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

As a brief alcohol screening instrument the CAGE has demonstrated a high degree of accuracy in identifying problem drinkers among adults. However, some studies have questioned its screening accuracy within a college population. The research presented in this article contains the results of two additional studies that examined the ability of the CAGE to identify problem drinkers within a college student population.

In both 1988 and 1992 a questionnaire of various drinking practices, including CAGE items, was mailed to a random sample of 1,000 students at a large midwestern university (response rate: 58.2%, 1988; 49.8%, 1992). Using identical problem-drinking criteria, sensitivity, specificity and positive predictive values at various cutoff scores of the CAGE were calculated for both sets of data and for gender.

At the recommended CAGE cutoff score of > 2 for a positive test the sensitivity and positive predictive values (PPV) were slightly higher for the 1992 sample. The PPV values at that cutoff score were 46% (1988) and 49% (1992) and 48% for the combined data. In both samples the screening values were lower for women.

These data from both surveys do not support the CAGE as a screening measure for problem drinking with this population. It appeared to be less accurate with women although that conclusion should be tempered by the fact that there was a relatively low percentage of problem drinkers found among women.