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

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).
• 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.