title: Validity of brief alcohol screening tests among adolescents: a comparison of the AUDIT, POSIT, CAGE, and CRAFFT.
abstract: BACKGROUND
  Adolescents should be screened for alcohol misuse as part of routine care. The objective of this study was to compare the criterion validity of the Alcohol Use Disorders Identification Test (AUDIT), the Problem Oriented Screening Instrument for Teenagers substance use/abuse scale (POSIT), and the CAGE and CRAFFT questions among adolescents.
  
  
  METHODS
  Fourteen- to 18-year-old patients arriving for routine healthcare at a large, hospital-based adolescent clinic completed the four screens and the criterion standard Adolescent Diagnostic Interview, which yields DSM-IV diagnoses of alcohol abuse and dependence. Receiver operating characteristic (ROC) curves were plotted to determine optimal cut-points. Areas under the ROC curves of the four screens were compared, and sensitivities and specificities were calculated.
  
  
  RESULTS
  Participants' past 12-month alcohol diagnostic classifications were as follows: no use (58.6%), nonproblem use (13.0%), problem use (20.8%), abuse (5.4%), and dependence (2.2%). Optimal cut-points associated with problem use or higher were 2 for AUDIT, 1 for POSIT, 1 for CAGE, and 1 for CRAFFT. ROC curve area of the CAGE was significantly lower compared with areas of all other screens. Sensitivities (95% confidence intervals) were AUDIT 0.88 (0.83-0.93), POSIT 0.84 (0.79-0.90), CAGE 0.37 (0.29-0.44), and CRAFFT 0.92 (0.88-0.96); specificities were AUDIT 0.81 (0.77-0.85), POSIT 0.89 (0.86-0.92), CAGE 0.96 (0.94-0.98), and CRAFFT 0.64 (0.59-0.69).
  
  
  CONCLUSIONS
  The AUDIT, POSIT, and CRAFFT have acceptable sensitivity for identifying alcohol problems or disorders in this age group. The CAGE is not recommended for use among adolescents.
authors.affiliation: Department of Pediatrics, Division of Addictions, Harvard Medical School and Center for Adolescent Substance Abuse Research, Children's Hospital, Boston 02115, USA. john.knight@tch.harvard.edu
authors.forename: John R
authors.initials: JR
authors.lastname: Knight
authors.forename: Lon
authors.initials: L
authors.lastname: Sherritt
authors.forename: Sion Kim
authors.initials: SK
authors.lastname: Harris
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Gates
authors.forename: Grace
authors.initials: G
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D000437:Alcoholism / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D008297:Male