Prevention experts recommend that medical providers screen young people for alcohol problems, but the most accurate and efficient method is uncertain. In a cross-sectional study of 358 people aged
15-24 years, researchers compared the performance of 3 common screening instruments against a gold-standard diagnostic interview.Subjects were attending a sexually transmitted disease clinic and reported alcohol use in the past year. One-third met DSM-IV criteria for a current alcohol use disorder.
The 10-item AUDIT* discriminated best (76 percent sensitivity and 79 percent specificity at a cut-off score of 9), followed by the 6-item
CRAFFT** (94 percent sensitivity and 33 percent specificity at a cut-off score of 2), and the 4-item CAGE*** (69 percent sensitivity and 63 percent specificity at a cut-off score of 1).
The AUDIT and the CRAFFT performed better than the CAGE among men, women, and blacks. Among whites, the AUDIT performed best.
Comments from Peter Friedmann, MD, MPH:
This study affirms that the CAGE alone is a limited screening tool for younger people. The AUDIT, though an excellent tool, is likely too long and awkward to score for widespread clinical use. Several features make the CRAFFT attractive: its brevity, easy scoring, relevance to young people, and high sensitivity even among diverse populations. Epidemiologic studies suggest that adding questions about typical consumption patterns, especially binge use, would increase the performance of these instruments to detect alcohol use disorders in young populations. Further research to clarify whether these instruments can also identify those who are at risk for or have experienced alcohol-related problems is warranted.
*Alcohol Use Disorders Identification Test
**A mnemonic standing for Car, Relax, Alone, Forget, Friends, Trouble
***A mnemonic standing for Cut-down, Annoyed, Guilty, Eye-opener
Reference: Cook RL, Chung T, Kelly TM, et al. Alcohol screening in young persons attending a sexually transmitted disease clinic: comparison of AUDIT, CRAFFT, and CAGE instruments. J Gen Intern Med. 2005;20(1):1-6.
Reprinted with permission from Alcohol and Health: Current Evidence.
Editor's Note: Based on research findings from a similar study by John R. Knight et al., AlcoholScreening.org is now a valid screening tool for anyone over 13-years-old. The Knight study, Validity of Brief Alcohol Screening Tests Among Adolescents: A Comparison of the AUDIT, POSIT, CAGE, and CRAFFT, was printed in Alcoholism: Clinical and Experimental Research, Vol. 27, no. 1, January 2003.
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