TREDA Patient name: ___________________

Date and Time: __________________

DE-ADDICTION & COUNSELLING CENTER
CARMELARAM P.O.,BANGALORE - 560 035

Alcohol screening questionnaire (AUDIT)

Please answer the below questions to provide you the right support:

30 ml.
375 ml. 150 ml.
One drink equals: liquor
beer wine
(one shot)
2-4 2-3 4 or more
1. How often do you have a drink containing Monthly
Never times a times a times a
alcohol? or less
month week week

2. How many drinks containing alcohol do you have 10 or

0-2 3 or 4 5 or 6 7-9
on a typical day when you are drinking? more

Daily or
3. How often do you have five or more drinks on Less than
Never Monthly Weekly almost
one occasion? monthly
daily
4. How often during the last year have you found Daily or
Less than
that you were not able to stop drinking once you Never Monthly Weekly almost
monthly
had started? daily

5. How often during the last year have you failed to Daily or
Less than
do what was normally expected of you because of Never Monthly Weekly almost
monthly
drinking? daily

6. How often during the last year have you needed a Daily or
Less than
first drink in the morning to get yourself going Never Monthly Weekly almost
monthly
after a heavy drinking session? daily
Daily or
7. How often during the last year have you had a Less than
Never Monthly Weekly almost
feeling of guilt or remorse after drinking? monthly
daily
8. How often during the last year have you been Daily or
Less than
unable to remember what happened the night Never Monthly Weekly almost
monthly
before because of your drinking? daily
Yes, but
9. Have you or someone else been injured because Yes, in the
No not in the
of your drinking? last year
last year
10. Has a relative, friend, doctor, or other health Yes, but
Yes, in the
care worker been concerned about your drinking No not in the
last year
or suggested you cut down? last year
0 1 2 3 4
Have you ever been in treatment for an alcohol problem? ⃝ Never ⃝ Currently ⃝ In the past
I II III IV
0-3 4-9 10-13 14+
 (For the Councillor)

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

“Someone using alcohol at this level

Positive Health Message – describe
0-3 I – Low Risk is at low risk for health or social
low risk drinking guidelines
complications.”
“Someone using alcohol at this level
may develop health problems or
4-9 II – Risky Brief intervention to reduce use
existing problems may worsen.”

“Someone using alcohol at this level Brief Intervention to reduce or

has experienced negative effects abstain and specific follow-up
10-13 III – Harmful
from alcohol use.” appointment (Brief Treatment if
available)
“Someone using alcohol at this level
Brief Intervention to accept referral to
could benefit from more assessment
14+ IV – Severe specialty treatment for a full
and assistance.”
assessment

Category classification for individuals with High Risk from Consumption:

Hazardous Alcohol Use: High scores on first three items in absence of elevated scores on other items.
Alcohol Dependence : Elevated scores on items 4 through 6 imply the presence or
emergence of alcohol dependence.
Harmful Alcohol Use : Elevated scores on the remaining items suggest harmful alcohol use.

A diagnosis of Alcohol Dependence Syndrome is made only if three or more of the following have been
experienced or exhibited at some time in the previous twelve months:
1.A physiological withdrawal state;
2.Alcohol use with the intention of relieving withdrawal symptoms
and with awareness that this strategy is effective;
3.An impaired capacity to control the onset, termination or level of use;
4.A narrowing of the personal repertoire of patterns of use;
5.Progressive neglect of alternative pleasures or interests in favour of alcohol use;
6.Persistence of use despite clear evidence of harmful consequences;
7.Evidence of tolerance; and
8.Strong desire or sense of compulsion to take alcohol.

Clinical Impression: