Variations on the CAGE alcohol screening questionnaire: strengths and limitations in VA general medical patients.

Bradley KA, Kivlahan DR, Bush KR, McDonell And, Fihn SD. Variations on the CAGE alcohol screening questionnaire: strengths and limitations in VA general medical patients. Alcoholism, clinical and experimental research. 2001 Oct 1; 25(10):1472-8.

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Abstract:

BACKGROUND: Several variations on the CAGE alcohol screening questionnaire have been recommended. This report evaluates modifications and additions to the CAGE. METHODS: Alcohol screening questionnaires were evaluated in male VA general medicine patients (n = 227; mean age, 65.8). Mailed questionnaires included two scoring options for the CAGE (standard and last-year time frames), questions about quantity and frequency of drinking, two questions about episodic heavy drinking, and the question "Have you ever had a drinking problem?" Main analyses compared alcohol screening questions, at various cut-points, to a gold standard of hazardous drinking during the past year ( > or = 14 drinks/week or > or = 5 drinks on an occasion) and/or DSM-III-R alcohol abuse or dependence, based on standardized interviews. RESULTS: The CAGE questionnaire with a past-year time frame was much less sensitive (0.57 vs. 0.77) but more specific (0.82 vs. 0.59) than the standard CAGE for detecting hazardous drinking during the past year and/or DSM-III-R alcohol abuse or dependence. An eight-item questionnaire that included the standard CAGE was most sensitive (0.92) but had low specificity (0.50). A single question about the frequency of drinking > or = 6 drinks on an occasion, included in the eight-item questionnaire, was both relatively sensitive (0.77) and specific (0.83). CONCLUSION: The CAGE questionnaire with a past-year time frame was an insensitive alcohol-screening test. An eight-item augmented version of the standard CAGE was the most sensitive. A question about the frequency of drinking > or = 6 drinks on an occasion performed better than the standard CAGE, which made it the optimal brief screening test for at-risk drinking.