Nancy Nguyen, LCSW

Expanding Pathways · San Jose, California

AUDIT-C · alcohol use screen

Three questions about drinking. A standard drink is roughly 12 oz of beer, 5 oz of wine, or 1.5 oz of spirits. Please answer as accurately as you can — this changes what I understand about how you're coping, not what I think of you.

Alcohol use

1.How often do you have a drink containing alcohol?

NeverMonthly or less2–4 times a month2–3 times a week4+ times a week

2.How many standard drinks containing alcohol do you have on a typical day when you are drinking?

1 or 23 or 45 or 67 to 910 or more

3.How often do you have six or more drinks on one occasion?

NeverLess than monthlyMonthlyWeeklyDaily or almost daily

Total score 0 / 12 Not yet complete

A brief screen, not a diagnosis. Commonly cited thresholds are 4 or more for men and 3 or more for women, which is why the band above is approximate — we'll interpret it together.

Printed name

Date

Your completed form has downloaded. Please bring the PDF to your appointment, or send it back to Nancy Nguyen, LCSW.

AUDIT-C, derived from the Alcohol Use Disorders Identification Test (AUDIT), World Health Organization. Bush, K., Kivlahan, D.R., McDonell, M.B., Fihn, S.D., & Bradley, K.A. (1998). Scoring is performed in your browser; nothing is transmitted or stored online.