Journal of General Internal Medicine

, Volume 23, Issue 6, pp 781–787 | Cite as

Effectiveness of the AUDIT-C as a Screening Test for Alcohol Misuse in Three Race/Ethnic Groups

  • Danielle FrankEmail author
  • Anna F. DeBenedetti
  • Robert J. Volk
  • Emily C. Williams
  • Daniel R. Kivlahan
  • Katharine A. Bradley
Original Article



The Alcohol Use Disorders Identification Test—Consumption (AUDIT-C) is a brief validated screen for risky drinking and alcohol abuse and dependence (alcohol misuse). However, the AUDIT-C was validated in predominantly White populations, and its performance in different racial/ethnic groups is unclear.


To evaluate the validity of the AUDIT-C among primary care patients from the predominant racial/ethnic subgroups within the United States: White, African American, and Hispanic.


Cross-sectional interview validation study.


1,292 outpatients from an academic family practice clinic in Texas (90% of randomly sampled eligible).

Measurements and Main Results

Race/ethnicity was self-reported. Areas under the receiver operating curve (AuROCs) evaluated overall AUDIT-C performance in the 3 racial/ethnic groups compared to diagnostic interviews for alcohol misuse. AUDIT-C sensitivities and specificities at recommended screening thresholds were compared across racial/ethnic groups. AuROCs were greater than 0.85 in all 3 groups, with no significant differences across racial/ethnic groups in men (P = .43) or women (P = .12). At previously recommended cut points, there were statistically significant differences by race in AUDIT-C sensitivities but not specificities. In women, the sensitivity was higher in Hispanic (85%) than in African-American (67%; P = .03) or White (70%; P = .04) women. In men, the sensitivity was higher in White (95%) than in African-American men (76%; P = .01), with no significant difference from Hispanic men (85%; P = .11).


The overall performance of the AUDIT-C was excellent in all 3 racial/ethnic groups as reflected by high AuROCs. At recommended cut points, there were significant differences in the AUDIT-C’s sensitivity but not in specificity across the 3 racial/ethnic groups.

Key Words

alcohol alcohol misuse race ethnicity screening diagnostic test 



The authors would like to acknowledge Colin Cooke for his thoughtful review of the manuscript.

Sources of Funding

The research reported here was supported by Health Service Research and Development (HSR&D) MD Postdoctoral Fellowship Research TPM 61-028 and the National Institute on Alcohol Abuse and Alcoholism R21AA14672. Dr. Frank is a senior general medicine fellow at the VA Northwest HSR&D Center of Excellence, VA Puget Sound Health Care System, Seattle, WA, USA. Views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs, the University of Washington, or the NIAAA.

Conflict of Interest

The authors have no potential conflicts of interest that pertain to the content of this manuscript.

Supplementary material

11606_2008_594_MOESM1_ESM.doc (26 kb)
Supplementary Table 1 Previous Studies Comparing Sensitives/Specificities of the AUDIT, AUDIT-C, and Single-Item Screen Groups (DOC 26.5 kb)


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Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Danielle Frank
    • 1
    Email author
  • Anna F. DeBenedetti
    • 1
  • Robert J. Volk
    • 5
  • Emily C. Williams
    • 1
    • 2
    • 3
  • Daniel R. Kivlahan
    • 1
    • 4
  • Katharine A. Bradley
    • 1
    • 2
    • 3
    • 6
  1. 1.VA Puget Sound Health Services Research and DevelopmentSeattleUSA
  2. 2.Department of MedicineUniversity of WashingtonSeattleUSA
  3. 3.Department of Health ServicesUniversity of WashingtonSeattleUSA
  4. 4.Department of Psychiatry and Behavioral SciencesUniversity of WashingtonSeattleUSA
  5. 5.Department of Family and Community MedicineBaylor College of MedicineHoustonUSA
  6. 6.Primary and Specialty MedicineVA Puget Sound Health Care SystemSeattleUSA

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