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.

DESIGN, PARTICIPANTS, AND SETTING: 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.

MEASUREMENTS: 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.

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Corresponding author

Correspondence to Dr. Robert L. Cook MD, MPH.

Additional information

None of the authors has any conflict of interest relevant to this manuscript or the data.

This research was presented in part at the June 22–26, 2003 annual meeting of the Research Society on Alcoholism, Ft. Lauderdale, FL.

See editorial by O'Connor, p. 96–97.

This work was supported by federal grants K23AA00303-01, K02 AA000291, K-08-AA00280, and K01 AA00324 from the National Institute of Alcohol Abuse and Alcoholism.

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Cook, R.L., Chung, T., Kelly, T.M. et al. Alcohol screening in young persons attending a sexually transmitted disease clinic. J GEN INTERN MED 20, 1–6 (2005).

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Key Words

  • alcoholism
  • alcohol drinking
  • screening
  • adolescents