Alcohol screening in young persons attending a sexually transmitted disease clinic. Comparison of AUDIT, CRAFFT, and CAGE instruments.
OBJECTIVE
To compare the ability of 3 brief alcohol screens (Alcohol Use Disorders Identification Test [AUDIT], CRAFFT, and CAGE) to identify adolescents and young adults with a current alcohol use disorder (AUD) and to determine whether there are gender-based or race-based differences in screening performance.


METHODS
Cross-sectional study of 358 young persons (55% males; 49% blacks; age range, 15-24 years; mean age, 20.6 years) who were attending an urban clinic for sexually transmitted diseases and reported alcohol use during the past year.


METHODS
Receiver operating characteristic (ROC) curve analysis was used to determine the ability of the 3 screens to discriminate between participants with and without AUDs detected in the Structured Clinical Interview for DSM-IV (SCID).


RESULTS
One third (33%) of participants met Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria for a current AUD (24% with alcohol abuse and 9% with alcohol dependence). The AUDIT performed best at a cut score of 9 (sensitivity, 0.76; specificity, 0.79), CRAFFT at a cut score of 2 (sensitivity, 0.94; specificity, 0.33), and CAGE at a cut score of 1 (sensitivity, 0.69; specificity, 0.63). The AUDIT had the best overall performance (area under the curve [AUC], 0.84), followed closely by CRAFFT (AUC, 0.79) and then CAGE (AUC, 0.70). Performance of screens did not differ by gender. The AUDIT performed slightly better in whites than blacks, but no race-based differences were observed for the CAGE or CRAFFT.


CONCLUSIONS
Clinicians should use the AUDIT or CRAFFT, rather than the CAGE, to screen young persons for AUDs. The AUDIT performs best, but its length may limit its utility in this setting. The CRAFFT is a suitable alternative, with excellent sensitivity and no gender-based or race-based differences.
Cook
Robert L
RL
Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA. cookrl@upmc.edu
Chung
Tammy
T
Kelly
Thomas M
TM
Clark
Duncan B
DB
D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000430:Alcohol Withdrawal Delirium; D019973:Alcohol-Related Disorders / Q000175:diagnosis* / Q000208:ethnology; D003151:Community Health Centers; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012749:Sexually Transmitted Diseases; D011795:Surveys and Questionnaires; D014505:Urban Population; D044465:White People