AUDIT and CRAFFT Outperform CAGE in Screening Young People
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% sensitivity and 79% specificity at a cut-off score of 9), followed by the 6-item CRAFFT** (94% sensitivity and 33% specificity at a cut-off score of 2), and the 4-item CAGE*** (69% sensitivity and 63% 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.
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.Peter D. Friedmann, MD, MPH
*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
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.