋 Impression: AUDIT-C [hazardous / possible dependence] — [not currently withdrawing] 📌 Plan: • Brief advice delivered: [yes/no] • Oral thiamine / Pabrinex as indicated: [ ] • GP informed / addiction liaison referral: [ ] • If withdrawing: CIWA-Ar pathway • Escalated to Reg: [yes/no] 👤 [Your Name], [Role] IMC: _______
Educational reference only. Medical disclaimer