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Screening for problem drinking : Comparison of CAGE and AUDIT.

K A Bradley¹, K R Bush, M B McDonell

¹Health Services Research and Development, VA Puget Sound Health Care System (Seattle Division), Seattle, WA, USA.

Journal of General Internal Medicine

|June 7, 2007

Summary

The Alcohol Use Disorders Identification Test (AUDIT) outperformed the CAGE questionnaire in identifying heavy drinking and alcohol abuse among male outpatients. Self-administered AUDIT is a superior screening tool for problem drinking in this population.

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Area of Science:

Clinical Medicine
Psychiatry
Public Health

Background:

Heavy and problem drinking are significant public health concerns.
Effective screening tools are crucial for early detection and intervention in clinical settings.

Purpose of the Study:

To compare the self-administered CAGE, Alcohol Use Disorders Identification Test (AUDIT), and an augmented CAGE for detecting heavy and problem drinking.
To evaluate the diagnostic accuracy of these questionnaires in a male outpatient population.

Main Methods:

Cross-sectional survey conducted in three Department of Veterans Affairs general medical clinics.
A random sample of male outpatients (n=261) who consumed at least 5 drinks in the past year participated.
Screening questionnaires (CAGE, augmented CAGE, AUDIT) were compared against established diagnostic standards using receiver operating characteristic curves (AUROCs).

Main Results:

For detecting active alcohol abuse or dependence, the augmented CAGE showed the highest AUROC (0.871), followed by CAGE (0.820) and AUDIT (0.777).
For identifying heavy drinking, the AUDIT performed best (AUROC 0.870).
For identifying both heavy drinking and active alcohol abuse/dependence, the AUDIT was superior (AUROC 0.861) to the augmented CAGE.

Conclusions:

The self-administered AUDIT is a superior tool for identifying patients with heavy drinking or active alcohol abuse/dependence compared to the CAGE in this male outpatient population.
The choice of screening tool may depend on the specific diagnostic goal (heavy drinking vs. abuse/dependence).