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Using the CAGE to screen for drinking-related problems in college students

E J Heck1, M D Williams

  • 1Department of Counseling Psychology, University of Kansas, Lawrence 66045, USA.

Journal of Studies on Alcohol
|May 1, 1995
PubMed
Summary
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The CAGE questionnaire, a common alcohol screening tool, showed limited accuracy in identifying problem drinkers among college students in two university surveys. Its effectiveness was particularly lower for women.

Area of Science:

  • Psychiatry
  • Public Health
  • Addiction Medicine

Background:

  • The CAGE questionnaire is a widely used alcohol screening instrument known for its accuracy in adult populations.
  • However, its efficacy in identifying problem drinking among college students has been a subject of debate and further investigation.

Purpose of the Study:

  • To evaluate the screening accuracy of the CAGE questionnaire for problem drinking within a college student population.
  • To assess the CAGE's performance across different genders in this demographic.

Main Methods:

  • Two cross-sectional surveys were conducted in 1988 and 1992 at a large midwestern university.
  • A random sample of 1,000 students received a questionnaire including CAGE items; response rates were 58.2% (1988) and 49.8% (1992).

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  • Sensitivity, specificity, and positive predictive values (PPV) were calculated using identical problem-drinking criteria for both years and by gender.

    • Main Results:

    • At the standard CAGE cutoff score of >2, the positive predictive values were 46% (1988), 49% (1992), and 48% (combined data).
    • Screening values, including sensitivity and PPV, were consistently lower for women in both samples.
    • The overall accuracy metrics suggest limited utility for the CAGE in this specific student population.

    Conclusions:

    • The findings from both surveys do not support the use of the CAGE as a reliable screening measure for problem drinking among college students.
    • The CAGE demonstrated reduced accuracy in identifying problem drinkers among women, though this may be influenced by the lower prevalence of problem drinking in this subgroup.