The guidelines should be considered tentative, subject to clinical judgment that takes into account the patient’s medical condition, family history of alcohol problems and perceived honesty in responding to the AUDIT questions.
While use of the 10-question AUDIT questionnaire will be sufficient for the vast majority of patients, special circumstances may require a clinical screening procedure. For example, a patient may be resistant, uncooperative, or unable to respond to the AUDIT questions. If further confirmation of possible dependence is warranted, a physical examination procedure and laboratory tests may be used.
In some cultural settings and linguistic groups, the AUDIT questions cannot be translated literally. There are a number of sociocultural factors that need to be taken into account in addition to semantic meaning. For example, the drinking customs and beverage preferences of certain countries may require adaptation of questions to conform to local conditions.
Patient instructions should also clarify the meaning of a standard drink. Questions 2 and 3 of AUDIT ask about “drinks consumed”. The meaning of this word differs from one nation and culture to another. It is important therefore to mention the most common alcoholic beverages likely to be consumed and how much of each constitutes a drink (approximately 10 grams of pure ethanol). For example, one bottle of beer (330 ml at 5% ethanol), a glass of wine (140 ml at 12% ethanol), and a shot of spirits (40 ml at 40% ethanol) represent a standard drink of about 13 g of ethanol. Since the types and amounts of alcoholic drinks will vary according to culture and custom, the alcohol content of typical servings of beer, wine and spirits must be determined to adapt the AUDIT to particular settings.
Elements of Brief Interventions