Alcohol Screening Tests

Abstract

Alcohol screening tests represent a vital category of standardized psychometric and clinical assessment batteries engineered to detect unhealthy alcohol use across a spectrum extending from hazardous and harmful drinking to severe alcohol use disorder (AUD). Originating from foundational epidemiological and clinical psychiatric paradigms, instruments such as the CAGE questionnaire, T-ACE, Rapid Alcohol Problems Screen (RAPS4), Fast Alcohol Screening Test (FAST), TWEAK, and the World Health Organization’s Alcohol Use Disorders Identification Test (AUDIT) operationalize behavioral, psychological, and physiological indicators of alcohol-related pathology. This comprehensive psychometric synthesis examines the conceptual frameworks, latent constructs, reliability profiles, factor structures, and clinical validities of brief multi-item alcohol screening protocols. Incorporating core operational indicators such as post-drinking remorse, alcohol-induced amnesic blackouts, impaired role performance, tolerance shifts, morning “eye-opener” drinking, traumatic injuries, and external concern, these batteries balance brief item counts (ranging from 4 to 10 core screening queries) with robust screening metrics. Across diverse healthcare settings, emergency departments, obstetrics clinics, and general population cohorts, these screening protocols demonstrate internal consistency estimates typically ranging between α = .75 and .93, high sensitivity (.70 to .96), and acceptable specificity (.68 to .95) for detecting diagnostic thresholds defined by the DSM-5, DSM-IV, and ICD-11 criteria. This review delineates the historical lineage, theoretical architecture, statistical parameters, administration conventions, and authentic item presentations of standard alcohol screening instruments.

Keywords

alcohol screening tests, AUDIT, CAGE questionnaire, TWEAK, RAPS4, FAST test, psychometrics, alcohol use disorder, hazardous drinking, brief screening tools

Authors

The development of standardized alcohol screening tests spans several decades of collaborative work among distinguished clinical researchers, epidemiologists, and institutional public health bodies:

• John A. Ewing, M.D. — Founding developer of the CAGE Questionnaire; Department of Psychiatry, Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
• Thomas F. Babor, Ph.D., M.P.H. — Principal investigator for the World Health Organization collaborative project on the Alcohol Use Disorders Identification Test (AUDIT); Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA.
• Juan Ramon de la Fuente, M.D., John B. Saunders, M.D., and Marcus Grant, M.A. — Co-investigators on behalf of the World Health Organization Division of Mental Health, Geneva, Switzerland.
• Marcia Russell, Ph.D. — Principal developer of the T-ACE and TWEAK screening instruments for obstetric and clinical populations; Research Institute on Addictions, Buffalo, NY, USA.
• Cheryl J. Cherpitel, Dr.P.H. — Lead developer of the Rapid Alcohol Problems Screen (RAPS, RAPS4); Senior Scientist, Alcohol Research Group, Public Health Institute, Emeryville, CA, USA.
• Colin Drummond, M.D., FRCPsych — Lead developer of the Fast Alcohol Screening Test (FAST); Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom.

Purpose

The primary clinical and epidemiological purpose of alcohol screening tests is the rapid, accurate, and low-burden identification of individuals engaging in hazardous drinking, harmful alcohol consumption, or manifestation of alcohol dependence and alcohol use disorder. Alcohol-related morbidity and mortality constitute major global health burdens, directly linked to cardiovascular diseases, hepatic cirrhosis, neurological degeneration, traumatic injuries, interpersonal violence, and psychiatric comorbidities. Because individuals with unhealthy alcohol use frequently interact with primary care clinics, emergency departments, inpatient medical-surgical units, and prenatal settings rather than specialized psychiatric facilities, primary screening must occur in non-addiction-specialty environments where clinician time is constrained.

Screening instruments are fundamentally distinct from diagnostic clinical interviews such as the Structured Clinical Interview for DSM-5 (SCID-5). While diagnostic interviews systematically evaluate each formal diagnostic criterion, screening tools serve as rapid, high-sensitivity triage filters designed to identify individuals at elevated risk who require immediate secondary brief interventions (e.g., Screening, Brief Intervention, and Referral to Treatment; SBIRT) or comprehensive clinical assessment. Consequently, these instruments are engineered to minimize false negatives (optimizing sensitivity) while maintaining sufficient specificity to avoid overburdening health systems with unnecessary secondary referrals.

In research contexts, alcohol screening tests provide standardized, continuous, and ordinal measures of alcohol problem severity. They serve as primary outcome variables or critical covariates in clinical trials evaluating pharmacotherapies (such as naltrexone, acamprosate, or disulfiram), behavioral therapies (such as Cognitive Behavioral Therapy and Motivational Interviewing), and broad public health policy evaluations. Standardized alcohol screens allow cross-cultural epidemiological tracking of patterns in risky consumption, binge drinking behavior, and adverse consequences across varying demographics, occupational cohorts, and socioeconomic strata.

Moreover, tailored variants of these instruments address specific clinical vulnerabilities. For example, prenatal screening tests such as T-ACE and TWEAK were developed to circumvent the high denial rates and physiological changes characteristic of pregnant women, for whom even low or episodic drinking presents substantial teratogenic risk of Fetal Alcohol Spectrum Disorders (FASD). Conversely, emergency department instruments such as RAPS4 and FAST were formulated to identify acute alcohol-induced crises, traumatic injuries, and amnesic blackouts with minimal item burden in high-acuity, time-sensitive settings.

Psychological Construct

Alcohol screening tests measure a multifaceted latent construct encompassing unhealthy alcohol consumption and its associated biopsychosocial consequences. Rather than treating alcohol misuse solely as a discrete moral failure or purely biological disease, modern psychometrics conceptualizes alcohol misuse along a dimensional continuum spanning low-risk consumption, hazardous drinking (consumption patterns that heighten the risk of future adverse health outcomes), harmful drinking (patterns causing actual physical or mental harm), and severe alcohol use disorder characterized by neuroadaptation, compulsive use, and loss of behavioral control.

1. Acute Neurocognitive and Behavioral Disinhibition

This sub-dimension captures transient disruptions in executive functioning and neurological memory consolidation directly induced by elevated blood alcohol concentration (BAC). The operational prototype for this dimension is the alcohol-induced amnesic blackout—evidenced by scale items probing whether respondents have been told by friends or family about behaviors they could not recall the following day. Anterograde amnesia reflects alcohol-induced disruption of long-term potentiation within the hippocampus. Psychometrically, amnesia items serve as potent indicators of acute heavy episodic (“binge”) drinking, distinguishing moderate consumers from individuals who achieve rapid neurotoxic blood alcohol thresholds.

2. Subjective Distress and Internal Conflict (Remorse and Guilt)

The intrapsychic tension caused by alcohol misuse is captured by items assessing feelings of guilt, remorse, or personal self-reproach following drinking episodes. Within psychodynamic and cognitive formulations, post-drinking guilt represents an ego-dystonic conflict between an individual’s personal values, moral standards, or self-concept and their disinhibited behavior while intoxicated. In empirical item response theory (IRT) models, remorse items consistently demonstrate high discrimination parameters, marking the transition from socially integrated, ego-syntonic recreational drinking to self-identified behavioral dysfunction.

3. Impaired Role Performance and Behavioral Dysfunction

A central pillar across the diagnostic definitions of substance use disorders is functional impairment across domestic, occupational, academic, or social domains. Items assessing failure to perform what was normally expected because of drinking quantify this breakdown in self-regulation and psychosocial role execution. This dimension captures chronic absenteeism, neglected parenting obligations, occupational accidents, and failed interpersonal responsibilities, directly tapping into the DSM-5 operational criterion of recurrent alcohol use resulting in a failure to fulfill major role obligations.

4. Physiological Tolerance and Neuroadaptation

Pharmacological adaptation of the central nervous system manifests as tolerance and physical dependence. Tolerance is operationalized through items examining the volume of alcohol required to achieve subjective intoxication (“feeling high”) or hold significant volumes without behavioral collapse. In instruments like T-ACE and TWEAK, tolerance is treated as a major early biomarker of chronic heavy exposure, reflecting down-regulation of GABAA receptors and up-regulation of NMDA glutamate receptors. Physical dependence and neurovegetative withdrawal are tapped by items assessing morning consumption—the “eye-opener”—where ethanol is consumed upon waking to alleviate autonomic hyperactivity, tremor, and psychomotor agitation caused by acute overnight withdrawal.

5. External Social Friction and Interpersonal Concern

Because denial, minimization, and cognitive rationalization frequently obscure an individual’s self-perception of their drinking severity, psychometric screening batteries incorporate external interpersonal indices. Items probing whether friends, family members, or medical professionals have expressed concern, offered criticism, or suggested cutting down provide an objective window into collateral social friction. These items identify systemic relational strains and clinical encounters prompted by the respondent’s drinking before the patient may internally acknowledge personal dependency.

6. Alcohol-Induced Traumatic Harm and Physical Injury

The behavioral end-state of severe intoxication involves gross motor ataxia, diminished situational hazard perception, and increased risk-taking, which frequently culminates in acute physical trauma. Items capturing whether the respondent or another individual has been injured as a result of drinking index both personal somatic peril and external social risk. In emergency medical epidemiology, traumatic injuries (e.g., motor vehicle collisions, falls, assaults) represent a crucial discriminator separating high-risk episodic drinkers from low-risk consumers.

Theoretical Framework

The theoretical architecture underpinning alcohol screening batteries integrates principles from behavioral economics, social learning theory, and modern neurobiological models of substance dependence. Historically, alcohol screening was dominated by the binary “disease concept” advanced by E. M. Jellinek in the mid-twentieth century, which conceptualized alcoholism as an all-or-nothing, progressive, and irreversible biological pathology. Early tests like the CAGE questionnaire reflected this paradigm, emphasizing lifetime symptom emergence, pervasive guilt, and severe withdrawal symptoms (eye-openers) to detect established chronic dependence.

In contrast, the conceptual foundation shifted markedly in the late 1970s and 1980s under the influence of the World Health Organization and pioneering addictions researchers, including Griffith Edwards and Milton M. Gross. Edwards and Gross formulated the Alcohol Dependence Syndrome (ADS) construct, which decoupled physical dependence from broad alcohol-related social and physical disabilities. According to this framework, alcohol dependence exists on a multidimensional continuum of severity rather than as an immutable, categorical state. In parallel, public health researchers recognized the “prevention paradox”: while severely dependent individuals experience the highest individual risk of severe complications, the majority of total population-level alcohol-related harms (e.g., traffic accidents, work absenteeism, interpersonal violence) occur among the far larger population of non-dependent “hazardous” and “harmful” drinkers. Consequently, contemporary screening batteries, epitomized by the WHO’s AUDIT and the emergency-room-focused FAST and RAPS4, incorporate consumption parameters alongside behavioral consequences, explicitly operationalizing the continuum of hazardous, harmful, and dependent consumption.

From a behavioral economic perspective, alcohol use disorder reflects a reinforcer pathology characterized by excessively steep delay discounting of future rewards and an overvaluation of the immediate reinforcing pharmacological properties of ethanol relative to alternative non-drug reinforcers (e.g., career milestones, relationship stability, physical health). Items indexing failed role expectations and external social conflict reflect the progressive displacement of conventional behavioral repertoires as alcohol acquires monopolistic control over the individual’s motivational hierarchy.

Furthermore, social cognitive theory, as articulated by Albert Bandura and adapted to addictive behaviors by G. Alan Marlatt, underscores the central roles of self-efficacy, outcome expectancies, and cognitive coping mechanisms. Within this framework, drinking to cope with negative emotional states or using alcohol as a morning eye-opener represents a maladaptive, self-reinforcing reliance on chemical regulation to manage negative affect and physiological distress. The manifestation of cognitive dissonance—expressed through remorse, guilt, and abortive attempts to “cut down”—provides direct theoretical justification for screening items that query internal self-evaluative discomfort.

Validity

The psychometric validity of alcohol screening tests has been established through hundreds of empirical investigations spanning multiple decades, clinical environments, and linguistic adaptations across global populations.

Construct and Criterion Validity

Construct validity is evidenced by strong correlations between screening test scores and clinical diagnoses derived from semi-structured gold-standard psychiatric interviews, including the Composite International Diagnostic Interview (CIDI), the SCID-5, and the Mini International Neuropsychiatric Interview (MINI). Criterion validity studies assessing the 10-item AUDIT against DSM-IV and DSM-5 diagnostic criteria for alcohol use disorder consistently report receiver operating characteristic (ROC) areas under the curve (AUC) exceeding .88 to .95 across diverse inpatient and outpatient samples (Saunders et al., 1993; Babor et al., 2001). When using the standard cutoff score of 8 or more, the AUDIT typically exhibits sensitivity between .85 and .92, with specificity between .80 and .90 for detecting harmful drinking or dependence in primary care settings.

Brief four-item instruments also exhibit exceptional criterion validity. In emergency department validation investigations conducted by Cherpitel and colleagues across multi-ethnic cohorts, the RAPS4 demonstrated an AUC of .89 to .94 for detecting 12-month DSM-IV alcohol dependence, frequently outperforming CAGE and AUDIT-C in identifying acute crises. A single positive response on the RAPS4 yields sensitivities exceeding .85 to .93 while maintaining specificities between .75 and .88 across diverse demographic groups, including Caucasian, African American, and Hispanic populations (Cherpitel, 2000; Cherpitel et al., 2005).

In obstetric and gynecological populations, Russell et al. (1994, 1996) established the superior criterion validity of the T-ACE and TWEAK questionnaires. While traditional instruments like the CAGE suffered from attenuated sensitivity in pregnant cohorts due to underreporting of guilt and lifetime framing, the TWEAK and T-ACE, utilizing tolerance and amnesia items, achieved sensitivities of .87 to .93 and specificities of .80 to .85 in detecting risk-drinking thresholds (defined as consumption of 1 oz or more of absolute alcohol per day during pregnancy) known to compromise fetal development.

Convergent and Discriminant Validity

Convergent validity is confirmed by robust, statistically significant correlations with physiological biomarkers of heavy chronic alcohol consumption, such as elevated gamma-glutamyl transferase (GGT), carbohydrate-deficient transferrin (%CDT), and mean corpuscular volume (MCV), with correlation coefficients typically falling between r = .35 and .60 (p < .001). Conversely, discriminant validity is demonstrated by weak-to-moderate correlations with general measures of neuroticism, somatic anxiety, and unrelated medical illnesses (r < .20), confirming that these screening tools specifically index substance-induced pathology rather than diffuse psychological distress or somatic hypochondriasis.

Reliability

Alcohol screening tests consistently demonstrate strong psychometric reliability across internal consistency, test-retest stability, and inter-rater agreement parameters:

Internal Consistency

For the comprehensive 10-item AUDIT, multiple cross-national studies have documented Cronbach’s alpha coefficients ranging from α = .80 to .93 across primary care, university, and general community populations, reflecting high internal consistency among the items. Subscale analysis of the AUDIT indicates that items 1–3 (consumption dimension) consistently show alphas between .75 and .88, while items 4–10 (adverse consequences and dependence signs) exhibit alphas ranging between .82 and .89.

For brief binary instruments such as the CAGE, RAPS4, and TWEAK, Kuder-Richardson Formula 20 (KR-20) and Cronbach’s alpha coefficients typically fall between .70 and .84. Although shorter scale length mechanically constrains raw coefficient alpha values, mean inter-item correlation coefficients remain robust (ranging between .35 and .55), indicating tight conceptual coherence around the central core of problematic alcohol consumption without excessive item redundancy.

Test-Retest Reliability and Temporal Stability

The temporal stability of alcohol screening batteries has been thoroughly verified in non-interventional test-retest designs. Intraclass correlation coefficients (ICC) and Pearson r coefficients for the AUDIT over intervals of 1 to 4 weeks consistently range from r = .84 to .94, confirming that the questionnaire reliably captures stable behavioral patterns rather than transient daily mood swings. Similarly, test-retest evaluation of the CAGE, T-ACE, and FAST across 2- to 6-week testing intervals yields Cohen’s kappa values for diagnostic agreement exceeding κ = .75 to .88, reflecting substantial to almost perfect inter-temporal reproducibility.

Inter-Rater and Administration Modality Reliability

Studies evaluating diverse administration modalities—including clinician-administered oral interviews, nurse-administered triage intake, self-completed paper-and-pencil questionnaires, and computerized/digital self-assessments—demonstrate high cross-modality equivalence. Intraclass correlations across modalities regularly exceed .90. Furthermore, inter-rater reliability among independent clinical interviewers assessing identical clinical subjects yields kappa coefficients typically exceeding κ = .85.

Factor Analysis

Structural evaluations employing both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) have rigorously established the latent dimensionality of standard alcohol screening instruments.

Dimensionality of the AUDIT

Within the psychometric literature on the AUDIT, structural debates have centered on whether the scale is best represented as a unidimensional construct or a two-factor model. Although a single general factor often accounts for over 50% to 65% of the total variance, confirmatory factor analyses consistently indicate that a two-factor oblique model provides superior fit across diverse international cohorts:

• Factor 1: Alcohol Consumption — Comprising Items 1, 2, and 3 (frequency of drinking, typical quantity consumed, and frequency of heavy episodic drinking). Standardized factor loadings on Factor 1 consistently range from .72 to .91.
• Factor 2: Alcohol-Related Problems and Dependence — Comprising Items 4 through 10 (impaired control, morning eye-opener, guilt/remorse, blackouts/amnesia, role failure, injuries, and external concern). Standardized factor loadings on Factor 2 typically span from .65 to .84.

Model fit indices for this two-factor structure across large epidemiological samples demonstrate exemplary psychometric parameters: Comparative Fit Index (CFI) > .96 to .98, Tucker-Lewis Index (TLI) > .95 to .97, Root Mean Square Error of Approximation (RMSEA) < .045 to .060, and Standardized Root Mean Square Residual (SRMR) < .040.

Factor Structures of Brief Screening Batteries (CAGE, RAPS4, FAST, TWEAK)

Brief four-to-five-item instruments generally demonstrate clear unidimensionality in exploratory factor solutions, with principal component analyses revealing a single dominant eigenvalue (accounting for 48% to 62% of the total variance) and all item loadings exceeding .55. In the Fast Alcohol Screening Test (FAST), hierarchical two-stage structural validation confirms that the initial core consumption question (Item 1: frequency of consuming eight or more drinks on one occasion) operates as a primary screening gateway, loading heavily on acute heavy consumption (.85), while subsequent items (blackouts, role failure, and professional/relative concern) load robustly on secondary problem consequences (.68 to .82).

In item response theory (IRT) modeling using two-parameter logistic (2PL) formulations, screening items consistently display high discrimination parameters (a-parameters ranging from 1.20 to 2.65). Threshold parameters (b-parameters) reveal a systematic hierarchy of symptom severity: items indexing external concern and guilt exhibit lower threshold parameters (indexing lower problem severity), role failure and amnesic blackouts occupy intermediate thresholds, and morning drinking (the eye-opener) demonstrates the highest severity threshold, functioning as a decisive indicator of physiological neuroadaptation.

Instrument / Measurement Tool

• Instrument Type: Multi-tool standardized screening battery and psychometric inventory for unhealthy alcohol consumption, hazardous drinking, and alcohol use disorders (encompassing the CAGE, T-ACE, RAPS4, AUDIT, FAST, and TWEAK frameworks).
• Administration Format: Self-administered (paper-and-pencil, computerized, mobile app) or clinician-administered structured clinical interview.
• Item Count: 10 standardized core screening items compiled across principal behavioral and consequence domains (integrating the clinical indicators from the validated RAPS4, AUDIT, FAST, and TWEAK assessment systems).
• Target Population: Adolescents and adults (ages 12 years and older) across primary care, emergency medicine, prenatal obstetrics, psychiatric triage, and community epidemiological research.
• Administration Time: Approximately 1 to 3 minutes for brief 4-item variants; 3 to 5 minutes for the full 10-item assessment.
• Response Scale & Scoring Frameworks:
  • RAPS4 Sub-Protocol (Items 1–4): Scored dichotomously (0 = No, 1 = Yes). A positive score on at least 1 out of 4 items indicates possible alcohol abuse or hazardous drinking, warranting thorough clinical evaluation.
  • AUDIT Standard Protocol (Items 5–10 / Full AUDIT): Items 5–8 utilize a 5-point frequency scale (0 = Never, 1 = Less than monthly, 2 = Monthly, 3 = Weekly, 4 = Daily or almost daily). Items 9–10 utilize a 3-point categorical scale (0 = No, 2 = Yes, but not in the last year, 4 = Yes, during the last year). On the full 10-item AUDIT, a total sum score of 8 or more indicates hazardous or harmful drinking behavior, with scores of 15–19 suggesting high-level alcohol problem severity and 20 or higher indicating likely alcohol dependence.
  • FAST Sub-Protocol: Gateway scoring where 0–4 points are assigned per question. A score of 3 or higher identifies hazardous drinking.
  • TWEAK Protocol: Items 1 and 2 score 2 points each; subsequent items score 1 point each (total possible score: 7 points). A cutoff score of 2 or more indicates harmful drinking risk in obstetric and clinical screening.

Permissions & Fee and Test Year

The individual alcohol screening tools documented herein were developed across several key public health milestones:

• CAGE Questionnaire: Developed by Dr. John A. Ewing and first published in 1984 (informally presented in 1969/1970). It resides in the public domain and may be used for clinical and research purposes without fee or licensing restrictions.
• AUDIT: Developed under the auspices of the World Health Organization (WHO) and formally published in 1989 (manuals updated in 1992 and 2001). The AUDIT is in the public domain and is freely available worldwide for clinical, educational, and research applications. Commercial reprinting in copyrighted medical volumes generally requires standard administrative copyright permission from the WHO.
• T-ACE & TWEAK: Formulated by Dr. Marcia Russell and colleagues (T-ACE published in 1989; TWEAK published in 1994). Both instruments are open-access, public-domain instruments designed for clinical dissemination, particularly in maternal-fetal and primary health programs.
• RAPS4: Formulated by Dr. Cheryl J. Cherpitel at the Alcohol Research Group and published in 2000. It is placed in the public domain for clinical and academic use.
• FAST: Developed in 2002 by the UK Health Development Agency in collaboration with King’s College London (led by Professor Colin Drummond). It is widely distributed for public healthcare use within the UK National Health Service (NHS) and internationally without user fees.

References

• Babor, T. F., Higgins-Biddle, J. C., Saunders, J. B., & Monteiro, M. G. (2001). AUDIT: The Alcohol Use Disorders Identification Test: Guidelines for use in primary care (2nd ed.). World Health Organization. https://apps.who.int/iris/handle/10665/67205
• Cherpitel, C. J. (2000). A brief screening instrument for problem drinking in the emergency room: The Rapid Alcohol Problems Screen (RAPS). Journal of Studies on Alcohol, 61(3), 447–449. https://doi.org/10.15288/jsa.2000.61.447
• Cherpitel, C. J., Ye, Y., Moskalewicz, J., & Swiatkiewicz, G. (2005). Screening for alcohol problems in two emergency service samples in Poland: Comparison of the RAPS4, CAGE and AUDIT. Drug and Alcohol Dependence, 80(2), 201–207. https://doi.org/10.1016/j.drugalcdep.2005.03.025
• Drummond, C., Oyefeso, A., Phillips, T., Cheeta, S., Deluca, P., Winfield, H., Jenvey, E., Galea, J., & Saunders, V. (2005). Alcohol Needs Assessment Research Project (ANARP). Department of Health.
• Ewing, J. A. (1984). Detecting alcoholism: The CAGE questionnaire. JAMA, 252(14), 1905–1907. https://doi.org/10.1001/jama.1984.03350140051025
• Hodgson, R., Alwyn, T., John, B., Thom, B., & Smith, A. (2002). The FAST Alcohol Screening Test. Alcohol and Alcoholism, 37(1), 61–66. https://doi.org/10.1093/alcalc/37.1.61
• National Institute on Alcohol Abuse and Alcoholism. (2003). Assessing alcohol problems: A guide for clinicians and researchers (2nd ed., NIH Publication No. 03-3745). National Institutes of Health.
• Russell, M., Martier, S. S., Sokol, R. J., Mudar, P., Bottoms, S., Jacobson, S., & Jacobson, J. (1994). Screening for pregnancy risk-drinking. Alcoholism: Clinical and Experimental Research, 18(5), 1156–1161. https://doi.org/10.1111/j.1530-0277.1994.tb00097.x
• Russell, M., Martier, S. S., Sokol, R. J., Mudar, P., Jacobson, S., & Jacobson, J. (1996). Detecting risk drinking during pregnancy: A comparison of four screening questionnaires. American Journal of Public Health, 86(10), 1435–1439. https://doi.org/10.2105/ajph.86.10.1435
• Saunders, J. B., Aasland, O. G., Babor, T. F., de la Fuente, J. R., & Grant, M. (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption–II. Addiction, 88(6), 791–804. https://doi.org/10.1111/j.1360-0443.1993.tb02093.x

Items of the Scale